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Success stories after multiple attempts – insight from IVF coordinator

Linda Sywalová, MSc.
Patient Coordinator
Insight from a coordinator- patients' success stories
From this video you will find out:
  • Who is an international client coordinator?
  • What do the first contact with the clinic and the coordinator look like?
  • What are the IVF legal restrictions in the Czech Republic?
  • What are the treatment options at GYNEM?
  • What are the success stories of GYNEM patients?

 

Patients' success stories - the IVF coordinator shares her insight

In this webinar, Linda Sywalová, M.Sc., Coordinator at Gynem IVF, located in Prague, the Czech Republic has been talking about patients’ success stories from the clinic.

Legal restrictions – The Czech Republic

The IVF treatment is said to be possible for women younger than 49 years old with a verified male partner. In other words, it is only possible for couples in The Czech Republic. In contrast, the restriction of age limit for men does not exist, and it is also added that gender selection is not legal as well as the donation has to be anonymous. Depending on the clinic, further restrictions can be added as weight limits and so forth.

Treatment possibilities

For greater understanding, the treatments first involve intrauterine insemination followed by the IVF with its cells. Next, sperm and egg donation as well as embryo donation are the following levels. It is mentioned that combinations of own and donor cells are also possible depending on each case, as well as using the donated sperm. Another possibility described as rare is surrogacy, although some restrictions must be followed. One restriction is related to the usage of own eggs and sperm and then creating the embryo for transferring to the surrogate mother. Additionally, another restriction implies evidence of a medical reason for the surrogacy.

Some additional treatments that are sometimes necessary to be performed before embryo transfer include endometrial scratching. It implies the scratching injury of the uterine cavity which is said to boost the immune system and implantation of the embryo if done during the 21st day of the cycle. Another possibility is an ERA test, which identifies the window of implantation of any woman to check standard receptivity and selectivity. Genetic testing as well as NK cells testing is also available.

During the treatment, sometimes it might be recommended to apply intralipids to downregulate natural killers which usually prevent embryo implantation. Intralipids are administered for up to three hours, sometimes less, usually one week before the transfer, the day of the transfer, and one week after the transfer, but this varies depending on the doctor’s recommendations.

Another recommended procedure is sperm pre-selection. There are many types of pre-selection depending on the issue, such as IMSI, PICSI, MACS, and Fertile Chip.

The Embryoscope is a 24/7 screening or monitoring system. Typically, embryologists need to check embryos daily during cultivation to evaluate their quality and cell numbers. With the Embryoscope, they can monitor embryos continuously without handling them, viewing them on a monitor. It’s also used during pre-implantation genetic testing to determine the optimal time for biopsy.

Just before transfer, assisted hatching or EmbryoGlue can be added. EmbryoGlur is applied to help the embryo implant, while assisted hatching involves slightly disrupting the zona pellucida to facilitate embryo hatching. These procedures are particularly recommended for frozen embryo transfers.

PGT-A (Preimplantation genetic testing for aneuploidies)

The biopsy is usually done on the blastocyst, with the extraction of one cell from the edge of the embryo to avoid destruction of it. However, it is said by embryologists that merely one cell does not have to be representative of the whole embryo and vice versa if poor quality is identified. Needless to say, this test is usually recommended for women over the age of 40 years old.

The key is to keep in mind that good results are often observed when patients are not stressed and maintain good mental health. Therefore, it’s crucial to find ways to manage stress before, during, and after the transfer. This could involve activities like meditation, massages, spending time with pets, or being in nature. Stress can negatively impact treatment outcomes, so maintaining a positive mindset and avoiding stress whenever possible is essential.

Another recommendation is fertility acupuncture, which is typically done before and after the transfer, around 30 minutes each time. Many patients have reported positive experiences with this approach.

Patients often ask about the need for egg donation and whether they can proceed with their own eggs. Recommendations from the doctor will depend on various factors such as test results and age. For instance, while the Anti-Müllerian hormone (AMH) provides insight into egg quantity, it doesn’t indicate egg quality. High AMH levels don’t necessarily guarantee successful embryo implantation. Therefore, while AMH is important, it’s not predictive of egg quality.

In IVF treatment, a common practice is to consider a “rule of 3.” If a patient has had 3 unsuccessful inseminations, doctors may recommend transitioning to IVF. Similarly, after 3 unsuccessful IVF cycles, they might suggest considering egg or sperm donation based on individual circumstances and results.

Case reports

Case 1: a female patient, 42 years old, and a male patient, 40 years old, from Iceland with no prior experience with fertility treatments before coming to the clinic.

Their first IVF cycle has been performed using the woman’s own eggs. The first fresh embryo transfer resulted in a negative pregnancy test. The second transfer, using frozen embryos, also had a negative result. Another stimulation cycle was performed, resulting in a high number of eggs, so the recommendation was to freeze all embryos for future embryo transfers. The first frozen embryo transfer ended with a negative test result. For the second attempt, aspirin was replaced with Clexane, but it also resulted in a negative test. This cycle was repeated several times until the 7th transfer where Prednisone was added, it finally led to success, and they welcomed their baby.

Case 2: a couple from Germany, a 35-year-old female, and a 43-year-old male. Before coming to the clinic, they underwent 4 IVF cycles but only managed to have 2 embryo transfers due to unsuccessful embryo development. They were initially seeking egg donation, however, another IVF attempt with sperm pre-selection and pre-implantation genetic testing for aneuploidies (PGT-A) was suggested, along with intralipids and Clexane.

The couple opted out of genetic testing and asked to proceed with intralipids and Claxane administration. On the day of egg retrieval and embryo transfer, intralipids were administered. Despite not reaching the blastocyst stage, the transferred embryos resulted in a positive pregnancy test after 2 weeks. Intralipids were administered twice more in the following weeks, and they now have a healthy baby.

Case 3:  a 36-year-old female and a 33-year-old male from Switzerland, had never achieved pregnancy before coming to the clinic. They attempted intrauterine insemination (IUI) 3 times and underwent 2 cycles of IVF without success.

When they came to the clinic, they were considering egg donation due to the female partner’s low menstrual flow and their history of unsuccessful IVF attempts. They opted for egg donation to increase their chances of success. Initially, 2 top-quality blastocysts (5AA grade) were transferred along with EmbryoGlue. Despite the good endometrial lining measuring 10.2 millimetres, the transfer resulted in bleeding shortly afterward, and the pregnancy test was negative. The female partner was highly stressed and nervous throughout the treatment process. To help her relax, she was advised to do some activities that would calm her nerves. For the subsequent frozen embryo transfer, only 1 blastocyst has been transferred instead of 2. Additionally, she underwent acupuncture on the day of the transfer. This time, her endometrial lining was slightly thicker, measuring almost 13 millimetres. The pregnancy test came back positive, and they welcomed a baby girl into their family.

Case 4: a couple from the UK. A female patient was 35 years old, and her partner was 38 years old. Before coming to the clinic, they underwent 6 cycles of IVF, which resulted in 1 live birth. Their daughter was around 4 or 5 years old. She had irregular periods and a low AMH level, which were concerning signs.

During her stimulation cycle at the clinic, she had a low response, and only 4 eggs were retrieved, resulting in 1 embryo on the day of transfer, which was transferred on day 2. The doctors agreed to transfer it, as she strongly desired it. The test after the transfer was negative. Additional tests, including an ERA test, didn’t provide new insights. Egg donation was recommended, but the couple wasn’t ready to choose this path yet. After 2 two or 3 cycles later, they decided to pursue egg donation. It was a big decision, but they finally agreed. In April 2019, they reached out to the team at Gynem, while in April 2020, the couple informed them they had conceived naturally. Against all odds, she became pregnant, and everything went smoothly. This unexpected success was truly miraculous, as our doctors initially believed there was no chance of success. Their positive test result led to the birth of their baby. This experience underscores the unpredictable nature of fertility treatments.

Conclusions

Various techniques, such as ICSI, sperm pre-selection, and the use of frozen embryos and eggs are essential. Single embryo transfer can be successful, especially when transitioning from IVF to egg donation, reducing the risk of multiple pregnancies. ERA tests, intra-lipids, and endometrial scratching are beneficial additional treatment options that can increase the chance of success. Maintaining a positive mindset during treatment is crucial, as stress can negatively impact outcomes. Other practices, such as massages and acupuncture, can also contribute to overall well-being.

- Questions and Answers

What do you mean by a verified male partner when it comes to law in the Czech Republic?

We won’t check if you are married or if you are actually a couple by showing pictures or something like that. What we need is that the male partner signs the documents where he needs to agree with the treatment either he will come with you to our clinic and sign it at the clinic. If you’re using a donor, or you will have to go to a notary in his country and sign the document and the identification with the notary to make sure that it’s him who is signing the document. Then, you come with this original signed identified by a notary document to our clinic. You sign it there so that you can have the treatment here.

How can I make sure egg donation embryo transfer is successful? Is there anything I can do to make it successful?

Something I recommend or is recommended by our embryologist is, for example, the EmbryoGlue or Assisted Hatching, which is something that we recommend more, but it depends if it’s possible. Sometimes, the embryos on the day of the transfer are already hatching, so it is not necessary to do the assisted hatching. In that case, you can do the EmbryoGlue. If you’re not asking me about the laboratory techniques, but you’re thinking about what you can do personally for the transfer to be successful, very important is to be positive, about the transfer. If you think from the beginning that it can’t work and won’t work, it will not work, also avoiding stress is very important. Another thing, that we recommend not to do after the transfer is to have hot showers or to go to saunas and doing, something that is not recommended during the whole pregnancy like lifting heavy things. Also, avoid jumping, you can walk normally, but it’s better to avoid running very fast, all of those things should be avoided during the whole pregnancy. I also suggest acupuncture sometimes. We have really good results with that, so before and after transfer. I think that is what can help you as well.

What are the costs of surrogacy at Gynem?

The Gynem clinic is only doing the treatment for the surrogate mother and for the patient, however, we are not organizing the surrogacy, so you have to find your own surrogate mother, and you need to have an agreement signed so that we are allowed to do the treatment. All 3 of you will have a consultation with us, usually via skype, where also the doctor has to inform the surrogate mother or to check that she knows what she will be going through the whole procedure, the whole pregnancy that it’s not an easy decision. The cost of the surrogacy over the price of the IVF is 1500 EUR, which is the surrogacy fee, we have to do all the administration plus it’s the treatment for the surrogate mother.

Can the surrogate mother come from another country?

Usually, it is the case that she comes from another country because obviously if you come from, let’s say the UK, you bring your surrogate from your country, you won’t find her in our country. I don’t know why, but all of my surrogate mothers that came for the treatments were from Denmark, and it was usually a sister, or it was a best friend of the recipient. It worked out, and we had live births in Denmark.

Is there any waiting time for egg donation, and do you offer any price packages at Gynem

We don’t have a waiting time for egg donation. However, since there is a long preparation time rather than waiting time, what happens is that after the consultation, you have the time to think about if you’re interested in having the treatment at our clinic if you’re sure about it because of a deposit has to be paid. As soon as the deposit is paid, we start to search for the donor, that usually takes 3 weeks to 1 month, and after this, we need to synchronize the cycles that take maybe 1 to 2 months, and then in total, we have 2 to 3 months of preparation so that we actually, just start with the treatment. We do offer price packages, we have 2 of them, we have a basic one and a comfortable one. The basic package includes frozen eggs that are already on stock at our clinic, you have a guarantee of 1 embryo for the transfer, a good quality embryo, which means that it can be even an embryo at day-3. With the other package, we have a comfort package which is with fresh eggs, this package is a little bit unpredictable, let’s say because, of course, we have a donor that comes to the clinic, and we do our best so that she has as many eggs as possible, however, it may be a donor that comes for the first time, which is in most of the cases, and she has 3 eggs only at the day of the egg retrieval. However, you have a guarantee of 2 blastocysts for the embryo transfer. If she doesn’t have a sufficient number of eggs, we create, let’s say 1 blastocyst day-5, we will create another blastocyst for later use, so we can transfer this one, and then in the meantime, we will prepare another embryo, which we can transfer, and use it for a frozen embryo transfer in the future. We can, of course, discuss that, or you can contact me via email, and I would send you everything via email plus the price list, and we can discuss that h in person.

Do you provide your patients with time-lapse photography and embryo grading report upon their request?

Yes, so after the egg retrieval both in the egg donation and IVF, we update you every day regarding the embryo development. First, one day after the egg retrieval, we inform you how many eggs were fertilized, and then from the next day, we inform you how many cells each embryo has, and then we inform you about the quality of the embryos. That is something we do during the cultivation, and then if you choose to have the Embryoscope after your treatment, we can send you a video, it takes maybe 30 seconds up to one minute – the embryo development or cultivation until the day-5 when we transfer it into the uterus.

Can the pre-implantation genetic testing discard a good embryo?

It is possible to choose an embryo thanks to the pre-implantation genetic testing, this is something that is recommended when we have a lot of embryos so that we can choose from. For example, if you have 1 embryo only on the day of the transfer and you are interested in the pre-implantation genetic testing, it doesn’t really make sense to do it. There’s something that is not recommended by our embryologists. If we have 8 embryos then yes, it makes sense to do genetic testing to choose the best-looking embryo.

How many days should we take off work after embryo transfer or retrieval?

It is not necessary to really relax too much after the transfer. Usually, our patients start work normally, one week after the transfer day, but of course, it depends on your work. If you need to lift something heavy at work, it is not recommended to continue this work, so it is something that you have to specify depending on your job. I would recommend is to wait 1 week and then go back to your normal life and hope that your life will change completely.

How do you assess the quality of eggs once retrieved?

This is something that an embryologist should answer, however, what I get as a coordinator and what you get because you get it from me is that it is evaluated depending if it has fragmentations. Fragmentations usually make the quality of the embryo evaluated as a grade 2. Grade 1 is the best grade, minus 1 is the second-best, grade 2 is still good and everything that is lower than 2, so minus 2, or 3 is not really good and usually doesn’t cultivate till a blastocyst stage, however, what is the evaluation system called I cannot really answer this question.

Is being under 40 (35,-36)not too young for egg donation? They still have their own good eggs, isn’t that right?

Unfortunately, in most cases, yes, it is possible to have the IVF when you are less than 40 years old. However, in some cases, doesn’t really have good results, we even had patients that were 26 years old, and they were menopaused, it is really sad because again another patient coming from Switzerland had 3 IVF’s, they had 3 egg donations, now she’s 28 years old and she has as a big file, so, unfortunately, this is not always the case that if you are under 40 years old, the egg donation is not going to be suggested.

What day of the FET do you measure the endometrium? For example: on what day should it be around 10mm?

During the preparation for the frozen embryo transfer, we recommend checking the endometrium on day 10 of the cycle however, if it is day 9 and day 11, it is fine. The main thing is to measure it before you start using progesterone, and it should be around 10 millimeters, well it is advised that if it is day 10, and the endometrium is more than 7 millimeters thick, it is still thicker and thicker and usually during the transfer it should be from 8 to 12 millimeters thick. Sometimes, it can be even thicker, and in that case, it can be even too much, so we rather prefer not to go over 12 millimeters, so somewhere between 8 and 12 millimeters is ideal, as you mentioned 10 millimeters during the transfer is not necessary. On Day 10, that is too early because it’s still growing, and then on the day of the transfer, it might be too thick, and that is also not something that we are looking for.

What is the approximate price for an IVF cycle without PGD at Gynem?

There is a fixed price for the standard IVF cycle, which is 2400 EUR. However, it depends if we’re using a pre-selection, if we’re using an Embryoscope, if we are using the EmbryoGlue, assisted hatching. The cycle without medication costs 2 400 EUR at our clinic, and then the medication cost is somewhere between 800 and 1500 EUR depending on the medication type, medication brand, and, of course, the dosage that you need.

Do you think keeping the same protocol for the next transfer is wise after a failed IVF?

I am also sometimes surprised that the protocol for one of my patients doesn’t change the second or the third time if it is the second transfer, that is something that our doctors also do, so the protocol doesn’t change the second time or the third cycle. However, if we already had three cycles and the protocol is the same for the fourth one, there is something wrong. We should already do something before the protocol or maybe during the protocol change the medication type, brand or add something before we do some extra testing maybe, there is something wrong, and there is a waste of embryos, which is a pity. It depends on the case mainly if there is a pregnancy or not, however, if if you already had three times a cycle with the same protocol and the doctor prescribes the fourth time the same protocol, there is something wrong.

When is the use of intralipids recommended at Gynem?

To be honest, I have noticed that it depends on the doctor, but usually, it is one week before the transfer, sometimes the day of the transfer, and definitely one week after the transfer. Sometimes, it varies, and it is two weeks before the transfer and two weeks afterward. Sometimes, as you could see to continue, on the other hand, in most cases, one week before the transfer even the day of the egg retrieval, not one week but five days before, so the day of the egg retrieval, the day of the transfer, and then five to seven days after the transfer.
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Authors
Picture of Linda Sywalová, MSc.

Linda Sywalová, MSc.

Linda Sywalová, MSc. has been working at the Gynem Fertility Clinic in Prague for over 2 years. She's a part of a team of coordinators, who assist clients from all over the world so that they feel in good hands and have a familiar face when travelling abroad to undergo fertility treatment. If you get in touch with her and you speak English, French or you are from one of the former Yugoslavian countries, it is possible that it will be her, who will call you and tell you everything about the medical procedure, arrange your initial consultation with the doctor, explain the protocol to you, make sure you have enough of medication, welcome you every time you are at the clinic and hopefully celebrate the positive pregnancy test with you.
Event Moderator
Picture of Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.
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