Recent questions from patients asked during live online events
What do you do to prepare your endometrium?
I prepare artificial cycles, I prepare cycles that I can control. I don’t like natural cycles because natural light cycles can give you problems – that means you can have an early rise of progesterone and you can lose the implantation window. So, by artificial cycles, you can control the endometrium – you are sure that you have the right size and you know exactly when you will give your progesterone and then you know exactly the time that you will do your embryo transfers, so having artificial cycles is much better, and give you better chances of having a successful pregnancy. Natural cycles are good, but he can be sometimes detrimental with their premature rise of progesterone.
Are you happy now?
It’s a hard question. What I already said is that I’m never going to get over this. It’s the sadness that I’m going to carry with me for the rest of my life. But that doesn’t mean that I can’t have other amazing and happy experiences. I can say that I’m probably like everybody. Some days I’m really happy and some days I’m really not. Just because I had this one really hard life experience doesn’t mean that I don’t think I might have another one in five years’ time that I’ll have to contend with. I’m training to climb Mount Everest at the moment and after a really busy weekend at the Fertility Show, I got on a train and I went to the Lake District. I was out on the hills climbing the mountain and I felt so happy at that moment! Being in the outside with my pack on my back and feeling excited about what’s going to happen in the next few months – at that moment I was happy. But it doesn’t mean that I’m happy every day. I don’t think that’s possible. And it also doesn’t mean that I won’t ever get over the sadness that I’ve been through. And I don’t want to. I think that Gary Barlow said that actually about the stillbirth of his child. He doesn’t ever want to get over that because he wants to always remember her. And I always want to remember my pain. It’s me. And that’s the answer.
Would you recommend a Mediterranean diet or other foods to lower the pain?
I do believe in the Mediterranean diet and I do believe we are what we eat. I think the diet is important, but we need more research to prove that it is effective for pain management and improving fertility.
What is the difference between embryo donation and embryo adoption? Or is it the same?
Yes, it’s the same thing but people use different names – so that’s why we put both of them.
What exactly do you mean by “analogues”?
The term “analogues” refers to a medication which is analogical to gonadotropins. We put patients on three-month courses of analogues in order to induce an artificial menopause.
Do you recommend probiotics administered orally or only vaginally?
It is more recommended to use them vaginally. The reason is simple: if you take them orally, some of them can be like deactivated by the stomach and its fluids. If you take them vaginally, they are going to be very close to the uterus and to the endometrium so they will act faster. The concentration of the bacteria would be much more increased if they are used vaginally.
Do all the clinics use time-lapse technology? If not, what is the alternative used by these clinics? Does it make a difference in the sense that it allows embryos to develop up to the day 5?
Time-lapse is becoming more and more used these days. In my personal opinion, it’s really useful. But we didn’t start working with time-lapse incubators when they were released. We needed about 4 years to add them to our standard procedure because we first wanted to confirm that the results were going to be better. So we had invested four years into working with time-lapse incubators until we added them to our workflow in the lab. If the clinic that you are going to does not have them, this is going to be a problem. Of course, that depends on how many embryos you have. In my opinion, this is crucial because we are talking about the group of patients that does not produce a lot of embryos. If you are 27 and you have a problem with your tubes but you’ve got really lovely ovarian reserve, you produce 11 or 18 eggs during IVF and you have 10 embryos. And if you end up with 8 to 12 embryos, this is not going to make a really big difference in terms of results. But if you only have 4 or 5 eggs and you have just 1 or 2 embryos, then it is going to be a really big difference in terms of cumulative life birth. So if there is anything that we can do in order to take care of these embryos and slightly increase their number, it is going to boost your chances of success. Maybe not in the first attempt – but you are going to have more options without having to go through another round of IVF. So according to me, if it’s possible, choose the clinic which has the time lapse technology in its lab.
You mentioned adenomyosis earlier, what treatment do you do for this condition, and when do you do it?
Adenomyosis is quite an important condition for repeated implantation failure. It depends on the degree and the average of the uterine cavity, which is affected by adenomyosis. Some patients have just little focal adenomyosis which doesn’t have any effect on implantation. Some patients have pain during the period – they have severe adenomyosis. In these patients, we need to stop this activity under the endometrium to reduce inflammation and to increase chances for implantation. Using some treatments like agonists before the transfer it is one of the options. Some patients with focal adenomyosis probably will need one month of treatment, and it will be enough. In some of the patients that already had implantation failure, and they have severe adenomyosis, sometimes a three-month agonists treatment is mandatory before transfer to increase the chances of implantation. So from 1 to 3 months of treatment before the procedure.
What about matching the egg donor’s looks?
The database includes photos of the donors, so you will be able to choose by yourself, or, if you wish, you can give your photos to our coordinators and they will choose donors who best look like you.
What about the Matrice lab test? Matrice lab test: helps to find if there are Natural Killer cells in the endometrium.
In literature, there are several things described. There are articles stating that on the one hand, it may afflict the implantation window, but mostly, in the latest retrospective research, there is data stating that increased numbers of NK cells in the endometrium are linked to recurrent miscarriages. So, the women become pregnant, but these pregnancies may terminate at different stages, but mostly they terminate before 10 weeks of gestation.
Do you recommend PGT-A in egg donor treatment? Do you see difference in success rates?
We recommend PGT-A if the partner’s semen is used and we diagnose a disease in the semen itself. Before doing any fertility technique, we request a karyotype test for the parents if we’re going to use their gametes. If we’re using donor eggs, we don’t need the karyotype of the recipient. But we’ll need the karyotype of the male partner if we’re going to use his semen. Apart from that, when we’re analysing the semen and we suspect a disease, we can request a karyotype test in the semen. It’s because there’s no correlation between normal karyotype in somatic cells and the normal karyotype in gametes (sperm or eggs). In those cases, we would recommend PGT-A. If the sperm doesn’t have any kind of problem, we don’t recommend it because the age of an egg donor is less than 30 most of the time. So the probability of aneuploidy is really low. The benefit of doing PGT-A in such cases is really not shown and increases the cost of the treatment. Another situation to imagine is when the sperm is good quality, the donor is young, we check her fertility and everything is ok but we have recurrent miscarriages or we don’t have any implantation. Then, of course, we need to investigate further and we need to investigate the embryo just in case we have a problem with the fertilisation – the union of the egg and sperm.
Do you usually perform a single or a double embryo implantation?
It depends on the patient’s medical history and age, as well as recommendations by their fertility doctor. The final decision, however, belongs to the patient, as some couples do not want to risk a twin pregnancy. Conversely, patients with repeated embryo implantation failures often opt for a double transfer as they are afraid of another failed.
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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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