IVF 101 – A beginners guide to the world of IVF and assisted reproduction
Well, hello, everybody.
We are officially live.
And yeah, for those who are joining us,
this is a live Q&A and webinar.
We're going back to basics.
We're talking about IVF
right from the start.
What is it all about?
What you need to know.
on your journey before you
get started or if you have
started already so and also
welcome to our podcast
listeners this is episode
four of hatching a plan
with myself simon tomes and
this is emma the
embryologist who happens to
be my wife or I am simon
who's emma's husband how you doing
I'm good.
Yeah.
Do I have to do that bit again where I go,
I'm Emma, I'm Simon, what, no.
Okay, that's not funny.
It's very confusing.
But folks, before we get stuck in,
we want to ease you into this.
We appreciate it.
It's a very overwhelming topic.
So just to remind folks.
I'm overwhelmed.
Yeah.
Yeah.
Likewise.
I'm not quite sure why I
decided to do such a broad.
Well, it is a big one.
We've had lots of questions.
I've got sheets and sheets
of questions that have come
in via Instagram.
So thank you, folks,
for already asking your questions.
Just to remind people,
I am no fertility expert.
I'm just Emma's husband.
I'm here to amplify her
voice and expertise.
Emma,
you have 22 years experience as an
embryologist.
You are a director of
embryology and genetics at
the Evol Clinic.
So Emma really knows her
stuff and has a huge
passion for this topic and
the world of fertility.
So it makes sense for us to
get Emma on this webinar
and ask her lots of questions.
So to get to know you,
I'd love to know where
you're all dialing in from.
So if you want to post a
comment in the chat,
just say where you're where
you're dialing in from and
say hello um and then also
get your questions in like
danielle has already jumped
in with some questions
there so thank you danielle
um what we're going to do
we have a load of questions
that come through on
instagram keep the
questions coming in on the
chat we'll bring them up on
screen and emma will do her very best
to answer them.
So we're based in Teddington
in Greater London.
Whereabouts are you based?
Ah, Kerry.
Kerry and Jason from Tumnage
Wells in Kent.
Ah, good stuff.
Thank you for sharing there, Kerry.
A few more folks coming in.
We got Artie watching from Hampshire.
Ah, lovely stuff, Artie.
We do like Hampshire down on
the South Coast.
Lovely stuff.
We've got Lynette and Oliver
from South Wales.
Charlotte and Matt from
Paisley outside Glasgow.
Oh yeah, familiar with Paisley.
Joining from Scotland, Aberdeen.
Seppi, nice one.
Chloe and Arthur here from Reading.
Victoria and Nick from Leicestershire.
Wonderful.
So I guess if we can make some assumptions,
it seems like there's some
couples that have joined us.
Which is good.
Which is really good.
That is really cool for
those who are couples.
That makes my heart full.
yeah it really does it
really does for those you
know we've got to support
each other right so good on
those who are in a couple
situation who are on this
call together that's
fantastic so just um before
we dive in um yeah why are
we doing these webinars and
why are we doing this
podcast what's the the
reason behind it um I think
we've said this before,
but we had quite a
difficult road to parenthood.
And I think there were so
many unanswered questions
about our own road, which was different,
different, different, the same.
I think it's, you know,
half a dozen of that and 13 of the other,
whatever you call it.
Um,
and I just don't think it should be
that hard to access
information before you are
about to potentially
finance yourself through
something that is
let's face it,
can be extortionately expensive.
I don't think that these questions,
the really initial stuff,
should be that hard to get answers about.
That's why Instagram came about.
That's why the post came about.
That's why every waking
moment I try and do
something that educates in
the fact that you
shouldn't... This should be
something we're educated about at school,
but we're not.
Yeah, we don't get educated at school.
Don't get me started on that.
Yeah, that's another topic.
We're trying to get Emma into school.
So if you folks have any access to that,
get Emma into schools,
universities and workplaces
as well to raise awareness.
Absolutely.
So let's get stuck in.
So I'm going to go with a
tricky one straight away
because I think this is an
important one to ask.
So Emma, what is one hard truth about IVF?
The hardest truth I think
about IVF is that it doesn't always work.
And I think that you have to
go in with an open mind
that that is always a possibility.
It is not a fail safe.
We are not at a hundred percent.
I wish we were, but we're not.
And I think that if you can
somehow prepare yourself
which you have to go in with hope,
you have to, otherwise there's no point,
you have to have hope.
But you have to go in
understanding that it's not, it is not,
it doesn't work for everyone.
And it can be heartbreaking.
And you have to set that
with your patients when they come in.
That's the number one thing
you share with them to start off with.
I mean,
it's probably not the number one thing.
You still have to give people hope.
But I think it's about
knowing what they need.
But I think it would be really unfair.
Like I've heard patients say, oh,
I went to see a previous
doctor and they just said, don't worry,
this time next year you
have a baby in your arms.
You can't say that because
you don't know what the
future holds for anyone.
So you just need to be realistic,
pragmatic and just honest.
Yeah.
It doesn't work for everyone.
And that is the hardest truth.
Yeah, that is the hardest truth.
Okay, well, let's jump into what IVF is.
First of all, what does it stand for?
How does it work?
What's the process for it?
We won't go into the history
because I don't think we've
got time to do that.
But more like, why IVF?
What does it do?
IVF stands for in vitro fertilization.
So in vitro is Latin for in a petri dish.
In vivo is the opposite of in vitro,
which means in a physiological body.
So when we talk about things
happening in vivo,
it means they've happened inside you.
When you talk about things
happening in vitro,
you talk about it being a
plastic test tube or a
tissue or a petri dish.
So in vitro fertilization is
the essence of taking
gametes,
eggs and sperm into a Petri dish
and creating fertilization
outside of the human body.
That's what IVF is.
So IVF encompasses all the
processes in a lab with gametes.
So eggs, sperm, ICSI's, biopsy,
blastocysts, embryos, all of those things,
lots of big words,
which one of the questions
we got onto is all the analogies,
which we'll go into in a bit.
assisted reproductive
technologies ART
encompasses more than IVF
it encompasses things like
inseminations and people
that don't ovulate having
help ovulate or timed
intercourse and stuff like
that that is not IVF that
is assisted help one in
eight couples will seek
assisted help one in five
couples will no other way around
Don't worry if you've got
the ones and fives.
Yeah, one in eight couples will... No,
that's right.
One in five couples will
seek assisted help.
One in eight couples will need IVF.
That's the other way around.
Yeah, that way.
That makes sense.
And how is... So when someone says like,
oh yeah, we had IVF,
Do they mean they actually
had the technique IVF or
they may have had another
technique like ICSI is another one?
Yeah, it's all under one umbrella.
So I think IVF,
we need to step away from IVF.
It stands for in vitro fertilization.
How that fertilization comes about,
ICSI is part of an IVF cycle.
It's just a process of
achieving fertilization.
So it's a different technique.
So it's a different technique,
but it all falls under the
umbrella of IVF.
Things like timed intercourse,
ovulation induction,
insemination, IUI,
that is not part of the IVF process.
That comes under ART,
assisted reproduction.
Yeah, got it.
We hope that makes sense, folks,
to kind of start with the basics.
And I think by the end of this session,
we do hope that folks will
have a set of questions
that they could take to a
potential clinic or clinics
that they could ask.
because I think this is
where it gets really useful
like the real practical
stuff yes it's important to
have the knowledge but I
think giving folks a set of
questions is what really
the knowledge formulates
the questions right yeah
absolutely so I think what
we should do here is
formulate the knowledge in
words and then I'll put a
list of questions after
this yeah on insta yeah
yeah so I think we've got
we came up with a whole
load earlier on yeah I kept
going and then there's that
one is that one
OK, well,
let's we talked about the
alternatives very briefly.
So what what would be a good
question to ask a clinic then?
I think we should start with
Chloe's question, actually,
because Chloe's written this one here.
Yeah, because that for me is a really,
really interesting.
interesting starting point
because I hadn't really
thought about that because for me, okay,
so you read it because
that's your job as the host.
Yeah, absolutely.
So for listeners,
this is a question from Chloe.
Thank you, Chloe.
What is considered a full IVF cycle?
It's unclear to us whether a
cycle would include only
one embryo transfer or
transfers for all embryos available.
Good question.
Now, for me,
an IVF cycle is the collection
of eggs mixed together with sperm
with a group of embryos
created and that cycle
completed in a process of
either freezing all those
embryos or transferring an
embryo and freezing the rest.
That is a cycle of treatment.
If you then go on to do a
frozen embryo transfer,
that is a frozen cycle of treatment.
But when you speak to,
when you talk to people like myself,
If I ever say to someone,
how many cycles of
treatment have you had?
I'm actually asking you how
many egg collections have you had?
I see.
I'm trying to work out how
many times we've tried to create embryos.
Whereas I completely understand.
This is where the whole PGT
thing came in in our previous webinar.
When you are having rounds
and rounds of embryos put back,
when I speak to people, they say,
I've had five cycles of treatment.
I think that that is one air
collection with five embryo transfers.
Yeah.
So I think it's it's the language,
but I'll hand up medical
professionals deal with
cycles of treatment as in
cycles that you are creating embryos.
So when we say you're going
to have to do another cycle,
we normally mean you're
going to have to do another
egg collection.
So question to add to that,
is that universal across clinics?
So you're based in the UK,
is that they use the same
language or is that miscommunication?
We talk about it as frozen
transfer cycles.
But when we talk about cycles of IVF,
we are talking about egg collections.
Okay.
And in all clinics, that's universal.
Yeah.
Generally.
Yeah.
Whenever I, wherever I've worked,
that's how we talk about it.
Okay.
Okay.
Got it.
Hope that helps answer your question there,
Chloe.
Thank you for asking.
Is there a follow-up one on
here that you want to pick?
No.
Oh, let's just jump on in.
So, um, okay.
So jumping in with a
practical one here from Anne on Insta,
how many appointments will
be required days off work?
So let's go back, probably before that,
let's start back to...
what how do we start this
process so you're gonna at
some point no let's go back
a bit more I'm gonna go
back even further who needs
it yeah okay let's say that
so there's going to be
people that come to ivf
because they are struggling
to conceive naturally as a
couple there are going to
be people that come to this
because they are in a
same-sex relationship and
thus have to use assisted
reproductive technologies
to conceive there are solo
mothers by choice coming to
this because they don't
have a partner and
therefore have to access
sperm and assisted reproduction.
There are people coming to
this pre-chemo or medical
treatment that need to
preserve their fertility.
There are people coming to
this to just preserve their fertility.
And there's probably other
things that I haven't even thought about.
Surgical procedures, genetic conditions.
I mean, there's so many.
So the first point of call
would be why are you coming
to this and therefore what
your needs are?
So I would say the first
port of call is once you've
identified that need,
you speak to your GP and
your GP will start to
signpost you dependent on
your own personal
circumstances to
potentially what clinics
are available to you if
you're seeking NHS funding.
If you are not seeking NHS funding,
I urge you to do your own work.
There are clinics like my
own clinic that will do
free consultations like 15 minute chats.
Try and work out very
quickly what you need.
Can we help you?
All of those things.
And there are a lot of
clinics now that instead of
waiting to go through your GP,
if you are a couple needing
fertility support,
the NHS can take 12 to 18
months to even start to see
you with that.
you can get into private
clinics and do what's
called a couple's fertility
review or a female-only
fertility review or a
male-only fertility review
or a same-sex couple fertility review.
The reason we do these is
it's because it's an inexpensive-ish way,
500 quid's worth,
to get yourself tested at a
level that you're going to
need to be tested to seek
fertility treatment.
Okay.
And you have to have tests.
So I'm asking the real like
back to basics questions here.
But could you go in going, hey,
we reckon we need this type
of treatment because we've
done this research.
We've gone through this flow chart.
It's ended up here is the thing we need.
Do you have to have tests?
Yes.
So you have to have a
certain level of test.
What I will say is when you
have those tests are really important.
Okay.
How come?
Because some of them expire.
So you don't want to pay for
tests too many times.
So I would say if you are
presenting yourself to a
fertility clinic and you're
not doing the fertility review,
you need to have, if you're a couple,
you need to have a semen analysis done.
Again, you can get these done privately.
You can get home kits now.
for men.
I'm not a massive fan,
but they are available.
How come you're not a massive fan?
Because I would prefer to
see my semen sample myself, to be honest.
As a reproductive professional,
no amount of what's written
on a piece of paper is
going to replace me looking
down a microscope and
actually looking at it.
You will need an AMH,
which is an anti-malarian hormone.
Now,
you will not be able to access that on
the NHS.
It's one of the very,
very many things that they
won't do because it's a
very expensive test.
However...
you will find that they can
be very highly priced in
clinics and everywhere else.
There are actually companies
called Hortility that you
can do a home AMH test
It's incredibly cheap comparison.
And we will, as a clinic, I know I will,
accept those as test
results for your AMH.
I would say your AMH,
which is your sign of ovarian reserve,
would need to be done
within about six to nine
months before you have
treatment so that it is accurate.
So another big word there,
ovarian reserve.
So how many eggs have you got left?
How well are you going to
stimulate if we are going
to give you some drugs?
Yeah.
What does that look like?
What is your reproductive function like?
One blood test.
And that is,
and it takes into account age?
No.
No, it's just a blood test.
Just a blood test.
Yeah.
Age is a different
conversation that we have
once you get in a clinic.
Do we want to talk about age
now or is that another time?
No, I think if we get into age now,
we will never finish this podcast.
We will go beyond the hour.
So those sorts of things,
semen analysis and AMH,
what we call baseline bloods.
So if you do get referred to your GP,
your GP should give you baseline bloods,
which on day two is FSH,
LH and oestrogen.
They are hormones that your
GP should be referring you.
You'd always have your thyroid checked,
TSH, T4, 3T3.
Again, your GP will guide you on this.
Those don't really expire.
They are things that I would probably,
when you're starting to
seek fertility help,
maybe within those six months before,
those are the bloods you can have done.
The bloods I would say you
don't have done are when
you come to treatment,
everyone needs virology screening, HIV,
Hep B,
Hep B core and Hep C. They expire
after three months.
So do not pay for them to be
done until you are ready to
go into treatment of that
situation because
when in this country,
your first round or your first cycle,
going back to that word,
your first cycle of IVF,
those bloods are only valid
for the three months beforehand.
And as a reminder, folks,
because there's a lot of words,
acronyms in this world.
Right.
So come back to this.
This is going to be on YouTube.
This is going to be
available on all your
podcasting platforms.
So so revisit this conversation again,
because you're using a lot of words like.
what does that mean like
that is overwhelming I'm
going to post actually
after this because someone
actually asked me a
question about could I do
an acronym thing I did it
about two years ago on
insta so I just need to
re-flag it um where I've
broken down the glossary of
terms for all the different
fertility things that
you'll you'll hear these
words and you'll be like
what the is that what does
that mean so I have
actually got them on my
insta load of glossary of
terms of what it all means
I'll reshare it.
Brilliant, that's great.
So coming back to Anne's question,
so I think the thing from
Anne is like the appointments, it depends,
right?
Okay,
so it really depends on what
treatment you're having.
So let's go in,
so say you are coming to this for an IVF,
you will always need a,
so your initial consultation,
if you choose to go with a clinic,
you can normally do video
calls for the initial consultations,
but at some point you will need a scan.
Now, the NHS will do an internal scan,
so a female internal scan,
which is a transvaginal scan.
It is a probe in the vagina
that looks at the ovaries and the uterus.
Again,
the NHS don't do the type of
scanning always that we want them to do.
So you probably will need a
gynae scan with a fertility
specialist just to check
things in the clinic.
So you will need to visit
the clinic at some point.
So most people come in.
What you can do with a lot
of clinics is go in on one day,
the appointment, the semen analysis,
the scan, see a doctor, all done.
So that's your one day.
And then you start making a
treatment plan.
Now, during your actual treatment, you,
as the female,
whether or not your partner,
or if you're on your own coming with you,
whatever your circumstances,
you'll probably need to be
in the clinic between five
and 10 times over the space
of four to six weeks.
And it really varies on what
type of treatment you're having.
Those appointments normally
involve a scan and a blood test.
And then it really depends
on which clinic you're
using to how accurate they
are with their timings.
These are the,
one of the things I would
say you need to ask,
how much do you stick to time?
Can I have early appointments?
how am I gonna juggle this around work?
Do you have work that you can talk to?
How secretive do you want this to be?
These are your questions for yourself.
So those are the sorts of
things that you can ask your clinic.
Some clinics will start at
half seven in the morning.
We start at like quarter to
eight and they do,
Evening consultations and
stuff like that to try and
juggle around people's work.
So again,
that is one of the big questions
that will go on our list is
how do I juggle this around work?
What appointment times do you offer for X?
I will say that when you're in treatment,
all the appointments have
to be in the morning
because we have to get your
blood results back by the night.
I see.
That's good to know.
Okay, right.
Well,
let's jump on to some more questions.
Actually, I think talking about AMH,
Victoria had this question.
Should we take this one?
Yeah.
So the question is, thank you, Victoria,
for sharing.
Re-AMH,
what is the lowest you would accept
for someone to do IVF?
Right.
Now,
this is one of the main questions you
should be asking any clinic
before you even walk through the door.
Will they treat you?
Because your AMH defines a
successful outcome.
the lower your amh the less
eggs you will collect the
more difficult as a patient
you are to treat and
therefore the lot of
clinics will avoid patients
that won't get many eggs
because it affects their
success rates wow it's
wrong that's totally wrong
but if you walk into
clinics they will want you
as a patient but I know
many clinics that won't
treat anyone with an amh of
under five okay
We will treat absolutely anyone.
I've got patients pregnant
with an AMH of 0.1.
But that is a big question
before you walk in.
I know my AMH.
It's a really powerful thing
to know your AMH because
that is one of the questions.
Will you allow me to have
IVF in your clinic with this AMH?
Yeah.
That's on the list.
Yeah.
So yes, in the E4 we will.
I know plenty of clinics
that will treat AMHs really low.
But when we talk about, as I mentioned,
probably very un-PC talk
about cherry picking.
That is what goes on.
People won't treat women
with low AMHs because they
are incredibly difficult to treat.
There's a lot of monitoring needed.
There's a lot of bespokeness needed.
It's not bucket chemistry anymore.
It's not, you can't sit into a protocol.
You need a lot of support
with women with really low AMH results.
So that is on the list.
Will you treat me?
That's a great question.
And it's, will you treat me?
Here's my AMH.
That feels like the core information.
And remember, AMH does wiggle a bit,
but not massively.
So if it's low, it's low.
It's never going to go from one to 20.
You might get it between one
and two or one and three.
So a low AMH is anything under about four.
We consider that a low, again,
this is all age related.
So if you were a woman in 44
and had an AMH of four,
you'd actually be doing
quite well because it does
decrease over time.
It's not gonna change that much.
You can definitely do things to make it
a little bit more plumped up,
but there's not a lot.
You can't go from a low AMH
to a massively high AMH.
So there's no lifestyle changes.
There's a little bit,
like definitely nutrition helps with AMH,
but it's not going to,
you can't change your
functional ovarian reserve
that dramatically.
But what you can do with
nutrition and lifestyle is
change the way you respond
to the drugs better.
Ah, okay.
That's a whole other podcast.
Okay.
Which we will do with
Melanie Brown because
Melanie Brown's a
nutritionist and I plan on
bringing her on and doing that with her.
Yeah, yeah.
Because she can talk through
nutrition and what you can
do to elevate your response to drugs.
But I'm not going to go
there because I'm not a nutritionist.
Yeah, let's get Melanie on.
Absolutely.
But thank you for your question there,
Victoria.
Much appreciated.
Okay,
let's jump back to some questions
from Instagram.
Okay, so, oh, this one from Georgie,
we appreciated.
Thank you, Georgie.
Is it okay to ask 10,000 questions?
You know what it is?
I think it is important to
ask as many as you can.
Which one would you like to
jump into next?
I think key lifestyle
changes to help prep.
I think that's a really good
one in the fact that we can
definitely do things to
help our bodies respond.
I would always say get some
support from people that do
all the holistic stuff.
I'll be brutally honest,
and I used to think it was
all mumbo jumbo.
I now 100% don't.
Acupuncturists are actually
a bit like counselors.
They're brilliant.
There's some really amazing acupuncture,
especially the ones I work
with in London.
They will talk you through.
There's really good
nutritional help just to
help you get your body in a
really good place.
it it's all about getting
your mind and your body in
a really good this is this
is an emotional journey as
much as it is scientific
and I think it's really
important that you you get
yourself in a place where
you're you can accept the
drugs that whatever drugs
you're going to be given
they work the best they can
um but I don't know I don't
have all the answers to
that I don't know exactly
what it is and I think
again it's quite bespoke to
your needs if you've got an
under functioning thyroid
the nutritionist might say do this and
So I think that's why it's
really important to get
that advice from the experts.
But yes, definitely,
if you have got the time,
we always say three months
prep before IVF for both parties,
male and female,
if there is a male involved.
Good question from Miss K32
about lifestyle,
particularly lifestyle choice.
Is it OK to have the old
glass of wine now and then,
both men and women?
Yeah, I think so.
I think actually,
even if you spoke to Mel who Mel Brown,
who does like so much nutrition,
she would be all about like,
it's all about moderation
and actually cortisol,
which is your stress hormone.
If you can have a glass of
wine at the weekend, I don't, you know,
you've, you've got to live this journey,
this journey.
I hate that word, but it is what it is.
Yeah.
Um, can take a long time.
Absolutely.
And you mentioned about it,
the emotional side of it,
not just preparing your body physically.
Yeah.
I mean, we've got some thoughts around,
you know,
how if you're in a situation
where you are with a partner,
how best can your partner help you?
Because we've got a lot of
we've made some assumptions here,
but there are a lot of partners here.
I mean, generally, I'd say I'd say so.
I'd say probably.
Less than 10% of the
patients I see are solo
mothers by choice.
Obviously people doing egg
freezing is different
because egg freezing,
you are coming to that on
your own to freeze eggs,
not create embryos.
I think that that does fall under IVF,
but slightly different
aspect of what the end point is.
Well, you're a partner,
so I know how a part,
but what would you expect?
I think let's throw that
back at you as the partner.
What would you want?
What would you expect to do?
Well, I think, um, I mean,
you'd be in full support mode, right?
Would be kind of, well, yeah, you'd have,
you'd have to be, I'll tell you now,
20 years ago, it wasn't like that.
It was,
I remember couples used to walk in.
Um,
it was very much seen as a female
problem.
It was definitely a female.
There was a lot of blame.
There was a lot of fault.
It's not like that now.
It's not like that.
And I think we've educated
people enough to realize that this is,
you know,
40% of the problems I see are male,
male fertility led,
whether or not you can see
it down the microscope or not.
It is,
That is it.
Unexplained infertility is
only a fancy word for we
don't know what the matter is.
Yeah.
Because we haven't done the
right test or we're not there yet.
We're only Louise Brown was 46 last week.
You know,
it's not like Louise Brown is the
first IVF baby.
So we're not we're not there yet.
But I mean, what do you want to do?
Yeah.
I mean, I think on a practical level,
the partner could remind.
Remind the person when to take medication,
when to do injections,
because there's lots of
injections involved,
depending on the type of treatment.
Actually help with the injections.
I think also, I mean,
you have to do lots of
difficult phone calls.
Yep.
Lots of difficult phone calls.
So a partner could be in a
position to take that call.
be on the line as well.
So both of you are on that
call at the same time.
So I think you've often
talked about the person
who's going through the
treatment themselves.
Sometimes they're in an
emotional headspace where
it's so overwhelming that
they won't actually hear
what they need to hear.
So a partner could be the
ears in that case and
listen and actually take all the notes.
I sometimes phone both people.
Yeah.
No, no.
I have them on speaker.
I do the other one on one
off the other to make sure
that actually there is that
continuity of support
because not everyone's
taking everything in when it's bad news.
Exactly.
They don't want to hear what
you're having to share with them.
Um, be at the appointments,
be at the scans, be present, be present,
ask the questions.
Yeah.
Come on webinars like this.
Yeah, absolutely.
Because some people find this really hard.
Yeah.
It's a really daunting
process being told you need
to start this process.
And that's why we know we're
sort of edging our way into
the world of IVF.
Be the person that does do the research.
100%.
Do the research.
And then on a lighter note,
we've got a little note
here is to buy some pineapple socks.
So pineapples are the sign
of infertility treatment.
A lot of folks come into
your clinic with their
pineapple socks on.
So yeah,
trying to find the light moments
when you possibly can,
given it can be painful.
incredibly intense and an
emotional journey.
So I think, yeah,
looking out for your
partner is essential.
Absolutely, full support mode.
And also,
is yourself in support mode
getting support from people as well?
Yeah, absolutely.
Okay, so let's see where we're at.
We've got a few more
questions coming through on
the chat here.
So is there one in
particular that you feel
you want to take?
No, let's just go.
Let's pump some out.
Let's go for it.
Let's go rapid fire.
So Laurie, thank you for sharing.
I'm going to read this one
out loud for our listeners.
I'm a 39-year-old woman with
an AMH of 3.4 and follicle count of 4.
I've been advised by GP to
try to conceive naturally
for a few months but not
leave it too long before going on to IVF.
Would you say that three
cycles is going to be
needed or if you can only
afford to do one cycle of
IVF is it still worth trying?
That's really tough because again,
what Laurie's told us there
is everything I need to
know that actually given
Laurie's AMH and Laurie's
antral follicle cancer,
what that means is how many
follicles are sat on the
ovaries before we're able
to stimulate it means she's
probably only going to get
four to six eggs depending
on what given month that is.
So you're already in a
position where your funnel,
we talk about the IVF
funnel quite a lot on my
Instagram page is quite small at the top.
Now,
the reason the GP has told you to keep
trying naturally is actually your AMH.
does not determine your
ability to get pregnant naturally.
Because in any cycle of
natural menstrual cycle,
you will release one egg as
long as you are ovulating
and ticking over.
All that number tells me is
what I'm going to be able
to capable to do or what
the doctors are going to be
able to capable to do, given the drugs.
Now,
the question I have goes beyond what
Laurie's asked, and that is,
what did your family look
like when you started this journey?
Did it look like one child?
Is this secondary infertility?
Because if it's a secondary infertility,
we would come at this with
a different game.
We would come at this with a
different mindset,
because if I'm sat in front of Laurie,
who is with her AMH of 3.4,
and I know I'm going to get
four or six eggs.
I want to know how many children you want.
Because if you say to me,
I haven't actually started my family yet,
I'm in the mindset of
actually maybe if you could
afford to do it,
I probably would do three
cycles of treatment to bank
embryos and then get you
pregnant with one of those embryos.
Because actually,
by the time we come back to you, you know,
we hopefully could get you pregnant now.
But the time you come back to it,
you're going to be 41,
42 and your AMH will decline.
So it's about context, context, family,
context, have the conversation.
So your GP is absolutely right.
Like you trying to get
pregnant month after month isn't going.
You are 39.
You have got the same.
I think it works out about
7% a month at 38, 39.
chance of conceiving that's
nothing to do with your AMH
because as long as you've
got normal cycles and
you're ovulating those are
your chances given your age
but then you've got to then
realistically look at what
does this look like for
your future and that's
that's the conversation to
have I do think it's worth
having a go at IVF I have
had a huge amount of
success with women with an
AMH of three and above
Thanks for asking your
question there and for sharing Laurie.
Just to go back to that,
there are things you can do
to prep women with low AMHs.
I'm not going to pretend to
be an expert because I'm not,
but they have started using
growth hormone quite a lot
in women in the month
preceding egg collection.
And we are definitely
getting more eggs out of
people than you expect.
I'm not going to go into
that but it is some it's
food for thought
interesting we are 46 years
into this now and there are
things happening all the
time yeah to try and help
ovarian reserve work better
for us in a clinical
setting I'm not talking
about in a natural setting
I'm talking about in a
clinical setting because at
the end of the day the more
eggs we can get out of you
the better this is going to
be in regards to how many
embryos we can create yeah
so they are starting to use
things like growth hormone and stuff
Thanks for sharing, Laurie,
and for your question.
Okay, next up we have Sepi.
Thank you, Sepi.
Any advice for those who
need to do IVF for genetic
reasons to increase the
chances of success?
Does back-to-back egg collection help?
Back to back egg collections are fine.
I think people used to be
really scared of them.
So let's talk about what a
back to back egg collection is.
So you would do a stimulation protocol,
which is you have your period normally.
So let's go through a normal
protocol for me at work
would be someone has a period.
We do their drugs for two weeks.
We then collect eggs.
We create embryos in the lab.
They don't take any what we
call luteal support.
So there's no progesterone.
They're not having a
transfer because we're
testing these embryos for
maybe genetic disease.
And then you have this group
of embryos that are growing in the lab.
And by the time you finish
growing this group of embryos,
they've already started
their next period and they
go straight into another
stimulation round.
It works really well.
There's no problems in doing it.
It depends what the genetic problem is.
It depends how many embryos
are in here at the end.
Because my question would then be,
for example,
say I've got 10 or 15 embryos,
which is a hyperinflated amount,
but let's just play devil's advocate.
You might have enough in
those 10 or 15 that you
don't need to do the back-to-back.
The back-to-back works
really well sometimes for
people with really low ovarian reserve.
You can actually kick them
off and they keep going to go.
So the reason to do back to
back is so that you are
able to complete all your
egg collections in a really
short space of time before
you start putting embryos back,
especially when you're
doing genetic testing.
But I think there needs to
be a bit more context there.
I'd like to know.
how many eggs we're going to
get and all of that because
then I would I would argue
that hold fire a minute
because actually you're
only talking about the
space of four weeks before
we've got all the results
back and we can do another
egg collection anyway yeah
you just wait the next
bleed so but back to back's
fine if that's what you've
been advised to do it's
fine yeah thanks for your
question seppy okay uh
let's take this one from kate
So Kate,
about to do my second egg
retrieval for IVF at Evil Hammersmith.
No embryos to transfer.
Last cycle, unfortunately.
How to know if it is worth
to keep doing more cycles or just stop?
Finance has been in consideration too.
Thank you.
Thanks for your question, Kate.
I suppose, again,
this is a context thing and
I'm really sorry you didn't
have any embryos.
I think it would be to do
with how many eggs you had,
all of those things.
But given that you're at the
Evewell Hammersmith,
we've got time lapse.
So the time lapse is the
incubators that we use to
look at the videos so we
can have a look at them and
then see how they're growing.
and therefore help you make
some informed decisions
based on the knowledge we
gained from the embryos
developing and why they're
not developing.
I think that would be, for me,
that sounds like we need to
have a chat with the
embryology team on this after this cycle.
if god forbid you're in the
same position I really hope
you're not because there
are tweaks that I imagine
have been made since the
first cycle to try and make
the second cycle more
positive um so let's keep
our fingers crossed but if
it doesn't work I think it
would be a very good sit
down with an embryology
team if you're in a
position where your clinic
is using time lapse and
you're not getting embryos
it would be really good to
sit down and go through
those videos to see what
they think the problem is um
and then help you make
forward planning future
planning whatever that may be
Got it.
Thank you, Kate, for that.
I'm going to jump to Charlotte.
This is a really good question.
Will the clinic train you
and your partner how to do
the injections?
Do you get to do the first
one with supervision?
Just to add to that,
I can imagine that's super overwhelming.
It's like, oh my goodness me,
I've got to inject something by myself.
That sounds full on, right?
And I can imagine how scary that can be.
It's a really good question.
And that is going on the list.
because I don't think you
would get the same I'm not
sure you'd get the same in
each clinic we do so and
actually what just to blow
everyone's mind there's
about six or seven
different drugs with
different injections some
come with pens some you have to mix
so if someone's a needle
phobe like I'd freak out
right having to inject a
partner or helping them do
that so as a clinic I know
we've got a lot of needle
phobes and actually
sometimes we do patients
injections for them yeah if
they can otherwise yes so
we always doing it what we
call an injection teach
where each drug is laid out
and some people have to mix the drug.
It really depends what drug you're on.
Some come with a pen that
just preloaded pen and all
you have to do is press the
button and it goes.
It's not in your leg,
it's in your stomach.
Just because you went like that,
like an empty pen.
So it is in your stomach.
Can't teach him anything.
Some of them are in your bum.
Some of them are in your tummy.
I thought most of them were in your bum.
No, your progesterone tablet.
So it depends what the injection is.
But yes, the answer is yes.
in in a really good clinic
you will be given not only
a full hour and a half
nurses consultation to take
you through what drugs
you're using but when you
come in for that what we
call our baseline scan
which is the scan to make
sure we're ready to start
you get an injection teach
and you get it as many
times as you need it
because it's and actually
what's really good there is
if your partner comes with you
they can also help you with
the injection so which we
talked about yeah support
mode is is injections yeah
absolutely great question
we also give you I think
one of the questions I got
of insta was about a visual
and a timeline and all of
that and actually what we
tend to give out is a calendar
of what you're taking every
single day by time,
and literally it's mapped out for you.
Because it has to be,
because timing is so crucial.
You talk about timing, it's so important.
Actually,
I think there's things on Etsy
you can buy to help you
with magnets and stuff.
I've seen them before.
Proper planners.
That's good.
Thanks for your question, Charlotte.
Okay, let's keep going.
We really appreciate you.
Keep the questions coming.
We've got another 20 or so minutes to go.
We can always go over the
hour if people are okay to stick around.
So this one from Chloe.
Here we go.
So Chloe asks,
how much time it normally
takes to have an egg
retrieval since starting stimulation?
Stimulation.
So there's two types of
protocols that we tend to use,
long and short,
which is exactly what it says on the tin.
Long protocols now have become,
that's all we used to use
back in the day.
What does that mean?
So a long protocol,
so a long protocol is a
protocol that you start in
the cycle before.
So you have your period and on day 21,
you start taking a drug for
about eight days.
then you have another period
and then you start taking
your stimulation so
actually you could argue
that you're actually in
cycle for six weeks yeah
yeah yeah we tend to use
and actually the literature
suggests now that short
protocols are easier to
manage and stop oh um
ovarian hyperstimulation a
bit better so instead of
having all this build up
into the cycle and don't
get me wrong some people
need long protocols it's
I'm not clever enough,
it's to do with your
hormones and your pituitary and stuff.
But I would say 90% of the
cycles I do now are a bleed
and you literally start
injecting on day two for stimulation.
So your answer there, Chloe,
is either six weeks but if
you're in the modern day
where we're doing it it's
actually most people are
only injecting stimulation
drugs for 10 to 12 days
before they take their
trigger your trigger
injection is the injection
you take to start maturing
all the follicles we've
grown and then you have an
egg collection 36 hours
after that got it okay so two weeks
So when people talk about the trigger.
Yeah.
Okay.
That's the bit that starts
my process because that's
when I start talking about
my egg collection and going into,
and maybe we'll do a thing on all of that,
but that's like,
but essentially if you're
in a short protocol, it's two weeks.
If you're in a long protocol,
it's six weeks.
So do you ask a potential clinic that?
Do you say, do you run long or short?
Does that matter?
Probably not immediately
because that's probably
decided after they've met
you and decided what your
medical needs are.
And that comes down to what
consultants like to use,
what protocols and why and
what drugs they're using and all of that.
But there's no like...
someone could go in and say,
I've heard short is better than long,
I want short.
Yeah, of course they can if they've done,
and they've had treatment
before and it's worked better for them,
then yes, you can have it.
But I think we're coming to
this as a brand new people, right?
So no,
it's probably not something... So
there's no point asking that question.
It's very bespoke.
It's something we tend to
use short just because it
works in our setting.
Yeah.
Yeah.
Good question there.
Chloe, thank you so much.
Right.
Oh,
and another question related to needles.
So Leanne, I have a phobia of needles.
Have you got any tips or
ways to overcome this fear?
Well, thanks for sharing, Leanne,
and I'm sorry to hear that you have.
needle phobia I would say
you're definitely not alone
no you're not you know and
actually the nurses have
got some really really good
tricks and tips to help
help with all of this I
think there's a lot of
amulet cream and me look I
think it's good amulet
cream you can get like
numbing cream you can get
ice you can get someone
else to do them for you
catch you off guard it
depends what your phobia is
to be honest it really is
like some people are I will
say that the needles we use
to inject the stimulation
drugs are minuscule I think
people have got this
overwhelming belief they're
not at all they're like
tiny little pins yeah so I
think you have to work with
your team to get the
support and see what advice
they can give you yeah um
you know there's there is a
lot of support out there
for people with needle
phobias I i don't tend to
do the injection teach so I
can only imagine but yeah
your nurses team is yeah
they're brilliant yeah
hopefully you can get some
support with that leanne
thanks for asking
OK, another one from Charlotte.
What's the full list of
activities we should ask to
get a complete cost for a
standard IVF cycle?
The core package seems to
vary a lot by clinic.
So this is a great question
and we were going to come
on to how much does it cost?
But this is one of the questions.
This is one of the questions.
Why are you having to ask?
for your price that you're
going to have to pay for your treatment.
It should be broken down.
Once you've had a treatment
plan given to you,
if you've chosen a clinic
and you've had a
consultation and they've
given you a treatment plan,
you should receive a full costings.
Yeah, broken down.
There shouldn't be any hidden costs.
And can you say things like, oh,
we don't think we need that.
Can you take that off?
I know that sounds really... No, you can.
You can.
There's like... Some blood tests or... No,
so blood tests, I would never like...
I will say that there are ways you can,
there's actually really
good people on Instagram
that talk about how you cut
the costs of IVF.
So you can get certain blood tests.
If your GP's really good,
you can get your virology
done through your HIV, BFC and that.
Get that done through the NHS,
but make sure it's just in time,
because it expires, like we said.
So there are things,
and you don't have to use their pharmacy.
You can use a different pharmacy.
You can get someone to write
you a private prescription.
But ultimately,
the costs that you're
paying the clinic shouldn't be,
it shouldn't be hidden you
should have you know you it
should all be written down
for you yeah that is one of
the questions and and when
it comes to like surprises
like sometimes when you're
you're paying for any type
of service there's like not
hidden costs but there's
unexpected costs like do
you do you recommend like
have an extra 20 percent
put aside or like what what
Yeah,
the most unexpected cost we have is
if you're booked for IVF,
which is when we mix the
sperm and the eggs together,
and then the sperm count on
the day maybe isn't good
enough and we have to convert to ICSI.
So ICSI is when we inject
the sperm into the egg.
It is more expensive.
It is a completely different skill set.
Because it's a much more technical...
that is something that can
be an unexpected cost but
everything else in my mind
should have been discussed
with you at the treatment
plan phase and although
there is wiggle room on how
much drugs you're going to
need a little bit like that
can change um your clinic
cost should have been you
so we give out cost pack
like we give a cost summary
yeah of course so yeah I
find that really hard to
understand a bit of a
cheeky question can you
negotiate on the cost
No, not really.
They're set out, I mean, beyond me,
I don't, obviously as an employee,
they are set out by how
much everything costs to run by clinic.
And actually the blood test, for example,
we outsource the blood work.
So we don't,
it's just what they charge us.
Because you have different
suppliers providing
different services based on,
particularly when it comes
to like genetic testing and
that kind of thing.
Separate companies take care of that.
You just do the retrieval.
Yeah.
Okay.
Gotcha.
Thanks for your question, Charlotte.
Which one would you like to take next?
Probably that one.
This one here?
Yeah.
Okay.
Thanks again from Chloe.
If an embryo transfer
doesn't end in pregnancy,
how soon could you have a
new embryo transfer?
What would be your recommendation?
If it's no pregnancy,
if it's a negative test,
then you have a bleed and
you can have a transfer in
the next month.
Unless there is something
that the doctor wants to do,
like in a further
investigation to find out
why the embryo didn't transfer works.
How often, typically,
does extra tests have to
happen before you can try again?
Is it a percentage like 10%?
I think it depends on how
complex your infertility cause is.
We have patients where they
have failed euploid,
so tested normal embryos.
And if that happens,
then although they're not 100%,
they're a lot closer than
an unscreened embryo.
So there are, yeah,
you can start to do things
like look at the womb and
stuff like that.
But I'm not going to,
I can't talk about why they
do that and when they do that.
Yeah.
In layman's terms, you can go next month.
You can have another embryo
put back without too much
problems next month,
as long as your lining looks okay.
The delay is when you have
biochemical pregnancy or miscarriages,
because then you have to
wait for everything to settle.
And that's a little bit more complicated.
And that is case by case?
Case by case.
Depends how long it takes.
You can't give a rough guide.
Okay.
Thanks for your question there, Chloe.
Okay.
We're going to grab one from Insta.
I thought this was a really good question.
From Pebbles and Clouds asks,
what options should we be
advocating for that might
not be offered routinely by the clinic?
So I guess that means extras
or extra services.
So this goes on my list.
This is another one on my
list that I think we should get to.
So another list of things,
the questions you should be
asking your clinic.
What should you be advocating for?
So for me, I...
Time lapse for me is
unfortunately not standard.
I think it should be,
and I wish that that would
change because it's so, so powerful.
I don't think they're better incubators,
but I do think the
knowledge you gain is
really important when
you're growing embryos under a camera.
And just to add to that,
as a non-professional in this world,
I think you routinely say from a clinic,
you have clinics you have
worked at in the past which
didn't have time lapse to
where you are now with time lapse.
You keep on routinely saying
it is revolutionized.
Oh, it's totally changed my world.
And actually what I
understand and actually for
everyone like work life balance as well.
It's not just I mean,
the embryos are undisturbed.
But I can actually see them from home.
I could click off here right
now and look at all the
embryos in both clinics in
London and just make sure
everyone's there.
And I do.
It's quite sad, isn't it?
I do that every night before I go to bed.
Honestly,
what should you be advocating for?
So for me,
I would be advocating for
blastocyst transfers.
A lot of clinics are still
putting embryos back on day three.
And if they are, I'd like to know why.
Okay, okay.
So you've jumped into full
on technical terms.
You said the word day three,
what the heck does that mean?
You've said the word blastocyst.
What the heck does that mean?
So what is the difference
between day three and blastocyst?
Why don't you say day something else?
So embryos start on day zero
for egg collection.
Then we go to day one,
which is when they are fertilized,
and then they grow and they
start to make cells.
And they go one cell to two cells,
two cells to four cells, four to eight,
eight to 16, 16 onwards.
And then once they get to
day five or day six,
they are called blastocysts.
You cannot bypass that stage.
The blastocyst is the stage
an embryo reaches primarily
just before it is ready to
create a pregnancy.
If you have a group of
embryos that all look the
same on day three,
there is still the
opportunity that some of
those embryos will not
carry on developing to a
stage that will make you pregnant.
It's called embryo arrest.
It is why people get this
misconception that they're
not getting pregnant
because they're not getting
fertilization.
It's probably not what's
happening because
fertilization is probably
going on when you're trying
to conceive naturally if
you are in a position where you can.
What's probably happening is
the embryos are failing to
grow inside you just like
they are in the dish.
We're just watching it happen.
So my question is,
why are clinics
transferring inpatients that have four,
five, six, day three good quality embryos
Why are we randomly selecting?
Why don't we wait longer and
have the knowledge of which
ones are going to grow?
If the incubation is good,
which in the UK it is incredibly good.
I'm not going to talk about all countries,
but the US, Europe, the UK, we're very,
very good at embryo culture.
We all very much use the same techniques.
Embryos will grow to the
blastocyst stage in a laboratory.
And therefore,
instead of picking embryo
one on day three,
which then went on to fail,
you pick embryo three at day five,
which has already shown you
it's much better to work.
So my question to,
my answer to that would be,
what should you advocate for?
Blastocyst transfers, blastocyst culture,
the opportunity to have
your embryos grown,
the opportunity to have,
if they get to blastocyst,
then you are in a position
to do genetic testing on
them if you want to.
And this comes down to what
questions do you ask your
clinic when you walk in the door?
When do you transfer my embryos?
Will you make me have a
different transfer if my
transfer was to fall on a Sunday?
Interesting.
What day do you do egg collections?
Because they're scheduling
them for their workload
rather than your needs.
So those things are on my lists.
And to add to that,
does your lab have time lapse?
Time lapse is a great benefit.
I don't think it's a deal breaker.
It's a great benefit if
you're coming to this and
you've got very complex
facility problems.
I think you need time lapse.
I don't think you need that
if you're coming to this day to day.
But I think day three versus day five,
I have known clinics to
give different options to
patients based on when
they've had their egg collection.
That is not your fault.
If you've had your
collection on a Tuesday,
you're automatically booked
for a day three transfer
because no one's working on a Sunday.
That's not fair.
Yeah, that's not fair.
So why,
if you're having your air
collection on a Wednesday,
are you allowed a blastocyst transfer?
Do you know what I mean?
So that's on my list.
Yeah, great question.
Or great questions to ask a
potential clinic that
you're going to work with.
Okay, let's jump around here.
Let's jump back to the chat, shall we?
Okay, which one should we take here?
There was one right at the top.
Oh, yeah.
Okay.
You tell me when to stop.
Keep going.
Danielle was the first question.
So let me ask the question.
So Danielle, apologies,
we missed this question a
little bit earlier on.
So thanks for waiting
patiently for us to jump on
this or for Emma to jump on this.
So Danielle asks,
what is the difference
between clinics that are
cheap and those that are expensive?
That is a great question.
Primarily running costs.
And the running costs are
going to be the difference
between the lab having time lapse,
the skill of the staff,
a seven-day service,
the blastocyst culture,
the ability to do PGTA,
the ability to offer genetic testing.
All of those things
extortionately inflate your
running costs.
So that doesn't mean...
you may need to go to an expensive clinic.
That means you have to have
the questions to ask your clinic,
to make a decision about
what treatment you need.
So I will say from
experience that there is no
such thing as budget IVF.
It is an expensive process.
the, I could say, I mean,
maybe I'll do that one day
and just like literally go through what,
how much we need,
like even to freeze embryos
and hold them in tanks
costs thousands of pounds a
week just to get the liquid nitrogen.
And I mean, it's,
it's unfortunate is an
incredibly expensive business,
which is why the NHS don't
fund it as much as we need them to.
Um, but that is it.
That is what you will find
is you'll find that maybe you're
your less expensive clinics
will have just have air
collections on Monday,
Wednesdays and Fridays.
Is that what's best for you?
What if you needed a
collection on a Saturday or a Sunday?
Is that going to ruin your
outcome if you don't get
your air collection?
Now,
there's definitely a bit of wiggle
room with air collections,
but there's not four days of wiggle room.
So, you know,
between air collection on a
Friday and air collection
the following Monday,
that's a lot of days.
So those are the questions.
That's the difference.
Yeah.
Yeah.
And I guess the level of
patient care as well outside of the lab,
you know, the doctor's experience,
the nursing, the counselling.
We haven't talked about counselling.
So that's another question
that's on my list.
That's on my list.
Because there isn't actually
a different answer there.
Your question to your clinic is,
do you provide counselling?
And if the answer is no...
then they're breaking the
code of practice.
You have to provide counselling.
We have to offer you counselling.
And to clinics,
they can offer that either
externally or they have
their own internal... Yeah,
we've got an external counsellor.
But yeah.
Yeah, gotcha.
But that's on the list.
Yeah.
And who sets that kind of counselling?
Is that just code of practice or the HFPA?
HFPA say that we all have to
offer counselling.
So for those who are unfamiliar,
HFPA stands for?
Human Fertilisation and
Embryology Authority.
It's the people we're
governed by through the government.
It's a government,
it was a 1991 parliamentary act.
Yeah.
They changed their rules
quite a lot and we all
scrabble around to keep up.
Yeah, of course.
Yeah.
But they state that you have
to offer some form of counselling.
We have to.
Yeah,
we have to have connections with the
counsellor.
Yeah.
Brilliant.
That's very important.
Thanks for your question there, Danielle.
That's a really good one.
Right.
I'm doing a quick time check.
So we have about five minutes.
So let's see where we're at
with questions coming
through on the chat and questions.
Yeah, let's take this one from Danielle.
So what tests can be done
before an embryo transfer
to ensure the highest
chance of a successful
implantation and pregnancy
with endometriosis?
Okay,
I'm going to remove the endometriosis
because it's quite a
contextual derived thing.
What things can be done to
do with implantation?
So you could look at the
genetics of the embryo, which is the PGTA,
which we tend to do in
women over the age of 37.
PGTA stands for?
Pre-implantation genetic
testing for aneuploidies,
which is women of advanced maternal age.
They tend to make more
embryos with genetic testing.
information problems.
So you can have your embryos
tested to make sure that
the embryo you're
transferring is viable for pregnancy.
just to jump in before you
move on we episode three of
hatching a plan if you come
back to an earlier episode
because we like to do
things in order because
well I mean we go in all
sorts of orders seriously
we didn't plan this one we
didn't but we have done an
episode on pgt and it's
definitely worth checking
out we could probably do
about three or four
episodes on pgt it's a
massive topic but if you're
unfamiliar with pgt
and it's something that you
may have to consider,
or it happens to be
something you're interested in,
do go back to episode three
of Hatching Your Plan.
You can also do,
so if you are having
recurrent implantation
failure and everything else
has been ruled out,
you can do what's called an
Emma and an Alice.
I'm not going to pretend to
know what it is.
It's definitely to do with
something with the
microbiome of the uterus
and the receptor.
You can do a receptivity assay,
although that's been a bit
poo-pooed by ASHRAE,
which is the European
Society of Human Reproduction recently.
There are also things like hysteroscopies.
You can look inside
someone's womb to make sure
that everything looks normal,
that you can't see on scan.
So there are actually a lot
of tests that can be done
to check the implantation
possibilities if something
is happening and there is
recurrent implantation
failure with good quality
assumed normal embryos.
Great.
Okay.
Thank you for that one, Danielle.
We've got time just for one more.
So let's get this one in from Lou,
who Lou has also said,
looking forward to the list.
Ah, good stuff.
I'm looking forward to the list.
I've got to write it.
It's a mega list,
but we're going to get it out there.
So Lou asks,
if there are lots of
unexplained round cells in the sperm test,
does that need to be
investigated before heading to IVF?
If so, how?
Yeah,
so it depends what the round cells are.
So round cells in sperm
samples are either germ cells,
which are the most immature
sperm cell that you can have.
or they're infection cells
so they're white cells the
problem is that you need to
stain them to see the
difference either scenario
you shouldn't have round
cells in your sperm sample
you you have a few everyone
has a few but not if you've
got loads you need to be
seeing a urologist so to
check there's a no
infection and if there is a
load of germ cells in there
where they're coming from
because that's to do with
testicular function so I
would be checking that
you've had you can need to
get them identified as what they are
if you can and you need to
see a urologist to find out
why they're there yeah so
specialist urologist can
look into that yeah got it
thanks for your question there lou
Should we take this one?
Should we break the rules and go over?
Yeah, let's do it.
And hopefully, folks,
you can stick around.
We're just going to do one
more question and then
we'll wrap up for today.
And this question comes in from Kate.
How best to prepare for an egg retrieval?
Anything I can do to.
Oh, I wish I wish it was.
I wish it was that straightforward.
Like I said,
I think if you've got the time,
then we always say try and
invest in the three month prep.
if we can,
if you haven't got the time
because age isn't on our
sides all the time,
the best thing you can do
is take your meds on time,
drink loads of fluids,
make sure you stay hydrated
because I think one of the
questions I had on
Instagram actually was how
crap are you going to feel?
People feel different.
Like some people breeze
through it and they're fine.
The emotional stuff's the hardest bit.
Some people find that they
make them really groggy.
The best advice I can give
you is keep your fluids up
as much as you can.
Three, four liters of fluid,
just like drain it all
through your kidneys.
um anything you can do a lot
of it's going to be out of
your hands which is
incredibly frustrating all
you can do is do like
literally do the meds as
you're told make sure you
turn up your scan
appointments get your
bloods done and then follow
follow all the information you're given
yeah and get the support you
can um from a sort of
mental health perspective
oh yeah absolutely there's
lots of that so we can we
can point you in the right
direction so absolutely
okay folks well god I could
have done another hour of
that I think we could have
done another well is there
let me ask you one more
question is there a
question I haven't asked
you or the audience haven't
asked that you think I
should have asked or should
have been asked
um I think that the bit at
the beginning probably
needed to be said a bit
more when you said what is
the one thing that is what
did you say the hard truth
I think there's more than
one hard truth yeah and I
think that unfortunately
for patients where you have
your treatment is a massive
factor in your outcome and
I feel really sad that
that's the case yeah
But I'm hoping that by doing
this and highlighting that
that's the case,
people can get the list
because the list is going
to come because I need to
put it together.
And then you can try and
understand this a bit
better so you can make informed choices.
And I get it.
Not everyone gets to choose
where they have treatment,
but at least you can know
what that looks like so I
think the hard truth is not
only that it doesn't always
work it really can depend
where you go to how well
you are looked after and
what the chance of your
success is and please
please be aware of the
cherry picking that goes on
yeah because it happens
yeah good honesty good
honesty and you know fair
play for you to share in that
so folks we're going to wrap
up now um so thank you so
much to everyone who has
joined us live and thank
you to you the listener if
you'll listen to this as a
recording on the podcast so
please do come back to this
again we appreciate that
emma has shared a whole ton
of helpful information so
this will be available on
youtube if you just search
for emma the embryologist
on youtube you can follow
the podcast there
Or if you look up Hatching a
Plan on all your popular
podcasting platforms.
Alternatively,
you can go to
hatchingaplan.transistor.fm
and that will give you a
link to all of the places
that you can get access to this.
So we've done, well,
this is our fourth episode.
So we've also got choosing a
fertility clinic.
So understanding the Vienna consensus.
We've also got everything
you need to know about donor sperm.
Plus, as mentioned earlier on,
we've got one on PGT,
so pre-implantation genetic testing.
And as a reminder, actually,
Emma shared on Insta,
so if you're not following
Emma on Instagram,
it's Emma the embryologist.
Emma shared that for one
person who signed up,
you're going to pick a random person,
aren't you?
You're going to offer just a call.
So just jump on a call.
Have a chat.
Emma can answer your questions one-to-one.
Because we're so grateful
for everyone who has signed
up to this session.
And we do wish you very, very well.
Please do stay in touch.
Stay connected with Emma.
Genuinely,
of course I'm biased because
we're a couple.
But she genuinely lives and
breathes this world.
It is her absolute passion.
Since you thought when you
were a 15-year-old person,
I'm going to get into this
and this is going to be my life,
my career.
So this is about education.
This is about supporting
each other and looking out
for one another.
And Emma does that day in, day out.
She lives and breathes this.
So please do continue to
stay connected to Emma.
She is an awesome human
doing good things for good people.
But yeah, thank you.
We're going to sign off now.
And yeah,
please do keep the questions coming.
Keep in touch.
Take care.
Take care, folks.
Thanks.
Bye.
Bye for now.