Recent questions from patients asked during live online events
I would like to try an adoption but my husband doesn’t want it. Should I try to convince him?
It’s hard. It has to be a joint decision for the sake of your relationship. You both need to be fully engaged in it and have made that decision together. From what I believe, the adoption process is not an easy process to go through so you would need to be fully engaged in that. I think it’d be worth trying to work out what the reasons are that he’s reluctant to it. It’d be good to know if he would be willing to look into it and – at least – do more research on it and find out more information just so that he’s not ruling it out straight away. Would he be willing to look into the different options? What would it mean? How would it affect you? What does the process involve? A good idea could be speaking to other people and hearing stories from people who’ve adopted. How did they find the process and how are they finding it now, living with an adopted child? It’s very difficult if one of you wants one thing and the other one doesn’t. So I’d say, it’s just about the communication and asking the questions. The reason he might not want to try it might be something that’s quite easy to answer – or, on the other hand, it might be a really deep-seated reason. You could maybe work it through. If he’s willing to start looking into it, then he might be able to make a decision and you’ll both feel like you’ve made the effort to consider it as an option. So I’d say: yes, encourage him to at least hear more about it so that you can rule it in or out. Tell him that you just would like to have more information so that you can make a decision and ask whether he will support you in researching it. You might find out that he’s more open to it once he knows more. When we were going through it, my husband wouldn’t even want to adopt. But I know somebody who’s a foster parent and when we went out somewhere together, she had one of her fostered children with her. After he’d seen this child and realised that it was a little boy who just needed somebody to love him, he changed his mind and his view on why he would adopt. I think he probably had ruled out adoption at the start, without really thinking about it. So when he actually realised that there are children there who do need loving parents and support, it changed his mind a bit. So it might just be that he doesn’t know enough about it. Just ask him if he will support you in researching it. Hopefully, that helps.
My embryologist said “The other embryo was slower: 2-cell on day 2, only 3-cell on day 3, small compacted morula on day 4 and fair quality early blastocyst 1B on day 5. In my opinion, this embryo has a low chance to start a pregnancy.” I have to travel far to get this IVF, and after hearing this, I feel like I need a new doctor. Do you agree?
Well as I said, the most important thing is to trust your doctor. You have to challenge him, you have to ask him what is his expert opinion and if you’re not happy with the answers then yes, you can change the doctor. I would not say I agree or disagree, I have to leave it on you – you have to make the decision if this doctor is good for you. You have to see you trust him. You have to see if he is honest. You have to see if he talks to you and explains things to you. In infertility, there is nothing right or wrong; it’s not black and white – it’s a rainbow of many colours. Even as I said to you, you might have a bad embryo and you can be pregnant with a normal pregnancy, or you can have a perfect embryo and miscarry or not get pregnant. It’s only chances – a good embryo has high chances of getting you pregnant, a bad embryo has lower chances of getting you pregnant. So, every embryo and how it progresses from two to four, to morula, to blastocyst is different – also you have to know something important: what time fertilisation was at, and what time the embryo was checked because you can do ICSI on one egg at one o’clock, and then do to ICSI on another after half an hour or after one hour, so you have to make sure of the timing when you check the embryos and when you do the fertilisation. I would say you are the one to make the decision about your doctor – you have to feel comfortable with your doctor and you have to trust. If you lose the trust, then you change, otherwise, stay there.
Further to my question 8, an adoption embryo under the age of 25 and with our own embryo (with donor eggs) is also under the age of 25.The adoption embryo will have NGS/PGS. Should we do PGS or PGD with our own embryo (with husband sperm)? Could you please advise as we had implantation failures around 8 times?
PGS is a kind of PGV. PGV is a broad definition of monogenic screening and is a screening technique. In the embryo, to check for euploidy or aneuploidy, we use a type of PGD that we call PGS or now pgtA aneuploidy. We perform pre-implantation genetic screening that is a type of pre-implantation genetic diagnosis. If you are using a donor you are not supposed to have any implantation failure.
5 failed on own egg cycles and two failed donor egg cycles. I’m already using immune treatment and have had implantation cuts now. Anything you can suggest?
You may try a further donor egg treatment after the hysteroscopy and implantation cuts, and if this has a negative outcome, we recommend donor sperm treatment, this means donor embryo treatment. The most important factor is the uterine cavity that you have already done. A new donor egg treatment is recommended and after this, if we still have the same unsuccessful outcome, we strongly recommend using donor sperm next time.
What age of the egg donor would you say is the best to have good quality embryos?
Our donors are between 18 and 25 years old. Sometimes we can have a donor who is 30 years old but this is not usual. We think this is the best age (18-25) because we can have a good number of good quality eggs.
I had a first IVF which was successful but miscarried. After this I had 4 that I had frozen transferred and all failed. Do you think that this is due to the embryos being frozen?
No, it’s not because the embryos were frozen. It all depends on how old you are and what quality of everything you had. And the other thing, after you miscarried did you have a scrape? Did you have a D&C? How is your endometrium? I recommend that before you do another IVF, if you have any more frozen embryos, definitely do a hysteroscopy.
What is the age limit for egg donation in your clinic?
In egg donation, the legal limit for an egg donor is under 35 years of age. If you mean the recipient, the intended mother, then the legal limit is 49 years of age.
Do you have a BMI limit for egg donation treatments?
We have the cutoff limit for BMI of 40. We don’t treat patients who have a BMI more than 40. With BMIs between 35 and 40, we assess the general situation of a patient. It’s not the same for someone who is super healthy but their only problem is high BMI and for someone who also has heart disease, high blood pressure, diabetes and something else. But apart from what I said, the ideal thing would be to have a normal BMI when we are about to start fertility treatment, to have an embryo transfer and afterwards for the pregnancy as well. It is not only because the chances of a successful outcome are much higher in such a case – it is also because there is a smaller risk of a miscarriage and complications along with the pregnancy for both the baby and the mother. We are very conscious that it can be super difficult at times to lose weight – it’s one of the health problems affecting many people in the world today. But most of the times, through a good programme of a diet, exercise, mentoring and coaching, a lot of things can be done. However, there is something more to consider here as well. It is of course not the same for someone who’s 30 years old and needs to do a fertility treatment – in such a case, we can say: Listen, you should lose some of this weight and then we can start treatment. But it’s completely different for someone who is 48 years old. So there are a lot of factors that have to be taken into consideration. Obviously, someone who is older, has a higher weight, too. And it complicates a lot of things. On one side, it means that we have less time, and on the other – age is also a risk factor with pregnancy, having complications, etc. And for us, it is super important to help patients to build healthy families and healthy babies. So to sum up: our limit for BMI would be 40. Between 35 and 40, we would individualise each case and see if there are any other risk factors for having complications. Finally, in case of BMI less than 35 (between 30 and 35), we would also help to manage the weight for the patient to be in the best possible shape for the transfer and pregnancy.
Can you tell us about the options on how to make embryos using donor eggs? Does it depend on country, or is it per clinic? I assume there are sometimes options to pay for a donor’s entire cycle, fertilise the fresh eggs and then freeze the embryos. But what else can happen? Buying frozen and already harvested embryos in batches? Planing a fertilisation in upcoming cycles by buying a portion of the eggs to be retrieved?
Usually, when you’re proceeding with frozen eggs, the clinic guarantees you a certain number of them after thawing. If there were eggs of poor quality, then they would not survive the thawing process. It doesn’t mean that you buy , for example, a container of 6 eggs and you find out that there are only 3 left after thawing. The clinic usually guarantees a certain number of eggs. Even more, I’d suggest you to go for the option of guaranteed embryos. Embryos are stronger and more likely to survive freezing. I’m not sure if you’re proceeding with your partner’s semen or donor’s semen. If your partner’s semen is meeting the clinic’s quality standards, they can guarantee you a certain number of embryos. If you proceed with donor semen, then the guarantee is already there of course. Sometimes in case of a double donation, there are not so many embryos because donor semen and donor eggs do not match well. It’s rare but it does happen. So you’d better consider your situation carefully and see if it is not better to proceed with a guaranteed number of embryos. And of course choose a clinic that is skilled in freezing embryos and conducting successful treatments with frozen transfers.
Is Coenzyme Q10 beneficial in those patients who do not have endometriosis?
We give CoQ10 to patients with endometriosis and to those patients who are over 37 years old. As I told you before, we see that the egg quality diminishes with age and CoQ10 has a positive impact on the machinery of the oocyte – the mitochondria. It’s the engine of the oocytes so it’s beneficial for women who have endometriosis and for women who are above 36-37 years old.
Do you provide information about specialized lawyers in the country of the intended parents, France in our case?
Yes, we will be able to give the contact details of the lawyers who deal with French citizens and surrogacy.
I’m 39. AMH is 8, AFC-12 and I had had two IVF with my own eggs that failed. I had two blastocysts in the first IVF cycle and one good quality in the second one. Should I try with my own eggs or should I consider egg donation?
I think that I would consider doing another IVF cycle with pre-implantation genetic screening. Another thing that is important is that we don’t have information about your partner and it is important to assess that there is no hidden male factor that might not have been diagnosed.
What #IVFWEBINARS attendees say
#IVFWEBINARS presenters' opinions
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.
With the above in mind, we have decided to launch a project that would highlight the importance of sharing valuable IVF knowledge and expertise with those who struggle to become parents. IVF Patients’ Supporter is a recognition we give to all the clinics and IVF experts who provide fertility patients with answers to their most crucial questions. Thus, they are making patients’ IVF journey much easier and – at least partially – more predictable.
But how do they do this? The answer is simple: they share their knowledge via webinars and patient meetings at MyIVFanswers.com! The aim of our interactive videos is to assist patients in making well- informed decisions when selecting the right country and clinic for their fertility treatment, as well as to give them the chance to learn more about available treatment options. That’s why we turn to the most renowned specialists in the field of assisted reproductive technologies and we are always very happy when they agree to share their expertise with all of us. Our viewers highly appreciate the insight into all aspects of IVF procedures they gain thanks to our webinars. It is enough to read their enthusiastic comments and shout-outs to understand how much such support means to them!