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How to prepare for an egg retrieval to make the best out of it?

Elias Tsakos, FRCOG
Medical Director at Embryoclinic , Embryoclinic

Category:
IVF process

preparing-for-egg-retrieval
From this video you will find out:
  • How to mentally prepare yourself for egg collection?
  • What kind of medications are used for egg retrieval?
  • How do I prepare my body for egg retrieval?
  • How long does the egg collection procedure take, and how is it performed?
  • What size should my follicles be for IVF egg collection?
  • How many eggs do we get with egg retrieval, and what is a good number?
  • What happens to the eggs after they’ve been collected?

What to do for a successful egg retrieval?

During this webinar, Dr Elias Tsakos, FRCOG, Medical Director of Embryoclinic – Assisted Reproduction Clinic in Thessaloniki, Greece, presented a topic on egg retrieval, ways to increase your chances. Dr Tsakos emphasized the importance of the balance of the body, mind, and soul to achieve the best outcome.

Egg collection – preparing your mind

Dr Tsakos started by explaining how important it is to ensure that you’re familiar with what you have to do. Dr Tskokos advised keeping your mind focused on the instructions from the nurses, the administrators, and the doctors and making sure you remember all the essential times for your medications. On top of everything, make sure that you stick to the protocol. What is also very significant with the time coming up to the egg collection is that you understand what injections you have to do, when you have to do them and the importance of sticking to the schedule and being sure of the times.

Egg collection – medications

Regarding the egg collection medications, you will be given some instructions about the FSH injections, which you will be doing daily, but the most important is the final trigger injection which will help your eggs to be released. Make sure you keep your mind focused on the details of the administration of that injection, so the timing of that injection is of paramount importance, you need to make sure you remember that and you don’t make any mistakes. Dr Tsakos also explained that the majority of the patients are doing fine with this, but sometimes it happens that the patient mixes the times or is confused about what to do and when. That is why it is, so significant to remember about the final trigger injection, which is either the hCG or the GnRH analogue injection, it has to be done around 36 hours before the egg collection. Always check with the clinic, double-check with your partner, put all the reminders on and get that timing right. With the time is coming up for the egg collection, you have to make sure you are given instructions about antibiotics, what time to come to the clinic, etc.

Egg collection – the timing

The timing of the egg collection is crucial. If you’re too late, it might be too late for your eggs, maybe your eggs will be released and so forth. To avoid stress if you’re travelling from outside the city or if you’re travelling from far away, make sure you have accommodation near the clinic and make sure you’re at the clinic on time. These are the most important aspects of preparing for egg collection. We always advise not to eat anything for at least 12 hours before the egg collection, so make sure you don’t sip a coffee or tea in the morning and don’t have anything to eat or drink, always double-check with your nurses, midwives, and doctors.

Day of the egg retrieval

On the day of egg retrieval, at Embryoclinic, the patients are asked to avoid wearing perfumes, hair spray and any chemicals that may interfere with the clinic’s and the lab’s air quality. Also, keep a checklist of what you need to bring with you, what you need to do the day before or on the day of the egg collection. Most of the patients have demanding jobs, so it might be good to take 1 or 2 days off before the egg collection so that you can focus your mind on that procedure. If you’re coming from abroad, it’s better to have a flight the night before. Although it may be a little relaxing, try to avoid alcohol. Dr Tsakos emphasized avoiding alcohol in the 10 days before the egg collection as well. Have an early night, have a bath, read a nice book, keep your mind as clear as possible and as focused as possible.

Egg collection – preparing your body

In general, with the time coming up to the egg collection, try to be as relaxed as possible, as healthy as possible, try not to smoke if you’re a smoker, try not to drink at all, try to exercise a little, but not excessively.

I like to give my patients the advice I take for myself, 30 to 45 minutes of a very gentle walk is probably enough for most of us so keep your body in good shape. When you’re coming up to the egg collection, also make sure you wash in the morning, you have a nice bath, a nice shower, however, do avoid any kind of hair sprays, body lotions, etc.

Egg collection – preparing your soul

Concerning the soul, Dr Tsakos added that he realizes that it’s very easy to suggest not to be stressed however, most of you will be stressed anyway. If there’s anything you can do to relieve that, that’s very welcome. Dr Tsakos added that he’s a big fan of complementary treatments, such as acupuncture, massage, or anything that can relax you, anything that can nourish your soul and make you ready and prepared for that procedure, have faith in your doctors.

Most of the clinics including Embyoclinic use a consultant anaesthetist, this is giving the confidence that the patients are safe and also, at the same time, doctors can do their procedures as relaxed as possible from the medical perspective point of view as well.

Egg collection – number of eggs retrieved

Prepare your soul and mind for the number of eggs that will be retrieved. According to Dr Tskaos, this is an area that sometimes is omitted, and doctors don’t pay enough attention. Medical professionals like to celebrate when they see the follicles on the scan machine, and they like to exaggerate the number of eggs that will be retrieved. It’s crucial to remember these follicles are potential eggs, so during your stimulation, you will be told of the number of potential follicles that may create a mature egg, however, be prepared that there are always losses.

If, for example, there are 10 good follicles, the chances are that there will be probably 7 to 10 eggs maximum. Out of those 10 eggs, some of them will be mature. There’s always a percentage of loss in the process after the egg collection, so be prepared and don’t be disappointed if, for example, your doctor quotes 6 follicles and you have 4 eggs retrieved. Don’t be disappointed and be prepared a bit that from the eggs retrieved, some of them may not be mature or may not be normal, and therefore they may not be useful for fertilization in the future.

All this happens during the same day of the egg collection, you should always talk and be told of the quality of the eggs, of the maturity of the eggs and the day after the collection, you should be informed about the number of fertilized eggs.

Generally, if there are 10 follicles, it might be possible to get 8 or 9 eggs, and out of those perhaps, 7 or 8 would be mature, and then 6 or 7 would be fertilized. Possibly, 3 or 4 would be of good quality embryos. This is normal, be prepared for that, and also, be prepared that with advanced female age, the percentage of loss may be a bit higher. By getting that information and asking those questions to your doctors, you will be prepared, and you won’t feel disappointed afterwards.

After the egg collection

The egg collection lasts between 10 and 20 minutes. Usually, you’re slightly sedated, so you don’t feel this small needle going in, and you don’t feel any pain. Some people use a local anaesthetic. Some don’t, if there are only very few eggs or if there’s no availability of an open anaesthetist. Therefore, it may be a bit more painful. After that, you come around very quickly, in most units, mild sedation is used provided by a consultant anaesthetist, which is, according to Dr Tsakos, the safest way to perform it, and it also provides a better experience not only for the patient but also for physicians.

You might feel a bit dizzy, some patients feel very pleasant and very high because of this short anaesthetic, and typically, they stay at the clinic in the bed between 30 minutes to a couple of hours. After that, you sit with a doctor, and you will discuss what happened during the egg collection procedure, how many eggs were retrieved and the expectations for those eggs. If the partner is providing the sperm, you will be given the details about sperm quality. You’ll receive written instructions on the medical treatment and the medications you need to take for a few days after the egg collection.

Then you go home, usually, in my practice, I suggest that the patients go straight home, and then they relax a bit, perhaps have something very light to eat and have a rest in bed. Then I ask them not to work on that day, not to drive on the day of the egg collection and perhaps go for a short walk in the afternoon and have an early night. Usually, the day after the egg collection, they can go back to normal activities.

Summary

In all IVF procedures, it’s crucial to address the mind, body and soul. It is very understandable and acceptable that you request counselling and support and consultations regarding those 3 areas.

Nowadays, anyone can do an egg collection with a little training because everything is so easy with the high-tech ultrasound machines, the needles have become thinner and thinner and therefore more and more visible. Egg collection has to be done meticulously, the doctors have to pay attention to every single detail, not only in terms of safety but also in terms of efficiency, every egg counts. It’s important to try to puncture every single follicle potentially containing an egg. It’s always exciting to retrieve as many eggs as it was quoted.

What to do for a successful egg retrieval? - Questions and Answers

I would like to ask your opinion on the birth control pill in the month before the IVF cycle? My doctor recommended it, but I hear that it can suppress the ovaries, especially after 40 with a low AMH. I’m 41, doing embryo banking, I have 6 frozen embryos on day-3. Also, how many embryos would you recommend freezing at my age? My clinic doesn’t do genetic testing, also they recommend freezing on day-3.

I think most of us would agree that using a birth control pill, we lose something like 5% of our overall success. This has been very clearly demonstrated in research, so my personal opinion is to avoid it. I hardly ever use it, the only way I would use it would be to time the cycle. If someone has 2 weeks of holiday at the end of July and they can’t have IVF or they can’t fly to Greece another time, then I would probably have to use it, I have no other option. In that case, I would only use it for as little as possible, not for the whole 21 days, I would probably use it for anything between 10 and 14 days. I would try to minimize the use of the pill. In my opinion, the value of the pill is only in the timing of the cycle if you can’t do otherwise. In my clinic, I hardly ever use it, and when I explain this to my patients, most of them understand, so they give us a bit more leeway in their timings of the IVF.

Embryo banking at 41, to be honest, generally I like to see blastocysts. I think most people do that for several reasons. One is that the blastocyst is giving us a pragmatic idea of what’s going on. The value of the blastocyst, in my opinion, is about double the value of the day-3 embryo. Also, in some cases, like advanced female age of 40 and sometimes cases with sperm issues, the value of the blastocysts is even bigger. On the other hand, having 6 day-3 embryos is still good going. There is a dilemma of how many to transfer at a time. Whether you would thaw 2 and, perhaps, transfer them or thaw 3 or 4 at a time and grow them to blastocyst, and see how many would grow in the culture after thawing. That’s a topic of huge discussion.

Genetic testing is another huge chapter, in general, yes, there may be an indication of genetic testing over the 40s, but again to do genetic testing, it’s best if we genetically test blastocysts. There are a lot of issues here and a lot of topics that have been brought up, so in summary, no birth control, in my opinion, unless it’s necessary, and if so, no more than 14 days. Blastocyst if possible, I mean especially if you are doing a first cycle first time and the 41, and they have two days three embryos, I would probably transfer them if they’re top quality even on day-3, but if I were to freeze them and if I had 6 embryos, like in your case I would probably prefer to freeze blastocysts.

Does a very low AMH after 40 mean a lower quality than if you had a higher AMH?

The last time I looked, AMH had nothing to do with quality, and it had to do with the quantity. I’m ready to be challenged on that, in my opinion, AMH has nothing to do with quality just with quantity

Do you have any experience using ibuprofen to block LH surge search and delay oocyte aspiration waiting for a bigger follicular size without rupture?

The answer is yes. Ibuprofen is non-steroidal, we can use other agents as well. It’s not so much about allowing time for the follicles to become bigger, it’s about ensuring that they will not rupture before we do their collection. It has a very limited place. I will give you examples, nonsteroidals have a limited place, in my opinion, when we’re doing the natural cycle, so we have a follicle that’s 16-17 millimetres and then to time the egg collection, we give hCG, let’s say tonight, and we plan an egg collection to be done the day after tomorrow morning. In that case, yes, ibuprofen, and most of those do have a place in the natural cycle because we want to avoid the LH surge provided we give hCG. If we don’t give hCG and we would try to estimate by using LH kits or by using LH measurements, I think it may become a disaster if we just give nonsteroidals because we may prevent ovulation altogether.

In my practice, I have to be honest, I don’t encourage natural cycles without hCG. If it’s a natural cycle and I have a follicle at 17 that I triggered tonight, I would give ibuprofen to block the LH and ensure I have the egg collection and the follicles are still there. Having said that, my first choice, even in the natural cycle, would probably be to give a bit of stimulation, FSH injection a small dose, perhaps 150 units, together with antagonists and by doing this, I would ensure by 99% that the follicle is still there when I do the collection.

Estradiol level dropped from 16 to 5 (units unknown to me) from trigger day to right before retrieval. Only 1 oocyte was retrieved despite 7-8 visible follicles 18 to 20 millimetres on trigger day. There is no history of empty follicles – 8-10 eggs retrieved each time in the previous 4 cycles. What could have possibly gone wrong? Is it possible that I ovulated right before retrieval? Can you tell the follicles that just popped from the intact one on the ultrasound during retrieval? No good explanation from the clinic, everything was just perfect according to them. I am devastated – I was unprepared for that. I started 300 Gonal-F for 6 days, then 250 units for 6 days of Pergoveris.

Estradiol level of 16 is extremely low, no matter what units it’s measured in, even 160 sometimes is low, so to be honest, I’m not familiar with any units that would be considered normal at 16. Dropping of Estradiol is another adverse factor which is called a crash. As I said, even if it had been 160 that dropped to 50 or even if it had been 1600 dropping to 500, it’s still a huge crash. This usually happens if the physician is afraid of hyperstimulation and they abruptly decrease the level of FSH stimulation dose. If somebody is on Gonal-F at 200 or 250 units and we decrease that to half so to 100 or 150 units or even if we stop the injections of FSH because we fear hyperstimulation, then yes, we may have a crash. This may be associated with empty follicle syndrome, so something went wrong.

On the other hand, I would still like to be optimistic. I don’t know what happened there, but it’s a sad outcome, it happens, thankfully not very often, but just keep the positive aspect which is the fact that it happened once, and hopefully, it won’t happen again. As a rule of thumb, I do not like to reduce the dose of FSH, to be honest, and especially in the antagonist protocol, I never reduced the dose because of this possibility and generally, I deal with women over 35-38 or even over 40, so I usually increase the dose towards the end of the stimulation period. There is a certain dose that you need to stimulate the initial follicles to increase the yield of follicles, then you need a higher dose to sustain the follicular growth.

I would be very hesitant to decrease doses in any of my stimulation protocols, and if there’s a fear of hyperstimulation, then there are other ways to eliminate and reduce the risk to almost 0. At the moment, I think we can confidently discuss and talk about hyperstimulation free clinics.

I presume that was an antagonist protocol. The first 6 days, you used Gonal-F 300 by itself, then on the 6th day, they added the antagonist, so that slowed down by itself. Even if you sustain the 300 level of Gonal-F, adding the antagonist would probably crash a few follicles, in my experience, if we have follicles under 14, they crash, that’s why when I put the antagonist in, I generally increase the dose as well instead of decreasing it. You were probably 100 units short every day from day 6 onwards because you decreased 50 units and didn’t increase the other 50. I think that’s why you had the crash, although as I said, I’m not familiar with the types of units you used,

We got this information through daily measurements of Estradiol levels. If you ask your clinic to measure Estradiol the day after you’ve started your antagonist, you will see there’s a bit of a drop. Sometimes, there’s a significant drop, this drop is very useful in the younger patient because it crashes the smaller follicles and therefore it decreases the chance of hyperstimulation, and this is, of course, one of the benefits of the antagonist cycle. However, for somebody struggling to get 5 or 6 eggs, maximum, that would damage a couple of eggs, so that’s why they would probably get fewer than expected, but in your case, I think that had a significant impact.

What can be done if the uterus lining is thin to make it thick?

Firstly, we need to diagnose why. Medicine is very simple, gynaecologists were not the brightest of doctors, we’re very simple people, and we deal with biology, nature, and sometimes we’re guided and supervised a bit thankfully by biology. First, we’ll start with diagnosis, why is the lining thin? We need to make a diagnosis, and the best way to make a diagnosis is a diagnostic hysteroscopy plus or minus the biopsy at the same time so that we have some histology. Usually, the uterus lining is thin because there is some damage there, the most common damage is adhesions. We diagnose that, and the management depends on the diagnosis. If it’s adhesions, this is one of the trickiest and the most difficult pathologies that we can treat in reproductive medicine. We can do a hysteroscopy, estrogen treatment, hysteroscopy again. Some people try to use platelet-rich plasma into the lining, and this is not proven yet, it’s considered an experimental technique, we don’t use it because we’re not convinced by the evidence yet.

Adhesions are a tricky diagnosis, however, there are cases in which the lining is thin for other reasons because of infection, and again this can be diagnosed with hysteroscopy and sometimes biopsy and also with microbiology testing of the tissue we extract. Provided that we’ve done all of this, then we look into the medication we use to make the lining thicker. The thickness is only one aspect of the successful outcome, we’re looking for, the description and the appearance are also important whether it’s trilaminar, whether it’s dense, whether it’s homogeneous and so forth.

There are other aspects of the thickness that we’re interested in. The majority of women respond very well to the oil estrogen, however, some of them don’t. Some women would require some extra add-ons like transdermal estrogen patches. I have a wonderful colleague in Italy who I collaborate with for some of their patients for examination, and he uses this amazing protocol of patches, and the vast majority of his Italian ladies that come, they have the most beautiful, juicy endometrium. Perhaps, this works very well, I don’t use it as a first choice in my patients, but I use it as a combination for some patients or as a second choice for the patients that do not respond to the estrogens. How much estrogen do we give, that’s another area we need to look at. In the frozen embryo transfers, whether we regulate or not, it’s also another area of discussion.

To summarize, first, get a diagnosis, do a hysteroscopy. Hysteroscopy, in my opinion, is valid for up to 18 months maximum, so if you haven’t had one and you’re concerned about your lining, have another one to get some more information about your lining. Discuss the options of estrogen supplementation to ensure that you have the optimum endometrial thickness.

What would be your recommendation would be for stimulation with AMH 0.03 and age 40?

AMH at 0.03 is virtually an AMH 0. It’s very low. I would like to repeat that a couple of times, I would also like to perform FSH, it’s not as accurate as AMH, but I would like to double-check that with FSH, LH, estradiol and progesterone levels in the first few days of the cycle, in the follicular phase of the cycle, between 2 and 5 days of the period to ensure that is it.

With the AMH of 0.03, I would expect an FSH of over 12-14, maybe an FSH of 18 and high LH. I would like to perform a very careful antral-follicle scan to see if any small follicles potentially would grow. I would like to listen to your menstrual history, so if you do have regular cycles and how long is your cycle to confirm that. Sometimes, we’re a bit suspicious, or we don’t quite believe everything we see unless the levels are extreme like, in your case, especially if it’s not confirmed with other additional tests. With regard to the ovarian reserve in which I do have a special interest, I would always like to double-check with FSH levels, antral follicle count (AFC).

If indeed you have an FSH of 14 to 15 and if you have 1 or 2 antral follicles maximum and if you have a cycle length of about 24 days, because that’s what I would normally expect, then, of course, I would expect maximum 1 or 2 eggs tops during the stimulation. I would probably like to treat you with DHEA, this has become my favourite because knowledge goes so fast these days, and I’m always scared that one patient will know a little better than me and will challenge me. At the moment, with the pre-stimulation modification, DHEA is perhaps the best that we can do to prime the ovary a little for the stimulation. I would probably prime you with, perhaps, 6 weeks of DHEA at 25 milligrams 2 or 3 times a day and then stimulate you possibly with a combination of FSH and LH to get the maximum out of you.

I wouldn’t overstimulate you, I belong in the group of IVF doctors who don’t believe in aggressively stimulating ovaries that are slightly failing, like in your case. I don’t see much of a point in stimulating you with a very high dosage, so I would probably stimulate you with a small dose of maybe 150, maximum 200 units of a combination of FSH and LH. I would possibly even try to attempt and use the benefit of a modified mild stimulation with the use of Clomid for 5 days at the beginning of the cycle.

You must understand that you belong in the area and the cases that we know very little about, and it’s a matter of trial and error. Trying not to waste time but, on the other hand, not to do unnecessary interventions that wouldn’t bring any benefits. Priming with DHEA, using LH together with FSH, in my opinion, with not very high dosage and possibly using Clomiphene at the same time for priming the ovaries and using another mode of stimulation at the same time.

What’s the best option during egg collection if a fibroid is blocking the ovary? How long shall I wait after I have the IVF?

I belong to the generation of fertility doctors who have been trained in fertility surgery as well. That happened up to the late 90s, most of us were specialized in fertility medicine and surgery at the same time. From 2010 onwards, most fertility doctors are not trained for the surgery. More specifically, minimal access surgery, which is a fertility surgery. I do have experience of almost 30 years in myomectomies and fertility surgery in general.

Generally, I don’t like fibroids, and I don’t like fibroids in my fertility patients, and when I say I don’t like them, I don’t mean small fibroids 2 to 3 centimetres that are not blocking the cavity, and they’re not obstructing my view when I do the egg collection. Anything bigger than 4 or 5 centimetres is a fibroid that I do not like to see. There are different views. If I have no access to the ovaries because of the fibroid, for me, this is an indication for surgery, and I wouldn’t hesitate to perform it.

For me, this is an absolute indication of surgery. My answer is that the best option during egg collection of fibroids blocking is not to attempt a stimulation at all. If it’s blocking, have the fibroid surgery and then go for the egg collection. I have many patients coming from all over the world to have the surgery.

It depends on the age is the answer. If somebody is 30 years old or 32 with perfect AMH, and I do fibroid surgery, I usually do it with laparoscopy or with robotics, and in general, within 6 months to 8 months, they can get pregnant. It could be less if there are pedunculated fibroids or subserosal fibroids and so forth. In the general rule of thumb, it’s 6 to 8 months, so if somebody is young, I would just remove the fibroids and then go on and have IVF and do the embryo transfer 6 to 8 months later.

Having said that, the majority of my patients are in their late 30s or early 40s, I have a wonderful Bulgarian lady at the moment in my clinic who had the same issue, we could not do their collection because of obstructed view, so we had fibroid surgery, then we did the egg collection and froze the embryos. Now we’re moving on to having a second egg collection, we’ll freeze the embryos until the 8 months have passed, and then we will do the embryo transfer.

What if my fibroid is outside the womb cavity?

his is a bit of a myth. It doesn’t matter where it is if it’s a huge fibroid, it’s still an issue. Fibroids have this amazing ability to grow, and they can grow unpredictably. Sometimes they don’t grow, but having a big fibroid even outside the cavity, I presume yours is more than 5-6 centimetres if it’s abstracting the ovary, it’s a potential complication for the egg collection. That area is full of big veins and vessels and can cause complications for pregnancy.

I have had dramatic surgery performed on patients who were not mine, they were referred by the doctors who got pregnant either naturally or through IVF, and they had dramatic complications with fibroids growing and encroached and being embolized or clotted during pregnancy, and that can be a nightmare. That could risk not only the pregnancy but the uterus and the life of a woman, so I do not like to embark on a pregnancy, especially on an assisted pregnancy with fibroids much bigger than 4 centimetres.

Do go through the uterine wall sometimes when you do oocyte retrieval?

Not intentionally, I must admit. We have done it in the past, but I don’t think it’s a good idea for many reasons. Sometimes we have very bad access to the ovaries, usually with pushing and jumping on somebody’s belly under the anaesthesia is doing the trick, and we don’t have to go through anything that we shouldn’t be doing. The answer is no, I try to avoid it. I prefer to be humble, apologize to my patient and say, I’m sorry there was no access to your ovary or to some of your follicles rather than going through the uterus and praying that I’m not going to puncture an important vessel and that this patient is not going to have huge complications. I think the more experienced we are, the less risk we take. For me, 1% risk is a huge risk because I do more than 100 egg collections every few weeks, so even 1 in 1000 complications when it comes to serious complications of functioning a significant vessel in the uterus is something that I wouldn’t like to take.

Abdominal egg collection was what I had with fibroids obstructing my ovaries. What is the benefit of embryo hatching, and would you recommend it for women who had just 2 eggs fertilized in a cycle?

The abdominal egg collection is something that I try to avoid, although I’ve done a lot of them in my early years, and that is for various reasons. I think it’s risky, I think it takes a long time, it involves a laparoscopy, it involves a general anaesthetic, not just sedation. I do not think it retrieves as many eggs as we would have liked because by doing the laparoscopic egg collection, all we see are the external follicles. A stimulated ovary also contains internal follicles, that we cannot see if we’re doing a laparoscopy, and we can only see by vaginal scanning. This is something I would not do, and I would probably try to avoid it.

Regarding embryo hatching, sometimes the embryologists decide to do assisted hatching. Most of them, including our units, do mechanical hatching, I’m not sure of the indications every single time. My embryologists are the ones who decide when it’s best to do the hatching or not. That’s why hatching, including some other lab techniques such as ICSI, EmbryoGlue, time-lapse, is something that I leave up to my embryologist to decide. From the patient’s perspective, there’s no extra charge for that because my embryologists have had the duty to perform as much or as little intervention in the lab to provide us with the best quality embryos.

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Authors
Elias Tsakos, FRCOG

Elias Tsakos, FRCOG

Dr Elias Tsakos, FRCOG, is a Medical Director of Embryoclinic - Assisted Reproduction Clinic in Thessaloniki, Greece. He has received extensive and certified training in the United Kingdom and is a Fellow of the Royal College of Obstetrics & Gynaecology. Dr Tsakos is also a Board Member Representative of the Royal College for Greece and Cyprus and a Board Member of the Hellenic Society of Assisted Reproduction. He is a Member of the British, European and American Fertility Societies (BFS, ESHRE, ASRM). Dr Tsakos has been living and working in Thessaloniki, Greece, since 1999.
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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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