Hatching a Plan

What is IVF and who is it for? What does a full IVF cycle look like? What is the lowest AMH for IVF? What injections are required? Plus many more questions answered during this insightful episode of Hatching a Plan with Emma the Embryologist and her husband, Simon Tomes. Follow up by reading 10 essential questions to ask during your IVF consultation.

Creators & Guests

Host

Emma Whitney

Director of Embryology and Genetics

Host

Simon Tomes

Technologist and Community Professional

What is Hatching a Plan?

Ever wondered what goes on behind the scenes in fertility treatment? Join Emma, the embryologist, and her husband Simon for a down-to-earth conversation about making dreams of parenthood a reality. Each episode dives into the science of embryology in a way that's easy to understand, empowering you to ask the right questions on your fertility journey.

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.

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.

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.

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.

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

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