Common IVF refund programmes promise clinical pregnancy in three attemptsDr Obidniak says that common IVF refund programmes promise clinical pregnancy in three attempts. It has been proved that when offered the possibility of several attempts, patients feel much more confident and calmer from the beginning. The doctors meanwhile know that even if the journey takes a little bit longer than expected, they will get the positive result in the end. However, Dr Obidniak admits that there cannot be any guarantees when it comes to IVF programmes. IVF outcomes depend mainly on patient’s age. There is a negative correlation between the advancing age of a woman and the positive IVF result. Until 2012, it was thought that implantation was the process of delicate interaction between the embryo and the endometrium. Latterly, data began demonstrating that there were other factors in the process, such as e.g. cumulus cells, microenvironment and various growth factors that contribute to either a success or a failure of the implantation. When talking about failures, we must take into account the genetic status of the embryo, the competence of the endometrium and the presence of concomitant pathology. Dr Obidniak highlights the significance of the genetic status of the embryo. Human beings have a rather high frequency of meiotic errors. Even if, according to morphology, the appearance of the embryo may be considered as excellent, about 40% of the embryos happen to be abnormal. Thus, the doctors should always assess the real status of the embryo. Today, good clinical practice involves preimplantation genetic testing and a selective transfer of one embryo. Preimplantation genetic testing (PGT) is the diagnosis of genetic and chromosomal alterations in embryos before they are implanted – in order to ensure that children are born free of hereditary diseases. The use of preimplantation genetic testing for aneuploidy (PGT-A) is recommended when couples are at risk of transmitting chromosomal alterations or monogenic diseases, when they have a medical history of repeated miscarriages, in case of implantation failure after several attempts with IVF and also when there is a severe male factor involved. Dr Obidniak says that another important point to pay attention to is the endometrium. It is crucial in the implantation process as it plays a role of microenvironment. It contains many growth factors that either contribute or hinder the implantation. Endometrium is a biosensor of embryo quality – it has both the capability to accept the embryo (receptivity) and select it (selectivity). In this way, it usually protects the uterus from an abnormal pregnancy leading to a miscarriage. Thus, it is very important to assess it in terms of functional and morphological alterations. According to Dr Obidniak, doctors today are in possession of the so-called ‘golden standards’ of endometrial competence assessment. These include a hysteroscopy (allowing to treat most of endometrial pathology at the same time) and the implantation window evaluation (in case of recurrent implantation failure). Taking everything into account, Dr Obidniak believes that IVF refund is a great tool for patients – but under the condition they collaborate with a reliable IVF clinic. It should always include PGT testing of embryos – only then it gives a real chance of IVF success. However, if one’s own resources are exhausted, there is always an alternative solution. It is either an egg donation or surrogacy programme. In case one of these solutions has to be implemented, an IVF refund programme is a great insurance for the patient. It proves that an IVF clinic is reliable and will do its best to find the best candidate for you. Summing up, Dr Obidniak mentions the undisputable pros of an IVF refund programme. It is a good way to estimate financial expenses beforehand as well as to assure full responsibility of a clinic in egg donation/surrogacy programme (‘shared risks’). Additionally, the risk of patient’s emotional burn-out is expected to be lower because of the guarantee they get. However, Dr Obidniak strongly advises to always pay attention to the clinic’s reputation and clearly assess both one’s own chances of success and emotional readiness. It is always an individual decision whether an IVF refund programme is really the right solution.