“It was certainly a positive move, coming to Bourn Hall,” says Kathryn Rayner, a Senior Fertility Nurse Specialist, who had previously been a midwife for 20 years. She particularly enjoys helping women with Polycystic Ovary Syndrome (PCOS) to conceive. “I have been given a lot of opportunities here to gain new skills and enjoy supporting the patients through their journey.” As part of our series celebrating the International Year of the Nurse and Midwife Kathryn tells her story.
Kathryn went straight into nursing training with her A level qualifications, as the course was more practical at that time, with fewer higher education options available. She was later able to convert to midwifery following an 18-month course.
“I worked at the Lister Hospital in Stevenage for most of my 20 years of nursing, but also briefly at the Rosie Maternity unit at Addenbrookes as well, mainly on the labour wards. I lived in Bedfordshire at the time, so it was just a short commute.”
Kathryn decided to change direction and applied for a post as a fertility nurse at Bourn Hall near Cambridge and joined the nursing team there in 2009.
Later, she moved house to Norfolk and joined the team at Bourn Hall Norwich, which is located in Wymondham.
“Moving into fertility medicine was a big change,” she remembers. “Working with the women, their partners and families was similar but the practices, drug regimes, and all that sort of thing were very, very different.
“Our medical director, Dr Thanos Papathanasiou, is very forward thinking and he is prepared to tailor the care to the patient, so it is not the same each time.
“Getting your head around the way fertility treatment works took a little while but I really enjoy it now, and pleased that I made the change.”
When the new clinic was first set up, patients were referred by their GP to the local hospital for fertility testing (Level 2) and then being given the choice of coming to Bourn Hall for IVF treatment (Level 3) or travelling down to London.
Patients in Norfolk now come to Bourn Hall for their fertility tests as part of the NHS fertility diagnostic service and Kathryn says it is a much easier for patients.
“Once we started offering Level 2 fertility tests in-house it ran much more smoothly. Much of the testing and diagnosis, like the scans and bloods, are all done in-house, with the same doctor looking at those results and then discussing with the patients their options.
“It is a much more joined-up pathway. Patients prefer it as they now see the same people at Level 2 as well as Level 3. I think that was a big step forward.”
Helping women with PCOS to conceive
Part of the work Kathryn finds rewarding is helping women with Polycystic Ovary Syndrome (PCOS) to conceive. PCOS impacts the ovaries and stops them from releasing mature eggs.
This is a common cause of infertility and can be diagnosed quickly at Bourn Hall and the treatment is often with a mixture of lifestyle advice and medication and the fertility nurses are very involved in this care.
“The fertility nurses are the first to see couples, after they have been referred by their GP, we discuss their wellbeing and fertility health and can often give advice at that stage that can help them move forward.” Kathryn continues.
“Something that would always raise concern with me would be an irregular menstrual cycle. Many women monitor their ovulation using ovulation kits, and often those with irregular cycles will have given up because they can’t pick up ovulation, and this would give you an indication there is an issue.
“We would also ask about other symptoms of PCOS, such as excessive body hair and check their weight. Women with PCOS may be overweight or underweight, but whatever they try to do they can’t seem to achieve an optimum weight.”
One of the skills Kathryn has gained is scanning and she says this can quickly show up PCOS.
“We scan the ladies quite early on in the process. From the scan you can see if they have numerous follicles on the ovaries, which is a sign of PCOS as the hormone levels are disrupted and the eggs are not being released.
Improving natural conception
“It is not known exactly what causes PCOS but we do know that it is a hormone imbalance. At Level 2 we check the hormone levels with a blood test – this would be FSH, oestrogen and luteinizing hormone, but if we suspect PCOS we would also check the testosterone and prolactin as well, because with PCOS women often have a higher level of male hormones. Occasionally we would also refer the patient to an endocrine specialist.
“If a patient does have PCOS, then in addition to weight management, they may be put on a drug called metformin, which helps balance the hormone levels. A combination of that and losing weight is often quite successful at helping them to conceive naturally.
Kathryn continues “Ovulation induction (OI) is often the way to go with PCOS patients, as long as everything else is okay and the male partner has a good semen analysis result.
“Ovulation induction is not invasive, it involves just stimulating the ovaries, scanning them and then advising the optimum time for intercourse to achieve a pregnancy naturally.
“I see a lot of women with PCOS and this treatment of managed weight loss and OI can have a good success rate, which is very satisfying for the nurses.”
The last few months during the pandemic have been difficult for patients and staff.
“Covid has been so disruptive to every part of our lives and this has been challenging. I have found being part of a supportive team has helped us all to adjust the way that we work and to find new ways to support patients.”