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Fertility Journeys

IVF Spain update Fertility Road on the progress of Kathryn & Richard’s fertility journey

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Kathyn and Richards Fertility Journey

We’re excited to share with the readers of Fertility Road Magazine how the journey to parenthood is unfolding for our 2017 couple, Kathryn Hobbs and Richard Clement.

This adorable English couple came to our fertility clinic for their first visit and consultation on the 27th of May. They met with our medical director, Dr. Natalia Szlarb. After reviewing their medical history and finding out more about their struggle to conceive she has been able to create a personalised treatment plan for Kathryn and Richard’s needs.

The story behind their journey to becoming parents and starting a family is difficult and touching. Kathryn is a primary school teacher who has fallen pregnant naturally followed by two miscarriages before coming to us.

Kathryn wanted to become an egg donor in order to be able to help other couples with fertility problems to become parents. She underwent a series of obligatory tests for donors among which was a karyotype.

The karyotype revealed that Kathryn had a balanced translocation. For this reason, she was unable to be a possible donor, but she was also told that she would not be able to achieve and sustain a pregnancy by natural means with her own eggs even with the help of a ‘mere’ IVF. This information delivered a hard blow to this couple but it also helps to establish a true diagnosis about their case.

Then couple decide to undergo an Embryo banking treatment, which consists of several consecutive ovarian stimulations, egg retrievals and with PGS (Pre-implantation Genetic Screening) for embryos from each cycle. PGS screens the embryos for anomalies in the number of chromosomes (aneuploidy), which account for failure of the embryo before implanting and preventing early miscarriage or malformations at birth. The only aneuploidy that is compatible with life is Down syndrome (which is the manifestation of a trisomy – or three copies instead of the normal two – of chromosome 21). If no anomalies are found in an embryo, it is said that it is euploid.

In total Kathryn underwent 4 IVF cycles of the above-mentioned process. These generated a good number of eggs (37 in total), all of them were successfully fertilised and no male factor was found, despite only two genetically normal (euploid) embryos were obtained.

The embryos were individually transferred to Kathryn on two different occasions, both resulting initially in a pregnancy that would later become a miscarriage.

What is a karyotype?

Our genetic material (genes) are arranged in groups or bundles that we call chromosomes. We have two copies of each. They are coiled up in the nucleus of each of our cells. In summary, genes are arranged in chromosomes, which are arranged in pairs of identical copies in the nuclei of cells.

A karyotype (karyo is the Greek word for ‘nucleus’), is a test designed to determine the number of chromosomes in each cell nucleus (which should be 46 in 23 pairs: 1 pair that determines the sex of the individual – XX for women and XY for men; and 22 pairs of nonsexual or ‘somatic’ chromosomes); and whether there are any missing, extra or rearranged pieces of chromosomal material.

Alterations in the number of chromosomes or in their arrangement can cause different degrees of issues in the carrier.

In the case of Kathryn, the latter was the case, she had a rearrangement of chromosomal material, which is called ‘translocation’.

What does having a translocation imply?

Translocations can be unbalanced or balanced. When a piece of a chromosome detaches from its original location and attaches somewhere else in the set of chromosomes, we call it unbalanced translocation.

When two pieces of chromosomal material exchange positions we call it balanced translocation.

Even though balanced translocations do not usually imply disease for the carrier they can interfere in fertility since the carriers can produce gametes (eggs or sperm cells) with anomalies in their genetic material which are transmitted to any resulting embryos.

The importance of the karyotype in this case lies in the fact that before knowing the result and taking into account Kathryn’s age it was expected that at least 50% of the eggs she generated would be normal. But due to her balanced translocation, this percentage was in fact greatly reduced.

If further analysis would have been performed before continuing with the treatment, the medical team would have been able to establish another approach to their case and maybe Kathryn and Richard would not have had to go through such a costly and long unsuccessful treatment that took a toll on them both financially and emotionally.

Dr. Szlarb: ‘It’s such a pity since Kathryn had two euploid blastocysts, which normally translates into a 70% chance of achieving pregnancy; when as a specialist you see that after 1 or 2 attempts the patient does not become pregnant you must ask yourself the reason for this result and you must perform deeper analyses such as an immunology test, or deeper endometrial studies, which perhaps would have saved Kathryn going through so many IVF cycles’

Finally, and despite all the hardships, Kathryn and Richard haven’t stopped trying to become parents, so they decided to enter the initiative created by Fertility Road Magazine which awards a complete fertility treatment in a renowned assisted reproduction clinic. This is how they came to find IVF Spain, and thanks to our experience both in the most usual and most complex infertility cases we were able to offer Kathryn and Richard a solution to their problem.

Dr. Szlarb: ‘In England, after each Embryo banking, an embryo was transferred to Kathryn without performing any additional tests of endometrium. At IVF Spain, we take a different approach. We always try to obtain embryos of the maximum possible quality and viability.

Once this is achieved, we perform additional tests to the patient with the aim of finding out the endometrium (womb lining) potential and possible problems. These tests would be for example immunological tests or the endometrial receptivity array (I-MAP). This way we are able to ensure the highest possible implantation chance. It’s been a really hard journey for Kathryn and Richard as they deal with their fertility issues. After several IVF cycles and miscarriages the consequences for them have been both psychological and emotional.

For this reason, they came to us and chose the egg donation route to finally achieve their dreams of becoming parents.

EGG DONATION IN IVF SPAIN

In Spain, egg donation is anonymous and it is done for altruistic reasons, although the donors do receive a symbolic financial compensation to make up for any possible inconveniences caused by the process.

Moved by this wish to help others, and thanks to the openness in Spain towards egg donation, there are many women keen to donate; which contributes to there being a wide range of available phenotypes.

At IVF Spain we offer an excellent egg donation program that relies on an egg donor bank of more than 500 donors of different nationalities (European, Asian and Middle Eastern, etc.).

By law in Spain the egg donor must resemble the recipient (the patient) as much as possible. With the aim of bringing this resemblance to its highest possible point, IVF Spain developed highly specialised software that was created for our clinic exclusively that helps us find the most adequate set of possible donors for each patient. Previous to starting the donor’s stimulation we perform numerous medical examinations that include genetic and psychological tests, as established by the Spanish law.

We always try to go a step further to provide our patients the best service and attention.

For this our donor testing includes (among other studies):

Genetic testing (aka Screening Recombine) able to detect up to 213 monogenic diseases.
• Karyotyping, as explained previously.
• Personal and familiar antecedents to rule out risk of transmission of any hereditary diseases.
• Study of diseases: HIV, chlamydia, hepatitis, rubella, toxoplasmosis, cytomegalovirus or syphilis, among others.
•Psychological assessment Kathryn and Richard will come back in August for the embryo transfer.

In order for the embryo to be fresh at the time of the transfer, we will synchronise the stimulations of the donor’s ovaries and Kathryn’s endometrium (womb lining).

By the time the donor stimulation must start we will have found a donor that holds the maximum phenotypic compatibility with both members of the couple.

Kathryn and Richard’s dream of creating their very own family is within reach, and at IVF Spain we will do everything in our power to make it come true.

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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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