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FERTILITY JOURNEYS

Oregon Reproductive Medicine Introduce Their Couple Heather and Brandon

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Heather And Brandon Smiling

The team at Oregon Reproductive Medicine has selected a couple to be part of our unique Fertility Journeys project. We are delighted to introduce Heather and Brandon, who after a nine-year journey with many setbacks and repeated unsuccessful attempts are embarking on their donor egg IVF treatment with genomic screening at ORM.

Heather writes…
Not all journeys are easy. We will admit that our road has been challenging. For many, having a child is trouble-free. In our case, having a child has been one of our most difficult challenges and a long journey with many disappointments – 2 previous fertility specialists, 7 IUI procedures, 2 IVF procedures, 4 surgeries and countless medical bills.

These types of struggles can either make or break you. We’re thankful that this journey has made us stronger and determined not to give-up.

Our journey began nine years ago. Brandon and I met and fell in love. We married in 2008 when I was 31. We saved-up and after a few years bought our home, filled with the hope of starting and raising our family there. We tried ourselves for some 3 ½ years to get pregnant but nothing worked.

By the time I was 35 we decided it was time to seek medical help. My first fertility specialist recommended that we try IUI. We tried at least 3 IUI procedures. None of these worked. We decided to change fertility specialists right before I turned 37.

During this transition timetime, I experienced an umbilical hernia. In connection with treating this, my second fertility specialist diagnosed me with Stage 4 (severe) endometriosis. My first fertility specialist had not diagnosed my condition correctly, despite my describing the painful menstrual cramps that I experienced and the significant difficulty my husband and I were having trying to conceive a child.

I underwent two surgeries, a laparoscopic surgery to unclog one of my fallopian tubes and a hysteroscopy to remove some of my endometriosis. Following this, we tried a further 4 IUI procedures. None of these were successful and by now I was 38 years old.

Heather And Brandon Sunny

As this stage, our second fertility specialist told us that we needed to strongly consider IVF to build our family. To be quite frank, this process, at the time, was simply embarrassing. I was overwhelmed with how something that was so simple for my family and friends had become the most complicated journey of my life.

Many friends and family told us to have hope and to keep trying. While these suggestions came from a place of love, they left me feeling like a failure, like a woman who wasn’t in control of her own body.

In the midst of our struggle to conceive, both of my parents were fighting with separate bouts of cancer – thankfully they are both now in remission. When you see people that you love fighting for their lives, you either live in fear or step out on faith. As a result, we decided that we would make it our mission to have an IVF procedure no matter the cost or the time it would take to get there.

I spent a year researching grants and funding support for IVF treatment. It was hard to share the intimate details of our journey in numerous grant applications and I was grateful that Brandon was up being on this journey with me. Unfortunately, my endometriosis meant that many programs would not help us.

I also worked to successfully convince my employer, a large university, to provide fertility care as part of our health insurance coverage. The work convincing my employer also got me involved with others who were seeking to get similar fertility coverage through their employers’ healthcare plans. Together we’ve shared our data with RESOLVE (The US National Fertility Association) for RESOLVE’s Coverage at Work Program so that others can benefit from our efforts and ask their employers to cover fertility care.

At last, after many, many grant applications, we received some help and by working odd jobs and saving we had enough financial resources to try IVF. By July 2016 we were ready. I was 39.

We underwent an IVF procedure with ICSI fertilisation and we transferred 2, day-3 embryos. Neither developed into a pregnancy. My specialist reassured me that she thought a second try would be beneficial so we shouldn’t lose hope.
We were lucky to receive some additional financial assistance and in December 2016 we had a second IVF procedure, this time with standard fertilisation. I was 40. This cycle just felt good. I had my egg retrieval the day before my mother’s birthday and the transfer the day after my father’s birthday. My fertility specialist was able to do the transfer with my favoritefavourite nurse and my pregnancy results were scheduled for Brandon’s birthday, two weeks later.

3 eggs were fertilised on the first day. They were all in great condition on day-3 when we transferred 3 embryos. Unfortunately, on Brandon’s birthday we got a voicemail message that we were not pregnant. I cried for days. I had difficulty speaking. I was mentally and emotionally exhausted. I felt that I was a failure and that I would never laugh or smile again.

My fertility specialist called me and said, “You are going to be a mother, but we need to explore other options.” She talked about surrogacy.

She talked about adoption. She talked about donor eggs. Every option that she mentioned was way beyond what we could afford. I decided to reapply for 3 other IVF grants. Everyone was a “No” because of my endometriosis.

Today, we live in faith and not hope that our growing family is right around the corner. We are optimistic and grateful that we will be working with the amazing and dedicated people at ORM and Fertility Road. But I’m also focused on what I can do to give myself and my husband the best chance of success. I have been working with a consultant to put my body in the best position possible. I believe the plan is working.

I have gone from at least 20 or so blood clots during my cycle due to my endometriosis to now only seeing two or so clots each cycle! I am taking supplements, an infertility smoothie and herbs daily to support and improve my health as well as combat the challenges that come from being diagnosed with endometriosis. I have eliminated many harmful foods from my diet (caffeine, alcohol, sugar, non-organic dairy, soda, low fat diet foods, processed foods, trans or damaged fats, GMO foods) and work out 20 minutes 5 days out of the week. I am committed to having a healthy body for a healthy baby.

Despite our long journey to date, we’re optimistic that with the help of donor eggs the third time with IVF will be the charm. We are looking forward to sharing the next chapter in our fertility journey and want everyone that will be following our journey to know that you are not alone.

Dr Barbieri comments on Heather and Brandon’s journey

Heather and Brandon are a wonderful couple who have had a long and difficult journey, but who at the same time have done a lot to help other people. As their physician for this Fertility Journey, I share the privilege that everyone at ORM feels at being able to help them on their path to becoming parents.

Their fertility struggles have played out over many years, and it’s possible that the influence of different factors has shifted over time. Being now 41, donor egg IVF offers Heather and Brandon the best chance of being successful.

I believe that Heather’s endometriosis will have certainly been a contributing factor during the early stages when they were trying to conceive naturally and then with IUI. Heather’s commitment to helping manage her endometriosis through good health is important.

By the time they had their first IVF procedure Heather was already 39. By this stage Heather will have been facing two natural processes that impact an older woman’s ability to conceive: diminished ovarian reserve and a higher rate of abnormal embryo formation, in addition to a lower egg number due to the impact of endometriosis on her ovaries. For women in this age group, less than one-third of embryos will form with the correct number of chromosomes and therefore be able to develop into a pregnancy and healthy baby.

Moreover, the fact that during Heather’s IVF procedures they transferred day-3 embryos means that they will have had a lower chance of success. At ORM we only transfer day-5 embryos and nearly all cycles, including donor egg cycles, involve testing of the embryos to screen-out those that are not chromosomally normal. These two factors can have a significant impact on success.
The entire team at ORM is honoured to be working with Heather and Brandon and we look forward to guiding them through the next stage of their Fertility Journey!

More Fertility Journey information including Heather and Brandon can be found 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 arrives 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.

Laura and Ian IVF Spain

“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 trisomy 22 syndrome, 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, a 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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FERTILITY JOURNEYS

Interview with Dimitrius Kavakas from Redia IVF Travel

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Redia IVF Travel

While the doctors are busy assessing the couples that have applied for this truly wonderful offer of free treatment at their clinic in Crete we sat down with Dimitrius founder of Redia IVF Travel for a bit of Q&A.

Q: Redia Ltd has been a business consultancy for Fertility Clinics. What made you develop the IVF Travel Portal?

A: It was during my years of experience of trying to communicate with patients on behalf of fertility clinics that I realized what patients really look for. This is not just a treatment but the drive to make their dream come true. So the three main elements that concern patients, particularly in the UK, became our concerns in order to try to bring out solutions for them.

Q: Which are those elements you are talking about?

A: The main element is success. They get into a process that is not easy nor pleasant with the goal of becoming parents. The second element is affordability since they do not know how much they will keep on spending until they reach their goal. This unknown cost is really scary for many fertility patients. Finally, the third element is time. Fertility has a clock and is ticking fast. Being in an NHS waiting time may be detrimental to the patient’s fertility levels.

Q: So what does IVF Travel offer in response to these three elements?

A: What we do is offer multi-cycle refund guarantee IVF programmes so that we can either offer success, in which case the main goal of the patient is achieved at a set price that they know from the beginning, or we refund the cost of the programme up to 100% so as to take away the financial uncertainty from patients. In addition, we do that by offering affordable prices by having our patients travel to other countries where they can have low cost treatment without any waiting time.

Dimitris Kavakas

Q: By offering lower cost than UK clinics do you not discount on quality also?

A: No, in actual fact, our partner clinics offer an equal and sometimes much better quality than UK clinics. What you find in countries such as Spain, Greece and Czech Republic, for example, is that clinics focus more on the individual and each patient feels that they are really taken care of. In addition, most of our partner clinics have lab infrastructures that can only be found in the most expensive UK private clinics.

Q: Do you have a way to screen clinics and ensure quality?

A: It is in our vested interest to do so. You see, we are risking paying refunds back to patients since our business model is like an insurance. We earn more when our patients have quick success. So that is why we make sure that we only work with clinics that deliver high quality of services and results.

Q: You talk about affordability; can you give us an idea of the cost?

A: The cost of the programmes would depend on many factors. One is the individual clinic and country of choice since prices of treatment fluctuate between clinics and between countries. In addition, the success rates of each clinic determine their prices. There is also a risk element that affects prices, so female patient’s age group is also one of the factors. Overall, I would say that on average, the cost of a 3 cycle IVF programme with all medication included as well as methods such as blastocyst culture, ICSI, IMSI, Macs, assisted hatching and embryoscope time lapse, including embryo freezing costs, would be similar or slightly more expensive than a single cycle of IVF at a UK private clinic.

Q: Are there conditions of eligibility to enter the programme?

A: Yes, there are conditions, however, in practice we accept almost 90% of interested patients. There are age conditions regarding the type of treatment and the refund percentage. Women up to 37 years of age can have a 100% refund guarantee. Women between 38 to 39 years old can become eligible but only with 50% refund. From 40 years and over, patients can only get into a 100% refund programme if they enroll in one of our Egg Donation or Embryo Donation programme, which have no age limit. In addition to the age criteria, there are a few basic medical conditions that patients should meet to enter into the programme. We ask for specific screening test which are assessed by our medical experts to evaluate eligibility. If everything is OK, they sign a contract and start treatment.

Q: What if there is a discomfort of patients at a particularly clinic they did the first cycle? Do they have to stick with that clinic for all the cycles of the programme?

A: No, patients have every right to change the clinic they have treatment at between cycles. If the cost of the programme at a clinic they wish to transfer is higher, they would just pay the difference.

Q: Do you offer any payment schedule to help patients with their payments for the treatment?

A: At the moment what we can do is spread the cost of the 50% of the payment over 6 equal monthly installments without any interest. We do ask however for a 50% deposit.

Q: Do you only work with UK patients and where are the most popular country destinations?

A: We work with patients globally, so no, we are not limiting our services to UK patients. Currently we work with clinics in Spain, Greece, Czech Republic, Cyprus, Turkey, India, Malaysia and Mexico. The popularity of a destination depends on the patient origin. UK patients prefer Spain, Greece and Czech Republic mainly, Australian patients prefer Malaysia and North American patients prefer Mexico.

More information on Redia IVF Travel can be found on their website www.ivftravel.com.

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