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.
You may be interested in reading: Egg donation cost in UK
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?
- Questions and Answers
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.