Recent questions from patients asked during live online events
Is DNA sperm fragmentation really giving reliable answers if semen is ok?
From my point of view, yes it is. But we don’t treat patients only on the basis of results. If a patient has a bad DNA fragmentation but he conceives a baby, then it’s wonderful and everybody is happy. But if there is a problem with fertility and we have the DNA fragmentation test showing that there is about 50% of not fragmented sperm DNA, we can only assume that this might be the issue. Believe me, I have seen patients with poor results, not only relating to the sperm fragmentation, and from those results, we would say that the patient has a very big problem with fertility. And then after some weeks or months, this patient has a spontaneous pregnancy. So we don’t treat the result, we want to treat the problem which is not having a baby. The results are somehow helping us to find the reason but they are not the reason. I hope you understand what I mean. Sperm fragmentation is also not something that is given to these patients forever. It is caused by many factors, e.g. by the inflammation which can be treated or by some environmental factors, cancer, high temperature or lifestyle. So sometimes we cannot influence DNA fragmentation but other times we can influence it and cause less sperm to have fragmented DNA. So keep in mind that this is something we can help with before we start the IVF treatment.
How often are intralipids transferred?
In cases of repeated implantation failure they are always available. The patient can also request intralipids themselves.
Can you give me any advice on what to eat before in-vitro?
You should be on a normal diet, without any restrictions. You just should take Omega 3 and anti-inflammatory supplements. We are not dieticians so we’re not the best persons to be asked that question. However, you should surely eat a lot of vegetables and fruit, whole grain bread, maybe less meat. In other words, you should eat according to the food pyramid and avoid fast food.
What is the AMH limit to decide that a patient should move to egg donation?
I have patients who are 36 and have a very low AMH and even though I explained to them that their chances of having a response to stimulation and coming up with a number of eggs was extremely low, they wanted to do the cycle, so we tried and we collected maybe one or two eggs. But they were young patients who had a successful outcome. I think that, again, age is extremely important in terms of deciding if it’s the moment to move to egg donation. Obviously, a patient who is young and has already tried several other cycles with her own eggs that didn’t succeed and aside from that has low AMH, I think that it’s time to speak about egg donation. I think the most important thing is to make sure that the patient is informed about all the options, that she is completely aware of what can be expected from each treatment and the success rates and problems that might arise along the cycle.
My husband has low sperm count. We tried IVF but had three failed cycles: two chemical pregnancies and one miscarriage. Would PGS be recommended? What’s the difference between PGS and PGD?
PGS stands for Pre-Implantation Genetic Screening, while PGD stands for Pre-Implantation Genetic Diagnosis. Screening is performed on a number of chromosomes in order to rule out the possibility of Down’s syndrome, Edwards Syndrome, and others.
PGD is performed when patients are carriers of or suffer from genetic diseases such as cystic fibrosis.
Going back to your question, we would need to test your husband’s sperm count and hormonal levels. If they allow for further treatment, we can prescribe medication to improve the sperm count. If you’re above 35 years old, PGS is definitely recommended.
How long do we need to wait for an appointment after shipping embryos?
We can organize an appointment even before shipping the embryos. We can discuss all the details and then just proceed with the shipping, so there is no need to come back after they arrive here at INTERSONO.
Do you believe the law will change in every country soon and there will be open donations? I mean not only for children, once they turn 18, but also for patients who will have the opportunity to meet the donor?
I don’t know. What we know today is that there are two countries that think of changing the legislation. One of them is Germany. We heard that they are thinking of changing the legislation to allow IVF and egg donation with non-anonymous donors only. There is also another destination where there are a lot of rumours about changing the IVF law. And this is Spain. When we were in Spain about two months ago and we visited the clinics, we learned that the law there would be probably changed to allow non-anonymous donation in this kind of treatment. So this is the change that I’m aware of and which may be important to patients. In Spain, it is confirmed that it’s happening and the changes are possible. Portugal, UK and Ireland have non-anonymous donation today. However, the last two have problems with the lack of donors. And I can tell you why: it’s because they’re non-anonymous. Although it is not that bad from a patient’s point of view, it looks very very different for a donor. Think of possible impact it could have on their future life. Someone could say that there is no such a problem in the US where there are a lot of donors – despite non-anonymity. Yes, but it is also the reason why so many American patients come to Europe for treatment. It’s because of a donor compensation that is between 8.000 and 16.000 dollars. Imagine what is the total cost of the treatment in such a case. So if most European countries go on with non-anonymous donation, the treatment will become much more expensive. Within a few years’, we’ll see what is going to happen.
What do you think would be the success rate of an euploid 5 days blastocyst 4BB? Would it be the same if the euploid blastocyst 5AB was day 6?
The first thing that I don’t know is the age of the person that produced the blastocyst. The success rate of the embryo depends a lot on the age of the woman who produced the embryo. If we had the 4BB blastocyst and the patient was 32 years old, I would tell you that we had a 40-50% chance of success. But if the patient has a 4BB blastocyst and she is 42 years old, then the success rate drops to 20%. When we have a day 6 euploid blastocyst, usually the success rate is lower. If it takes the embryo 6 days to reach the stage of blastocyst (instead of 5 days), it means that the baby is very slow in its development. So we wouldn’t have a lot of hope for the day 6 blastocysts – even if they look good. They don’t usually have the same success rate as day 5 blastocysts.
Is coffee harmful to fertility?
There are a lot of studies into this but not many of them have included a lot of patients. Some of the data says that in patients who take more than 600 mg of caffeine a day, more than 3 cups) might have a negative impact on fertility. In general, our recommendation is to not take more than two coffees a day. But we need to have more evidence about this, but there is no need to completely give up coffee if you really like it.
After 5 failed ETs, I checked the receptivity (biopsy) of the endometrium. On day 5 of taking progesterone, the number of CD56 marker was 19 in the large field of view. On day 7 of progesterone, the CD56 marker was 29. Are those numbers ok?
If we measure natural killers in the blood rather than on the endometrium, this is a mistake. I guess that this CD56 marker refers to endometrial cells, although I’m not 100% sure. The natural killer cell marker CD56 normally decreases during the implantation window, but these results of 19 and 29 are so weak that clinically it means nothing since we never test the maximum percentage of CD56 for naturally conceived babies at the moment the woman got pregnant because this would be unrealistic. So, actually, we don’t have normal values and the normal values that this test provides are completely arbitrary and, in my opinion, of no meaning. I can’t really answer this question, but we should not focus on 5 embryo transfers without pre-implantation genetic diagnosis. It would be a pity to blame the endometrium if we don’t know which of the embryos of the 5 embryo transfers—I don’t know if there were 10 embryos, for example—were normal or not. So, how can we blame our endometrium receptivity when we have no clue whether we transferred normal blastocysts?
I’m 33 and have premature ovarian failure. I’m having menopausal symptoms and considering starting HRT. Will that affect my chances of donor eggs working?
You have to be aware that the mean age for menopause for women in europe is 45-50 years old, and you at 33 are too young to live without estrogens – they make us feel young and make us look good. When we do egg donation cycles, we put you on a substitute cycle with estrogens and progesterone, and you have the same success rates as everyone else who is having regular periods.
What if the surrogate mother never gets pregnant?
She basically has a number of tries, how many times she can try in the program, as set by the doctor. If she never gets pregnant then she cannot proceed in the problem.
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#IVFWEBINARS presenters' opinions
Being a presenter of #IVFWBEINARS is a very good way to spread very important message for all the people that struglle with infertility and who might have some questions. I think that it’s great opportunity for people and patients to interact with us (doctors) and have some engagement and address their concersns. So I like to do it, I have to say 🙂
International Medical Director| Fertty International
It was better than I’d expected. I hadn’t done anything like that before and was a little nervous. I’m sure I can learn more and improve but it was a good first try! Questions were great. Really interesting and clear that participants were very engaged.
Foubder Director Donor conception network
A new experience that I feel really happy about. I enjoy presenting scientific data in a patient-friendly way and also contacting them directly, for example to answer their questions. Me 2nd webinar felt more comfortable than the first, obviously.
Dr Stavros Natsis
FERTILITy specialist | gennima IVF
In the world where all the information seems to be just a click away, it is more and more difficult to differentiate between valuable and useless content. This is especially true for IVF patients who are literally bombarded with knowledge that – unfortunately – they are rarely able to verify. Nowadays anyone can share any information online and finding a reliable source of expertise may become a challenge. And as we all know, verified and educational content is what all fertility patients need the most – at every stage of their treatment.
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