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Fertility Journeys

Understanding the IVF Process To Achieve Higher Success Rates With IVF cycles

Oregon Reproductive Medicine have selected a couple for its Fertility Journey – a donor egg IVF cycle with an ORM donor. While this is ongoing we share some of the elements that contribute to achieving consistently high success rates in IVF cycles.

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Oregon Reproductive Medicine

Oregon Reproductive Medicine have selected a couple for its Fertility Journey – a donor egg IVF cycle with an ORM donor. While this is ongoing we share some of the elements that contribute to achieving consistently high success rates in IVF cycles.

Founded in 1989 with the goal of building the best fertility programme possible, ORM is recognised globally for its consistently high live birth success rates, individualised care, and innovative leadership. This goal and the drive to help patients be successful with their first cycle permeates every facet of the IVF process and customised patient care at ORM. It led ORM, in 1999, to utilise the expertise of Intel clean room facility engineers, to develop its pioneering embryology laboratory clean room, one of the first in the world. More recently, it has been behind ORM’s commitment to making industry-leading genetic screening and testing available to its patients.

ACHIEVING CONSISTENTLY HIGH SUCCESS RATES
By its nature, IVF is an immensely complex procedure. Every patient and cycle is inherently unique. For patients to better understand the factors that contribute to a successful IVF cycle it’s helpful to divide the IVF cycle into four stages, each of which providers need to optimise to give the patient the best chance of success on the first attempt. These are: optimising the quality of the eggs; the embryology lab; selecting normal embryos; and optimising the transfer. Each of these stages of course has multiple critical components and no one single step or stage in an IVF cycle is the silver bullet for success. Success is driven by the cumulative impact of getting each component and stage in the IVF process right for each patient so that the potential for success is optimised.

Using the IVF PROCESS To OPTIMISE EGG QUALITY

The number and quality of a woman’s eggs is a key factor in the IVF process. Thorough pre-cycle screening involving ‘ovarian reserve testing’ is essential to count the approximate number of a woman’s eggs, as well as testing to understand how her body responds to the stimulation medications that will be used in the IVF cycle.

As every woman’s body has a unique response during each cycle to the stimulation medications, customising the treatment protocols and carefully monitoring the development of her follicles up to the egg retrieval procedure helps optimise this first stage. In cycles involving donor eggs an additional important element is the screening and selection of young donors for optimal health and fertility.

EMBRYOLOGY LABORATORY
An embryo developing within a woman’s uterus is protected from potential stresses and hazards from the outside world by the body surrounding it, but embryos developing in a laboratory do not have this natural protection. Providing a laboratory environment that is as stress-free as possible for embryos to develop in is a key factor in success. Air quality is critical to this stress-free environment. Harmful substances in the air – in particular volatile organic compounds (VOCs) – can leach into the culture media that the embryos grow within and damage them. Achieving optimum air quality begins with the basic construction of the laboratory and the materials chosen and then filtering and sterilising the incoming air before it reaches the lab. The quality and purity of the media and lab-ware that the embryos come into contact with also play a vital part in the art of successfully growing embryos.

Simulating the conditions inside the body as closely as possible is the goal of the IVF lab. Keeping embryos at a constant temperature and pH is critical. The equipment in the lab maintains that stability 24/7, 365 days per year. Also the quality of the staff and procedures – speed, accuracy and consistency – are key elements to a successful IVF laboratory.

ORM’s embryology lab was custom-designed and purpose built with all of these considerations in mind. The clean Portland air combined with state of the art clean room filtration technology helps to maintain consistently high pregnancy rates.

SELECTING NORMAL EMBRYOS
In every IVF cycle embryos are first examined under the microscope in order to select the best looking ones.

In addition to this visual inspection of the embryos, it is possible to count the number of chromosomes in each embryo. Chromosomes are packages of genes, or DNA, which are present in every cell of a person. Normally, there are 46 chromosomes (23 pairs) in each cell.

Embryos with the correct number of chromosomes have the best potential for implanting and resulting in a successful pregnancy. The formation of abnormal embryos (possessing extra or missing chromosomes) is a natural phenomenon (around 25%of embryos from a young woman’s eggs will be naturally abnormal) and is the most common cause of failed implantation and miscarriage. This is also the only type of problem that becomes more common as women get older.

Comprehensive Chromosome Screening (CCS) is the term for this type of testing. This process involves the removal of five to 10 cells from a day five or six blastocyst stage embryo. The cells are removed from an area on the embryo that develops into the placenta. The biopsied cells are tested in the genetics laboratory using advanced technology to determine the number of chromosomes that are present. CCS using Next Generation Sequencing technology is the most advanced form of this screening and is used by ORM’s in-house genetics laboratory. Transferring only embryos with the correct number of chromosomes can often improve the chances of a successful pregnancy and also decrease the chance of a baby being born with a disorder linked to a chromosome abnormality. At ORM about 80%of IVF patients now choose CCS as part of their cycle. Where a patient-specific genetic or chromosomal disorder is of concern, then Pre-Implantation Genetic Diagnosis (PGD), which involves the customised testing of embryos for a specific disorder, may be appropriate.

OPTIMISING THE IVF PROCESS TRANSFER

The optimal preparation of the recipient’s uterus for the embryo transfer is vital, as is the actual transfer of the embryo itself. The medication and monitoring protocol is important to ensure that the recipient’s uterine lining is optimal. The placement of the embryo(s) is carried out under ultrasound guidance to find the correct place in the uterus. A very soft catheter is used to transfer the embryo(s) to cause as little trauma to the uterus as possible. Keeping the uterus calm is the goal of each embryo transfer procedure to minimise uterine contractions that may disrupt implantation which happens after the transfer. Also at ORM we have an in-house acupuncture team for patients who wish to incorporate pre- and post- transfer acupuncture into their treatment. Studies show that specifically designed acupuncture treatments can increase blood flow to the uterus which may be beneficial to implantation. Acupuncture is also used to aid overall relaxation to minimise stress on transfer day.

OREGON REPRODUCTIVE MEDICINE
ORM’s global practice is led by Dr John Hesla and Dr Brandon Bankowski, who have helped patients from over 40 countries create their families. Both completed their training at Johns Hopkins Hospital – ranked no.1 in US reproductive medicine for 20 years – and are recognised internationally for their professional excellence and commitment to improving their patients’ reproductive care.

Dr Hesla joined ORM in 1999 when he co-founded its IVF programme. He was instrumental in building ORM’s pioneering embryology laboratory clean room, one of the first in the world. Dr Hesla continues daily to push that high level of innovation and excellence in our exceptional IVF laboratory. Dr Bankowski joined ORM in 2005 and he co-founded its industry-leading in-house genomics programme. He strives to help patients achieve the best success while caring for the genetic health of their family through increased awareness, screening and the utilisaton of cutting-edge genetic and chromosomal testing.

ORM moved into its new state-of-the-art Fertility Center located in vibrant downtown Portland in autumn 2015. It is home to our 100-strong ORM family of doctors, nurses, embryologists, genetic counsellors, psychologists, patient co-ordinators, donor co-ordinators and financial co-ordinators, among others. This world-class facility comprises 25,000 square feet and four floors of patient care facilities. ORM’s Fertility Center houses its embryology and genetics laboratories, and has brought together under one roof all of our fertility services and treatments, including IVF, egg donation, surrogacy, advanced genetic screening, as well as comprehensive fertility counselling, acupuncture, community education and proactive fertility care.

ORM’s new Fertility Center builds on its commitment to achieve the highest success rates while providing a customised, compassionate patient experience which has made it one of the most sought-after fertility centres in the world.

We look forward to welcoming you to ORM in Portland and to help you build your family! For more information visit https://www.facebook.com/OregonReproductiveMedicineUK

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Fertility Journeys

Free IVF Treatment With Gennet City Fertility Clinic

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Gennet City Fertility

At Gennet City Fertility we offer you bespoke fertility treatment using an individualised approach and cutting-edge technologies.

Our promise to you is that we will look thoroughly into your fertility difficulties; that we will use state of the art treatment protocols and technologies, and when appropriate, we will also ‘think outside the box’.

The members of the team at GENNET City Fertility were carefully chosen on the basis of their achievements while working in reputable units in London and overseas. Within our team, we share extensive experience of and vast knowledge in fertility medicine, assisted reproduction and the management of early pregnancy. Using this knowledge and experience we endeavour to provide you with the most expert advice and to guide you through a fertility journey that is caring, safe, professional and transparent.

At our clinic, we offer a number of fertility treatments:

  • Ovulation induction
  • IUI
  • IVF
  • ICSI
  • PICSI – IMSI
  • Egg donation
  • Sperm donation
  • Embryo donation
  • Surrogacy

We also offer many other services:

  • Joint, female or male fertility assessment
  • Egg freezing
  • Sperm freezing
  • Preimplantation genetic diagnosis
  • Preimplantation genetic screening
  • Urology and Andrology
  • Surgical sperm retrieval
  • Counselling
  • Psychosexual advice
  • Acupuncture
  • Nutritionist consultation
  • Support groups and support programs.

We are a proud partner of Access Fertility which is the largest provider of IVF Refund & Multi-Cycle Programmes and Fertility Finance in the UK.

Ramesan Navaratnarajah

WHAT ARE WE OFFERING TO FERTILITY ROAD READERS?

A FREE IVF TREATMENT DRAW & 50 FREE INITIAL CONSULTATIONS

We are offering a free fertility treatment (IVF/ICSI) including the medication to one lucky couple. In addition to this, we will select 50 couples for a free initial consultation with one of our fertility specialists worth £200.

TO APPLY

To enter the draw for the incredible free round of IVF/ICSI or a chance to have one of the 50 fully funded consultation appointments, please read the terms and conditions below and follow the link to the form to submit your application.

TERMS AND CONDITIONS

The fertility treatment prize includes initial consultation, pre-treatment tests (Antral follicle count scan, AMH blood test, semen assessment etc.), 1 cycle of IVF treatment, plus ICSI if required.

  • All medication
  • Medical and nursing appointments and care
  • All in-treatment laboratory tests and procedures
  • Monitoring and scanning costs
  • Egg Collection
  • Embryo transfer
  • Pregnancy serum test
  • Pregnancy ultrasound scan
  • Follow up consultation (if taken within three months of treatment completion)
  • Counselling
  • The prize does not include:
  • Cost of freezing embryos plus the storage of embryos.
  • Surgical sperm retrieval
  • Empirical treatments

This prize does not include any costs of having donor treatment. If the prize winner needs donor eggs or sperm we would deduct the costs of the above and the recipient would need to pay the additional costs.

The value of this prize is in excess of £6000.

This prize could not be used against surrogacy treatment.

THE ACTUAL PROCESS

We will contact the winner and aim to get them a consultation to start treatment as soon as possible, depending on their cycle.

Any offer of treatment is subject to the relevant Welfare of the Child checks. Patients would also need to have a BMI of less than 35 to undergo treatment.

If the applicant has travelled to a Zika affected country they would be required to wait the length of the relevant quarantine period before treatment could commence.

FREE IVF CYCLE SELECTION CRITERIA

The successful applicants that will be shortlisted for the free IVF treatment prize must be under the age of 38 years old and with a BMI that is 19 to 35.

This offer doesn’t apply to existing Gennet City Fertility patients who are currently undergoing treatment.

50 FREE INITIAL CONSULTATIONS SELECTION CRITERIA

The successful applicants who will be shortlisted for the 50 free consultation appointments must be under the age 50. The appointments will be offered according to the clinic’s availability.

This offer doesn’t apply to existing Gennet City Fertility patients who are currently undergoing treatment

The successful couple that will receive the free IVF cycle will not be included in the 50 free consultations draw.

TO APPLY PLEASE CLICK HERE

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Egg Donation

IVF Spain Update Us on Claire & David and Laura & Ian Progress

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Claire & David IVF Spain

During the first week of August, Claire (42) and David (35), the winners of this year’s Fertility Journey, visited our clinic for their first embryo transfer.

They were pleased to share with us the emotion and joy created by their short stay in Spain.

“We have spent some time in Alicante ahead of the transfer, relaxing in the area and preparing for our next visit to IVF Spain. Our experience with previous treatments with UK clinics has been very stressful but in Alicante, we have spent most of our time preparing for treatment by relaxing on the beach!”

Claire and David arrive at IVF Spain after having been trying to get pregnant for 7 long years and experienced 3 failed ICSI treatments with their own eggs. IVF Spain discovered that the quality of the embryos was poor and that they had always been transferred on day 3 of their development with a bad morphology. In order to increase their chances of getting pregnant, the clinic recommended an egg donation treatment – a fertility treatment which that greatly depends on matching the perfect donor to the patient.

To protect both patients and donors Spanish law requires that the donation process must be completely anonymous.  In addition, donors must be in good condition and younger than 35. Moreover, both donor and patient must share a phenotypical resemblance: hair colour, BMI, eye colour, and so on.

Dr Herea

Claire and David were grateful that so many women in Spain were willing to donate their own eggs, enabling others less fortunate, the chance of forming a family.

“We are really grateful that there are people willing to donate eggs. If we are being honest, it has taken a while for us to understand the Spanish anonymity rules for egg donors, but we have taken the time to consider this. It’s hard not having control or letting another person being in charge for something related to your baby. However, we even think now it is better that way, because the more you know, the more you want to know and we do prefer knowing nothing and leaving it in the clinic’s hands.”

There are other factors, however, that are crucial to achieving a successful pregnancy: the quality of the embryo and the microenvironment of the endometrial lining. This means that a successful pregnancy also depends on the successful communication between the embryo and the endometrial lining.

When we discovered that Claire didn’t have a single positive pregnancy test, we suggested to perform an endometrial biopsy to analyse the retrieved sample by means of the ER Map® test (Endometrial Receptivity Map) and accurately determine the receptivity of Claire’s endometrium during the window of implantation (the moment when the endometrial lining is receptive).

”The test results showed that Claire’s endometrium was post-receptive, meaning that a transfer performed on day 5.5 of progesterone (like in 70% of cases) would not end up in a successful pregnancy” explains Dr Natalia Szlarb.

“Before coming to IVF Spain, we had never heard of an endometrial study or ER Map. The fact that the endometrial study analyses the best time to transfer the embryo could make a big difference to our treatment. We were really impressed with the accuracy of the test. Our ER Map test result was post-receptive and although this was initially a concern, we later came around to the view that knowing the best time to transfer the embryo would increase the chances of success, and this might have been the reason our other treatments in the UK had failed” – Claire and David.

There are other key factors, however, to achieve a pregnancy such as the male factor. David suffers from teratospermia which implies that 96% of the ejaculate sperm cells have an abnormal morphology. Luckily, we were able to improve David’s sperm quality and fertilize the retrieved eggs.

We now wish them the best of luck!

Although it will not be until mid-September when Laura (41) and Ian (44), the 2018 runners-up visit us in Alicante for their embryo transfer, they already talked about the differences between IVF Spain and former clinics. They were impressed at how extensively their case had been studied by our fertility specialists.

“I think the longer you have treatment the more difficult it becomes. When you begin there’s a naivety along the lines of, ‘we’ll have one, maybe two goes at IVF and have a baby in our arms’. After 7 treatments (and lots of add-ons) the feelings completely change. You feel terrified that it won’t work, and you’ll never become parents. You’re scared it will work and you’ll lose the baby again (Laura and Ian have experienced 5 losses). You’re scared of physically going through the treatment as you’ve had so much. Each test and treatment creates fear – fear that it will hurt, be traumatizing, that it will give you more bad news. Then there’s the impact on your own mental health and emotional well-being. Can I handle this? What if the results say something’s wrong with me? Will I blame myself? It starts to really damage your mental health and well-being. Financially you start to feel that you’re risking everything, and it may not pay off.

For us we have renewed hope with IVF Spain. We have undergone tests that we’ve never had before (ERA, NK biopsy and KIR). We have paid for lots of very expensive blood tests and drugs but never received this kind of analysis. So, we feel as though the treatment is now specifically for us.

This creates more positivity, a feeling of being cared for and that maybe, just maybe, we’ll get to be parents.

Plus, we’re now using donor eggs. The hope starts to soar and with that comes excitement. Hope is the only thing that keeps you going and overcoming the fears I mentioned. This opportunity with IVF Spain has given us hope that we thought we’d lost.”

Laura is 41 years old and has already been through traumatic losses including an ectopic pregnancy. Due to this and to the fact that Laura suffers from recurrent miscarriage, our medical team at IVF Spain recommended an egg donation treatment to increase their chances.

The couple is thankful for the egg donation process being anonymous, as otherwise it would be really difficult to find a donor:

“For us, it’s taken some of the pressure away. I can’t imagine how difficult it would be to choose a donor ourselves. But putting your complete trust into someone else’s hands is hard.

We’ve explored whether it would be better for our future child to know the donor. I think that’s something we’ll never know. But we hope that he/she will understand our decision to choose an anonymous donor. It would be good to know a little more about the heritage of the donor but then we also know that we often don’t even know our own heritage. We’ll make sure Spain is a key part of their story.

It’s also really odd to not know who this person is. What they look like and personality. What’s motivating them to help us. One of the things I’ve been really consumed with is the gratitude you have for this person. I’d like to thank them but can’t.

Anonymity means we have a chance to become parents. Without it there’d be a shortage of donors like there is in the UK. For us, this makes it a wonderful gift – a chance to hopefully find a donor that is perfectly matched to us genetically (due to the KIR tests) as well as in physical looks.

I can’t stop thinking about what our future child will look like – but I think that’s quite normal” says Laura.

Immunologically speaking, finding a matching donor for Laura is certainly a challenging task, which is why IVF Spain suggested that we find out her KIR via a blood test. Ian was also tested for his HLA-C in order to determine whether the maternal – foetal interaction will be optimal or not.

Thanks to the KIR-HLA-C genotyping test it is possible to determine if the uterine KIR and the embryonic HLA-C will both be compatible. If so, the pregnancy will carry on successfully; if not, then the most probable outcome will be an unviable pregnancy and subsequent miscarriage.

“We carried out the KIR-HLA-C genotyping and concluded that the patient had a KIR AA. It is known that KIR expressed by the natural killer cells present in the maternal part and the HLA presented by the trophoblastic cells together will influence the outcome of the pregnancy. With Laura’s KIR AA variant, the sperm would have to be HLA C1 C1 and the HLA of the donor should be as well HLA C1 C1; as her husband has a HLA C1 C2 variant, we will treat her with a medication that reduces her immune-genetic reaction. We believe that not paying attention to this issue in the past is what may have caused the implantation to fail” suspects fertility specialist Dr Isabel Herrera.

We tend to recommend a single embryo transfer, as it has been proven that on patients with an immunological profile such as Laura’s, double embryo transfers would increase the immunogenetic reaction, hindering the achievement of a pregnancy” says Dr. Herrera.

It is also known that these cases tend to have a higher risk of pre-eclampsia, late spontaneous abortion or miscarriage.

Until their transfer day the couple will try to enjoy summer just as any other couple would;

“I’ve tried to just carry on as normal. Remain healthy, take pre-conception vitamins. Reach out and get support through the Donor Conception Network in the UK and connect with other people going down the DE route via online forums. It’s quite isolating and scary so it’s important to reach out and not feel so alone.

I’m trying to relax a little – not so easy with work but it’s a work in progress. I need to get that bit sorted now treatment is on the horizon.”

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Fertility Journeys

Laura & Ian Fertility Journey Couple 2018

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Laura and Ian IVF Spain

Laura and Ian are this year’s Fertility Road Magazine Runner-ups with IVF Spain. During their initial consultation with our specialist Dr. Herrera they were able to clarify all their doubts and were provided with a level of patient care, they had never experienced before throughout their 7-year-long journey. It was a completely different experience for Ian as well; this time he felt like a human being rather than a number.

You can find out more about their fertility journey here.

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