By fertility experts from Spain.
This time the speaker is Elisabeth Telega, International Patient Coordinator at IVF Media. For the past 2 years, she has exchanged over 15 000 emails, calls and chats with IVF patients. In this webinar she talks about common mistakes and traps that IVF beginners tend to fall into. You will learn about “red flags” and will know why you can feel dismissed by the clinic at times.
The IVF treatment is a journey and as with all journeys – it requires a lot of forward planning. At the beginning of her presentation, Elisabeth Telega advises patients what to focus on before they start looking for the treatment abroad. There are a few questions to ask oneself – the first is based around our particular situation. We have to take into account our age, marital status (if we are single or married) as well as the way we want to proceed with IVF – if we want to do it as a single mum, a mum with a male partner or a mum with a female partner. We should then relate our situation to the legislation in different IVF destinations. In Europe, there are about 40 countries and each of them has slightly different regulations regarding IVF treatment. For example, in some destinations, it is still not allowed to use donor eggs or to undergo the treatment with a same-sex partner. According to Elisabeth, knowing your status can help to narrow down your search and help you choose the most suitable country and – as a result – the most suitable IVF clinic.
The differences in legislation may not be vast, but they’re significant for sure. For example, Czech Republic and Poland accept only heterosexual couples, while in Ukraine, Latvia and Greece single women are allowed to undergo IVF treatment as well. This regulation opens the door to female same-sex couples wanting to become parents – providing, of course, that one of the women would be ok with not having legal rights to the child. Spain, on the other hand, allows both hetero and homosexual partners to have IVF. However, there are still some limitations there, such as the prohibition of both surrogacy and the shipment of semen from the UK in egg donation programmes.
Another important aspect in terms of IVF law is the patient’s age. We have to be aware that the cut off age for fertility treatment is different in different locations. According to Elisabeth, patients should realise it and by no means feel offended by it. One should not perceive age limitations as an indication for not having IVF treatment at all – but as a signpost to more conscious choice-making. For example, in Greece, the legislation supports women up to the age of 50 and in Spain – up to 50 years + 364 days. What it really means is that the woman cannot be older than 51 years old on the day of the embryo transfer. In the Czech Republic, the cut off age is 48 + 364 days (meaning that, in fact, a patient cannot be older than 49). Ukraine, Latvia and North Cyprus are the most liberal in this aspect as they allow women up to the age of 55 (however, the final decision is always based on the medical evaluation). Poland, on the other hand, has no age limit indicated by the law – however, the decision if a patient is allowed to undergo IVF treatment or not is determined by her medical condition and the ability to carry the pregnancy to term. Elisabeth reminds us that age limit can be set by law, guidelines from internal bodies (like a committee of ethics) or individual clinic rules – and that’s why it can be different for different IVF units even in the very same country.
In Elisabeth’s opinion, establishing one’s own legal status is as important as describing one’s own needs and this may even be a greater challenge. It often happens that people who struggle to become parents do not realise where the cause of their infertility comes from. According to Elisabeth, the first and most crucial step should be the consultation with the fertility doctor and doing the basic tests. If there are no problems with hormones, thyroid, etc. and the scans do not show any irregularities, you should proceed with checking yourself for natural fertility predictors, such as AMH (anti-Müllerian hormone) and AFC (antral follicle count). This information is necessary for a doctor to determine what to do next and how to plan the individual treatment.
Poor AMH and AFC results are generally an indication for egg donation. However, patients are often reluctant to choose this route because of various reasons, such as religious beliefs or some inner conviction that they should give themselves one more chance. Elisabeth admits that most good IVF clinics would agree on starting the treatment with own eggs IVF – but it is their obligation to always inform the patient what her real chances of success are.
Doctors should also prepare patients for all the consequences that IVF treatment entails. It is in their hands to make you aware of all possible risks, additional costs or responsibilities – such as, for example, whether to undergo the genetic testing or not what to do with extra embryos in case you get pregnant in the first round. Additionally, when you’re choosing an IVF clinic abroad, you have to take other issues into account – such as what if there is an age limit that excludes you from the treatment or what if the most common phenotype among donors is not the one you opt for. Those are surely the things to consider already at the very beginning of your IVF road.
What IVF patients want is one thing – but what they really need is sometimes completely different. Elisabeth says that this is especially true for – the so-called – ‘IVF veterans’. These are the people who already experienced several own eggs IVF rounds with unsuccessful results and despite all those repeated failures, they still did not allow themselves to consider egg donation. What Elisabeth suggests to do in such cases is to give oneself time. If you know there is already a problem with your eggs quality, time will not change much. Book yourself another round of treatment in 6-12 month’s time – your body will get a chance to recover and your mind will have the opportunity to re-consider all the possible options. Afterwards, it may be much easier for you to decide in which direction you want to proceed with your treatment.
Egg donation is definitely surely a difficult decision to make for every patient – partly because there are so many questions surrounding this process. Probably the most important one relates to choosing the most suitable donor and deciding how much you need to know about this person.
In Spain, the most popular European IVF destination, egg donation is strictly anonymous. Patients will never learn the donor’s ID – however, it is still possible for them to know her eyes and hair colour, height, weight, age and a blood group. Good clinics always select the donor on the basis of phenotypic compatibility with the recipient – this assures that both women will look almost like twin sisters.
There are countries in Europe where patients get access to more detailed information about donors such as their hobbies or the level of education for example. This is true for Greece, Poland, Latvia, Ukraine and North Cyprus. Additionally, there is a possibility of matching the donor according to the blood group of a patient or her partner – this is particularly important in case of potential blood or organ donation necessity in the future.
Elisabeth also mentions open ID donors. These are the ones who are willing to release their identities to offspring when the latter are over the age of 18. However, choosing this option does not guarantee that the donor will be willing to contact your child in 19- 20 years’ time. You have to bear in mind that it is a very long time and many things can change – in a donor’s life as well. That’s why – for people who prefer non-anonymous donation – ‘own’ donor sounds like a perfect solution. Choosing a relative or a friend as your trusted egg donor seems to be simple and reasonable. Unfortunately, it is not allowed in all IVF destinations. In fact, nowadays only Ukraine and North Cyprus have this option on offer. Nowadays, it is more common for IVF clinics to provide patients with donor’s picture – either as an adult or a baby. Still, you are not able to take the picture home or sent it over – it is accessible only at the clinic.
Further into her presentation, Elisabeth focuses on the search for the right phenotype. Or – to be precise – other phenotypes than Caucasian/White which is clearly the most popular one. But even within this type of phenotype (which is often referred to as ‘European’ as well) there are different subgroups, such as Slavic, Hispanic and Scandinavian. Generally, the rule is as follows: if you want a donor of a specific phenotype, go to the clinic in this particular location. So, for example, if you’re interested in Scandinavian phenotype, go to Scandinavia. Elisabeth also highlights that in the countries where there is a less diversified donor pool, some rare phenotypes (that are also harder to find) may be additionally charged for. Then Elisabeth lists the phenotypes that are rather uncommon in Europe and gives the names of countries they can be most often found: South Pacific Asian (Spain, North Cyprus, Ukraine and Greece), African Black and Caribbean (Spain, North Cyprus, Barbados), Middle Eastern (North Cyprus). Donors of the so-called mixed-race heritage are most common in Spain and North Cyprus.
Having said all that, Elisabeth proceeds to probably the most important questions IVF patients ask themselves – how to choose the clinic? There are a lot of factors to pay attention to but Elisabeth admits that success rates are not one of them. In fact, it is very difficult to determine the basis on which success rates are calculated by clinics and thus, it’s impossible to make comparisons based on them.
What really counts here is the clinic’s experience in conducting IVF treatment, the number of specialists (doctors, embryologists, midwives, etc.) and the medical team’s expertise. A great indicator of the clinic’s service quality is their approach towards patients. An online consultation with a doctor may be a good way to test that – as well as to eliminate the stress of “unknown”. additionally, Elisabeth stresses the importance of one’s own intuition. The so-called ‘gut feeling’ about people or places rarely misleads us and we should never underestimate it. Other factors that are of equal importance in the decision-making process are logistics (is the clinic easy to get to) and preferences (whether the clinic should be big or small, where it should be located, etc.).
What is the best piece of advice Elisabeth would give to patients searching for best IVF clinic?
Take time off and stop thinking about IVF! Surprisingly as it may seem, taking your mind off the IVF-related issues may have a calming – and healing! – effect. When you let your body and mind rest, the decisions are not so stressful and overwhelming afterwards.
What clinics usually suggest to do is to go with a fresh cycle first. Usually, when you proceed with egg donation (either with your partner’s sperm or donor sperm), the quality of embryos is good and you get 2 embryos on average. Of course, then it is more difficult to synchronise a donor and a recipient at the same time. If patients are coming to Spain from far away (e.g. Canada, the US or Australia), I suggest to consider a frozen cycle. And this is something you’ll know – the clinic will tell you if the cycle is fresh or frozen. They usually give the date of the egg retrieval, the number of eggs retrieved and then, after the transfer, how many embryos there are on day 3 and on day 5. So I can only tell you what is best for you when you come from far away and you have embryos to transfer. It is always easier to synchronise one person at a time. What I mean is that they get a donor, conduct the stimulation, get the embryos and freeze them. With a good clinic, you’ll loose only about 10-15% of embryos after the thawing process. Please remember that if embryos do not survive the thawing, they’ll probably not survive the hostile environment in your uterus either. And in the lab, there is always perfect ambience. Why does your doctor suggest Prague? To be honest, I am very puzzled about that. The Czech Republic is 10-million people country, it is 3-4 times smaller than Spain. I do not really know where this statement comes from.
You need to ask your clinic how they calculate success rates. Some clinics are very transparent and this is what we’re mainly focusing on from our point of view. You need to ask about success rates per embryo transfer. What I can say is that success rates can be better measured in egg donation programs – just because the age factor in case of a recipient is not so relevant as you are getting good quality eggs. If you think about own eggs treatment, then it is difficult to measure success rates. Because how can you do it? Every patient is different, they are at different age – generally between 25 and 45 years old. If you are up to 35, you still have a high percentage chance of getting pregnant with your own eggs. Then, over the age of 40-45, the quality of your eggs drops by half. This is confirmed by many studies – you can also get this knowledge from dr Natalia Szlarb’s webinars at eggdonationfriends.com . So always ask clinics what they mean by success rates they advertise – are these cumulative (meaning usually 3 attempts) rates or per embryo transfer. And please remember that sometimes it is advised to proceed with one embryo and sometimes with two embryos – and most of good clinics proceed with two embryos per transfer maximum. And yes, there are of course clinics that get higher success rates because they transfer more than two or three embryos at once… So please be careful with that.
First of all, I would suggest you to have a consultation with a doctor. Endometriosis can be sometimes treated or at least it can be checked how severe it is. When considering embryo donation or adoption – the budget is the most crucial here. In case of donation, embryos are created with the double donation from a female and a male donor. Adoption means there is an embryo already stored in the clinic. It is either donated or left over or given as an option to make somebody happy – and it costs less. In the Czech Republic, you do not have to be married to proceed with these treatments. You will be just signing the statement that you are in the relationship. And no matter if it is double donation or adoption (where you have no genetical link to a child), you’re still parents – you’re signing the documentation where you’re accepting these terms. How you decide about the clinic? This is the very same process like when you’re proceeding with IVF. There are three factors required: knowledge, gut feeling and what you’ll get to know from the doctor. Of course it would be best to meet the clinic’s team in person. As your case is a bit more complicated, it would be best for a doctor to see you in person to decide if you need a surgery or longer healing process. Maybe you need to wait longer or maybe it is something to proceed with right away? If you’re in the UK or within Europe, plan this trip – it’s a short one – as it is giving you most chances.
Yes, it is. You’ll be of course getting more information about donor’s eye and hair colour, hobbies, interests, etc. Most clinics will also share knowledge on a donor’s family medical history. However, neither you nor your child in the future will learn the donor’s ID at any point. I know there is a trend of checking your genetical link in one of the websites – you’re registering, you’re completing the information about your family history, you’re sending a sample of your saliva and they’re checking your background. This is of course more common in the US but I think that in a couple of years, it will be more and more common worldwide. In this way, even if your child is not be connected directly to their biological parent, they may be connected to the people related to the donor. So I think it is a matter of years and it will be possible to track down genetic information on everybody.
There are several factors. That’s why we want you to check yourself. First of all, you have to check your fertility status – when you have poor AMH or you are over 40-45 years old, the cause may be on your side. It means that you have poor quality or quantity of eggs. Additionally, there are other medical factors, like e.g. wrong implantation window. We also tend to forget that there are two in this equation: it’s both a female and a male factor. Sometimes it’s both of them and sometimes it’s none of them (meaning that there’s poor quality on both a woman’s and a man’s side). There are as many answers as there are people. I wish – and doctors wish as well – to have this answer because the worst case is when doctors simply do not know. Natural Killer cells or immunological problems can give you the answers but sometimes everything looks normal from both female and male perspective and yet – there is still no successful IVF or pregnancy. Unfortunately, I think there is no one simple answer to your question.
Clinics are doing their best and they’re following certain procedures related to sperm selection. But I do not know what you mean by ‘the best’. I can tell you what is important in case of outer sperm banks. This is a number of the certificates they have or their past history. Some of the banks are having a history – it means that they did some mess-up at some point in the past. Of course, it never happened again but it did happen at least once. So it is surely something to be checked. But from the clinics’ side? I wouldn’t be able to tell because they always follow certain rules. If there was something overlooked on the clinic’s part, it would mean they were gone from the market. They cannot allow such things to happen. And this is of course good for us.
If you are considering a semen donor, then I do not see any problem. Because morphology is 0%, it means there is no alive semen and there is no chance to proceed with your partner’s semen. However, if it is a medical condition – resulting from e.g. an injury – then it may require to be treated with some medication. So I would suggest to re-check all the tests with a doctor. I cannot give you medical advice as there are probably some other things a doctor would like to ask you about. I can only imagine that it is a case when the donor would be needed – for both of you.
First of all, you have to remember that no agreements could guarantee you that the donor would be ready to contact your offspring in 18-20 years’ time. Even if they say they will, many things can change in their lives in the future. Nowadays, open donation is allowed in Portugal – what I mean by ‘allowed’ is without the need to ‘bend the law’. There are clinics in Ukraine where you can have this option but there is an additional charge. Sometimes it is not very high – like e.g. 1000 Euro more – but it’s still ‘bending the law’ in a way. For example, they register a donor in a different country where open donation is an option. But as far as I know now, Portugal is the country where this option is within the existing law. Non-anonymous donation is also allowed in the UK. However, as I’ve heard recently, there are only 1.100 donors registered there. And because there are not so many donors, most of them are over 30 – while in the rest of Europe the cut-off age is 30 sharp. So apart from the price and waiting time – which is about 2 years in the UK – the donor’s age is another reason why it would be advised to proceed with your treatment somewhere else. Somewhere where the procedure is faster and the donors are simply younger.
Apart from all the tests that are usually prescribed prior to IVF with egg donation, you will be asked for a breast scan, a Pap smear and also to check your kidneys, heart and liver. You’d also need to find a GP who will be taking care of you during your pregnancy – meaning a doctor that would confirm you are fit to carry and deliver a child.
Yes, of course. You can contact us at: [email protected] . You can also visit eggdonationfriends.com , we’re there with WhatsApp contact information, you can also fill out the form there. Feel free to use our help!
I’m afraid I do not have enough information on that. I did not come upon any studies comparing those two methods. It would probably be the best to do the so-called ‘mystery client’ and ask another clinic about that – basing on your medical evaluation of course. See what they would suggest. Unless you have some medical condition that is an indication for this kind of testing, ask for a second or even a third opinion on that. I think NGS is the latest development but I cannot give you any publication as a referral for comparing those two. But if you wish to contact me on this later, I’ll may ask a few friendly doctors about it and get some insight into this subject.
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.
There is a thing called an ‘exclusive donor’. It means you pay more for the donor and the eggs of this donor are only for you. You can do more stimulations and have more embryos stored. But with this kind of guarantee, the semen quality has to meet the clinics’ standards, too. If it happens that the donor you paid for has more eggs than you need – because you got pregnant with the first time – you can come back for the remaining embryos later on. However, it does not mean that the quality of these embryos is guaranteed – unless you test it of course. If it is not ok, the clinic may see if the donor is still active. And then – unless you do the whole family planning from the beginning – they may stimulate the donor one or two more times (with extra charge of course) and produce more eggs or embryos for you.
If there are guarantee programs that offer either to get you pregnant or to give your money back, then I think it is an option. Definitely, there are guarantee programs for IVF with own eggs in Ukraine and Spain. However, I know that in Spain you’d have to visit the clinic personally so that the doctors could check you and your partner on the spot. They won’t make the decision on the basis of your medical file sent over from the clinic abroad. When it comes to Ukraine, I’d have to verify that. You can come back to me tomorrow and I will hopefully have the answer for you.
Fertilising fresh eggs is giving you more chances and there is 10-15% of a difference – not only in success rates but also in survival rates. If you go with the guarantee and there is a certain number of eggs that you get after thawing, the ones of poorer quality may not survive. It is surely to be checked with the clinic if they guarantee that the number of embryos will be similar. From what I know, good clinics suggest to proceed with a fresh cycle first and then follow up with a minimum of two frozen cycles. So it may be indicating that there are better chances with a fresh cycle. However, if you have any problems with getting the implantation window right or your lining needs more time to be prepared perfectly – meaning you need some more medication or more scanning and monitoring – then it’s good to proceed with a frozen cycle. It’s giving you more chances of the right implantation window and a successful pregnancy.
It’s a tricky question. Usually it is an agreement between clinics’ laboratories. They need to know how the embryos were frozen – it means that they have to act according to the right protocol on the other side, too. If there are two different clinics and different experts, things can go differently. So if you have an option to proceed with the shipment of embryos instead of eggs – try to do that. Embryos are stronger and more likely to survive than fragile eggs.
You need to check the contract you signed with your clinic. Of course it would be best to discuss the possible scenario prior to the whole procedure. If, on the clinic’s side, there were no doubts about the semen quality, the clinic has to take responsibility for what happened. They should generally give you a discount or another cycle that you are charged much less for. However, check the contract first and – if it’s possible – make sure all your arrangements and decisions are in a written form.
It is probably a question to the doctor. What I hear is that they usually regulate the cycle with a contraceptive pill. However, in case of PCOS it’s more complicated. There is something to be checked about your hormones and doctors may suggest you to undergo a mock cycle. It means that they would test how you respond to different medications and do the scanning. It is sometimes better to test different options and check what works better for you. Because of hormonal imbalance and irregular cycles, it will be very complicated to monitor you. But there are some pluses, too. Generally, patients with this condition generate more eggs and – as a result – more embryos. However, it is very individual and it is best to speak with a doctor directly. Discuss all your options and worries and what they would suggest to proceed with. It is also a good idea to have an online consultation – if you have your recent test results (at least 6 months old), you can contact us and we will definitely help you to get a different opinion from a different location. We won’t push you to choose only top clinics that may charge you some serious money – not at all. You can choose – the so-called – ‘economic’ versions and get to know their doctors, clinics and, first of all, if it is something you feel comfortable with.
There is a question of how you would like to proceed. If you’re proceeding with classic IVF (with your own eggs) and you mean the period from the egg retrieval till the embryo transfer, these are 3 weeks – and sometimes a month. After you start medication, a doctor will need to do scans and see how you respond to this medication, how the eggs are maturing, how many of them there are. Of course, there is also a trigger shot that you will be given up to 2 days prior to the egg retrieval. In fact, everything depends on how you react – in case the medication is not adjusted right or you respond to it in an unpredictable way, the transfer will be cancelled. It means that you would have to come back or wait another month for another cycle. But with the classic IVF, it’s the longest time you’d have to stay. However, you can also proceed in a different way. You’re getting your medication at home, you find the doctor or the clinic that would do the scans for you and you would of course update the clinic abroad on your progress. Then you would only have to travel for the egg retrieval. In such a case, if everything goes ok, the duration of your stay would only be 8 days.
If you’re proceeding with egg donation, the things can get complicated as well. If you want to do the synchronisation of both you and your donor, then your stay will take from 8 days to 2 weeks. Additionally, there is a risk – that most clinics won’t tell you about – of the wrong implantation window or no embryos to transfer. In both such cases, your cycle will be canceled. It means you would have to come back to the clinic once again later on. It is also something to be discussed with a doctor.
In case both of you cannot travel at the same time, I suggest that your partner travels to the clinic on his own and leaves the semen sample to be tested. Meanwhile, he can pick up the medication and bring it home and the donor can be stimulated so the doctors know how many eggs there are and they can fertilise them. Then, if the clinic is within Europe, you can go there to have your uterus lining and implantation window checked. They can prolong the cultivation of embryos and do the cycle. Of course, there is still an option of a frozen cycle. It is more safe if you’re travelling from far away and you cannot spend such a long time abroad. So as you see, there are many options to consider and it is just a matter of choosing the right one for you.
Yes, it is usually the agreement between clinics meaning that they have to fill up all the forms about how the eggs or embryos were frozen. There are certain steps they have to follow. They should not follow different procedures or protocols – on the basis of the information they received, you may assume that they would thaw the genetic material in a particular way. I believe that the courier company is also aware of that. Before you choose the clinic, I suggest you contact the courier company and learn if they cooperate with that clinic at all. If yes, then they should have some path to make the whole thing easier or simply be aware of this particular procedure.
This is also something to be discussed with a doctor. It is usually said to wait at least 2 cycles. It really depends if there was an implantation or not. It is really a very personal matter. You should talk to a doctor and simply ask him or her ‘why’.
No, I do not know which companies are more affordable. I do not compare them in terms of prices. I know which ones are reliable. This is also something I say to patients in terms of choosing a clinic. Sometimes you think you found a more affordable option and you’re happy that you will save – let’s say – 1000 Euros. But at the same time, you may lose 4000 Euros. This is because you chose poor quality and you do not give yourself a chance from the very beginning. And this is the same with courier companies – I would be careful and I’d always use the one that is reliable. By ‘reliable’ I mean the one with required certificates and no bad opinions or reviews running around. The verified one. It is also good to check this company with someone who’s already had some experience with this company.