International Year of the Nurse and Midwife – Karen’s Story

Treatment to overcome male infertility has improved considerably over the 25 years that Karen Evans, a Senior Fertility Nurse Specialist, has worked for Bourn Hall. She is one of the longest-serving nurses in the close-knit team, and the satisfaction she gets from her work has never diminished.

“I spent a couple of years dispensing IVF medication and then a fertility nurse post became available which I took up, and it was lovely to get back in to nursing.”

Karen’s responsibilities at Bourn Hall are now divided in to three key areas: performing ultrasounds on female patients in pre-treatment, treatment and early pregnancy; working as part of Bourn Hall’s specialist Andrology team treating male patients with low or zero sperm counts; and acting as the main point of contact and submitting all of the necessary paperwork to the industry regulator the HFEA.

As part of her senior role Karen has become a registered Pelvic Ultrasound trainer with the BFS to support the nursing team extend their role undertaking ultrasound scans. She also takes part in conducting appraisals to further help, support and mentor the nursing team.

Karen works closely with Bourn Hall’s specialist Andrology team and she explains that there are two main tests that are used to help diagnose and plan treatment for male patients: Semen analysis and blood tests.

“Normally a patient will have already had an initial semen analysis at their referring hospital before arriving at Bourn Hall,” she says. “The doctors will take a look at those and we can organize further blood tests and repeat semen analysis at our clinic if necessary.”

The semen analysis looks for sperm count (numbers), motility (movement) and morphology (shape), whilst the blood tests check for hormone levels such as follicle stimulating hormone (FSH) and testosterone. Genetic tests look at the Chromosomes and make sure they are normal.

“People tend to think that FSH is something only women have but men have it too, and that and testosterone are needed for sperm production,” says Karen. “If their FSH levels are too high it can indicate a sperm or testicular failure. Similarly, if a man’s testosterone is too low that can affect his sperm production.”

Once the team have had the tests back the patients are advised on next steps.

“Some men will be advised on lifestyle changes to improve their sperm count, taking vitamins and cutting drinking and smoking, whilst others may require hormone treatment or other medication,” says Karen

Even where men have a zero sperm count, they can be helped, as there may be sperm in their testicular tissue, which can be found through an operation.

As Karen explains: “For men who have very little or zero sperm count the most appropriate course of action may be a specialist procedure called surgical sperm retrieval, which involves them being put under a general anaesthetic so that the Andrologist (surgeon) can extract sperm directly from the testis by a needle aspiration or testicular biopsy.”

In the last ten years consultants Oliver Wiseman and Nimish Shah, both of whom Karen works closely with, have helped over 550 men needing sperm retrieval procedures.

“I have a lot of close contact with the Andrology patients and they are so grateful when their treatment is successful,” says Karen. “When a man is told that he has a zero sperm count it can have a real impact on his self-esteem. I sometimes find that or the patients can initially be a bit withdrawn and they can suffer quite a bit emotionally.

“One of the best parts of my job is hearing from a patient who has undergone sperm retrieval that he has had a child with his partner after successful IVF. One of our patients with a zero sperm count recently became a Dad for the second time.

“There are not many jobs around where you get to play a part in creating miracles and helping peoples’ dreams come true. It is a wonderful feeling and that feeling never goes away.”

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