Hatching a Plan

Are you considering IVF or other fertility treatments? Feeling overwhelmed by the process and clinic options? This episode is for you!

Join Emma, a highly experienced embryologist, and her husband Simon for a casual and informative chat. They'll be diving deep into the world of fertility, specifically focusing on the Vienna Consensus.

In Episode 1 of Hatching A Plan, you'll learn:

- Who Emma is and why she's passionate about fertility education
- What the Vienna Consensus is and why it matters when choosing a fertility clinic
- How the Vienna Consensus can empower you to make informed decisions about your fertility journey
- This episode is packed with valuable insights you won't want to miss!

Plus, there's more! Throughout the video, Emma and Simon will be answering questions submitted live in the comments.

Stay tuned! This is the first episode of an exciting new series.

Like and subscribe. Thanks for watching.

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.

Hello and good evening, good day,

wherever you may be.

My name is Simon.

Yours is worse than Instagram Live.

Pleased to meet you.

My name is Simon Tomes.

I am Emma the Embryologist's husband.

So this is exciting stuff, right?

Our first one.

Yeah.

It's quite clever, isn't it?

It's great.

So I can see this is the

first time we're using this tool.

And we can see we've got

seven people joining us today.

Thank you very much for joining us.

If you want to post... Nine.

Oh, nine.

It keeps going up.

Hey, good stuff.

We'll hit double figures in a bit.

Sorry,

this will get really serious in a minute.

But any of you that know me

know that this is just my edge way in.

But this is wonderful.

So we have Kelly from Rochester and Kent.

Hannah, we can hear you.

Thank you very much.

And Cheryl and Emma.

Hi from Lincolnshire.

Well,

hello from Teddington in Greater London.

We are not in a clinic.

We are not in a laboratory.

We are not in scrubs.

We are in our lounge.

So just to say that my background,

I am in tech and community,

so I am not a medical person at all.

This is all about Emma.

My role here is to host

today and to ensure that

your questions can come in.

and that I can ask them to

Emma and we can have a

conversation to help out

you know this is about

education and I guess yeah

maybe just before we jump

into the topic yeah Emma

like for those that might

not know you could you

briefly give a summary of

who you are and also why

we're here like take a step

back from this particular

topic but why you do what you do

Okay,

so I think most people will have a

clue of who I am.

I'm Emma.

I am an embryologist with 20

years experience,

currently working as the

lab director of the Evewell

Fertility Clinic,

which basically means I

oversee both sites on the

laboratory basis,

look after all the embryologists.

I have a team of about 15 on two sites.

Why are we here?

We are here because

throughout our journey to parenthood,

and throughout my time in

the last 20 years of doing this job,

I think that it is time

that the patients have an

opportunity to know

everything that they need

to know to make informed decisions.

I have spent many years in

an incredibly large clinic

and it wasn't until I

stepped away from that that

I realised that actually

the face-to-face patient

care made me realise that

people really don't

understand this and that

made me really sad.

I don't want our children to

grow up in a world where

they don't have access to

what they need to make

informed decisions about

their lives whether that be

from day to day and I'm a

fertility expert so I

figured that if I'm going

to do this I should do it

and if anyone's ever heard

me speak before I use the

term stay in your lane

quite a lot so that's why

we're here because I think

that the more I get into

this the more I realize

that people really don't

have the you don't know what

you don't know so my idea

is to be able to give you

what you know so that you

can make the right

questions and conversations

around what you need to know

Absolutely.

And Emma, so I, you know,

Emma lives and breathes this right.

And I'm here to advocate for her, you know,

living with someone who's

so passionate about the

world of fertility and like

just straight up cares so

much to make the life of

her patients and even, you know,

people that she's never met

before through her Instagram account,

Emma the embryologist,

if you're not following.

just helping people out like

I think like your your

reason you're on this

planet I mean there's loads

of other reasons why you're

on this planet but that's

certainly one of them so

yeah it's a real privilege

to kind of Emma is so

passionate about this right

so it was really uh hey

let's just go for it let's

start start doing webinars

let's start doing a podcast and this is

essentially the first one

isn't it and we'd like to

welcome you to our

experiment because none of

we didn't actually know if

it's going to work so

anyway let's go yeah let's

do it so this is recorded

um so if you do want to

come back to it another

time please do um we'll put

out links to it through

emma's instagram account um

yeah come back to it whenever

I think it'll stay up for as

long as we say it can stay up for.

And yeah, spread the word.

Please share this with

others who you feel will

benefit from learning about

the Vienna Consensus and

what it means for selecting a clinic.

Yeah, it's an important topic, right?

So should we dive in?

So the way this is going to work,

we get to a point where we

will ask you to ask your

questions and you can do

that in the comments.

But before we do that, I was thinking,

like, let's start super high level.

So Emma,

what is the Vienna Consensus and

why does it matter?

So the Vienna Consensus was

created in 2017 by,

basically they shoved a

load of us in a room at an

ESHRA conference.

I'd say us, I wasn't there.

So ESHRA for the audience

who doesn't know what that means.

ESHRA is the European

Society of Human

Reproduction Education and Embryology.

can I remember what that

last d I should know this

anyway I think it's

embryology anyway it's a

conference that happens

it's it's a very very

massive european conference

that we all um fight over

going to because it's it's

actually an amazing

conference this year it's

in amsterdam they put a

load of people in a room

and they basically said

right enough's enough um

you guys need to come up

with standards you need to

come up with standards

about laboratory practice

you need to have

And those standards have to be set from,

you have to encompass all demographics,

you have to encompass all the people,

you have to encompass all

different warps of

fertility and everything.

And obviously they are averages.

Not everyone will fall in them.

Some people will go lower,

some people will go higher,

but ultimately the reason

they set these standards

was so that we had what we

call key performance

indicators that we could

then all work towards.

And we set our own key

performance indicators within those

figures that if we fall below,

we are legally bound to

start raising an incident

report with the HFEA.

The HFEA uses the Vienna

Consensus to monitor clinics.

And just to jump in there, HFEA,

for those who are unfamiliar?

It's the Human Fertilization

and Embryology Authority.

I do know what that stands for.

Okay,

and that is for our international

listeners who,

because we're based in the UK,

That's the UK regulator, is that right?

Yeah, it's a bit like the FDA in America.

It's a bit like, there's lots of different,

but our regulator is the HVA.

It's an incredibly tight

entity that gives clinics

licenses and allows them to practice.

We're also regularly inspected.

And on one of those things

that we're inspected on is

key performance indicators

that we have to set out as a clinic.

And that all came from the

Vienna consensus.

The Vienna consensus broke

down every part of

laboratory practice into

things that have that you

can as a clinic affect how

many eggs a patient gets.

We can affect that because

we've got to have certain

stimulation protocols and

the skill of our doctors

and the understanding of

your own personal reproductive health.

is what affects that.

So you have those standards,

which comes from probably

the medicine side of things.

But once it gets to eggs collected,

number mature, number fertilized,

number usable, number frozen,

number surviving,

all of those things are

essentially handled by the

embryology team.

And so the Vienna consensus

was developed so that all

embryology teams had a standard to meet.

But I find it astounding that first of all,

it's called the Vienna Consensus.

And I guarantee half of the

people who watch this won't

even heard of it until last week.

And actually,

it 100% correlates with your

potential outcome of having

a baby in a clinic.

And so I personally, instead of,

we'll probably get there

with all the questions in a minute,

hopefully,

but I would like to see it

regulated heavily.

It is regulated to a certain extent.

But my question, as always,

is why is it not open

freedom information?

why don't people know this

why don't they know what

anyway let's carry on

because I could just talk

no that's cool that's cool

so hopefully folks that

that's kind of a good

introduction to it and that

yeah that makes sense um so

yeah so this is your

opportunity to to get your

questions in we're gonna

try uh I was gonna try our

very best to go for it we

have up until the end of the hour

So let's see how we get on.

So yeah, if you're feeling brave,

and you've got some questions,

like just absolutely go for

it on the comments.

I'll bring the question up on screen.

So that's there for reference.

And then we get started.

So yeah,

please have a think if you've got

a question for Emma related

to the Vienna consensus and kind of,

you know,

why that is important in your

choices when it comes to

selecting a clinic, please do go ahead.

yeah I mean we've I could

got some more questions to

to keep us going there m

but uh yeah let's let's see

if we get a few more in

from the audience I'm just

going to check to see if

anything's coming through

not at this stage but

that's fine okay well let

me let me ask a question then

So this is something that,

so you keep banging on

about live birth rates and

your view that they

shouldn't be the only thing

people focus on.

So live birth rates,

they shouldn't be the only

thing that people focus on.

Why is that so?

Because the only opportunity

that you have of having a

live birth rate in any

clinic is if you have an embryo

in the first instance and

when you walk into a clinic

and ask a clinic what your

live birth rates are even

if you give them an age

group which is great like

live birth rate is

absolutely important I'm

not saying it's not

important it's part of the

vienna consensus but you

have to get an embryo

before you get the

opportunity to have a live

birth so the questions we

all should be asking really

is what are my chances of

getting an embryo and then

If I get an embryo in your setting,

how likely is that to lead

to a live birth?

You've got some questions now.

Yeah, yeah, yeah.

You got more on that?

No,

because I think actually the questions

I can see coming in are

quite linked to where I'm going to go.

This is wonderful.

So Archna, thank you so much.

Can you run through the

funnel stats briefly again?

Sorry, I missed the beginning of this.

No worries at all for

missing the beginning.

All good.

So let's get that one up on screen.

So if anyone's following my Instagram,

you'll know that I talk

quite heavily about the funnel.

So everyone everywhere going

through any type of fertility treatment,

whatever that looks like,

even if you're trying to

conceive naturally,

there is essentially a

natural funnel or a funnel.

You have a group of eggs.

So many of those eggs will fertilize.

So many of those eggs will

make competent embryos.

So many of those embryos

will be genetically viable.

And at the end,

you get your pool of usable

embryos from each cycle of treatment.

So you get 12 eggs.

Depending on how narrow your funnel is,

you could either end up

with one or two blastocysts,

which is the stage that

embryos need to reach to

make you pregnant.

Or you may be really lucky

and end up with six or seven.

Now,

a lot of that is going to be governed

by your own inherent demographic.

Why are you sat in a clinic

in the first place?

What is your reason for being there?

What is what is your age?

What's the cause of infertility?

And a lot of that governs

how that that funnel looks.

But also a lot of it's

governed by the Vienna consensus,

because if a laboratory is

performing at what we talk

about as a benchmark value,

you're definitely going to

be better off with the

start of that funnel,

knowing that regardless of

your demographic, remember,

all clinics see all these demographics.

So averages do mean something.

No one is absolutely going

to fall into those averages, definitely.

And there's always going to be outliers.

But ultimately,

if your starting point is a

good benchmark clinic,

then your funnel will

hopefully not be as narrow

as in a clinic that's

underperforming or competent.

As we say,

underperforming is probably a

bit unreasonable.

Competent values are very good,

but it's important to understand that.

you know,

12 eggs in one clinic might only

lead to eight mature eggs,

and that's all gonna be

governed by how well you're

looked after through your

stimulation phase.

12 eggs in another clinic

might mean you get 11

mature eggs because maybe

you were better monitored

in a different clinic.

That, essentially,

your start of your funnel

already is bigger.

And then you've got culture

conditions in lab and stuff like that,

so.

So if I'm going into a clinic,

what sort of questions

should I ask that are

related to the funnel?

Like, do you say, you know,

what does your funnel look like?

Or is it like... This is really tricky.

And I think that's what

Cheryl's asked here is,

I think the next question,

you can probably put that on the screen.

So I think that's really

important because I think

this is where... Thank you, Archana,

for your question.

This is where we are going

to... This is where we

struggle because...

If you were to ask this.

So Cheryl's question is,

how should we use this to

assess a clinic?

Should we be asking clinics

to tell us if they fail at

any of their KPIs?

Great question.

So yeah, actually,

it's a really good question.

And it's really hard because

you will get this really cagey response.

If you walked into my clinic

and asked me this,

I can give you everything,

like literally on a page of

everything I've got.

do them quarterly most

clinics do them quarterly

and then we have to do them

annually regardless and

they have to be broken down

into ICSI for IVF

fertilization embryo

development all the things

I've outlined on the Vienna

consensus I have to do

every quarter for every and

I actually break it up into

age because I think what

the Vienna consensus misses

quite a lot is an age

reference the only age

reference they give you in

the Vienna consensus is to

do with implantation rate

which I get that because

they don't talk too much about PGTA

But ultimately,

it has to be said that your

funnel as you get older gets narrower.

So I don't think it's 100%

fair that every clinic is

expected to eat a benchmark

60% blastocyst formation if

the patient is 43,

because they're not going to.

You know,

you will get a narrower funnel in

the higher age group.

So I think the Vienna

consensus misses that.

But ultimately, your answer is yes,

the data should be there.

Whether or not they will

share it with you is, I would,

but I find it,

it's a difficult question to ask.

And I appreciate, but it is there.

They have to have it because

it's part of our code of practice.

It's part of our legislation.

And just quickly for our audience,

you mentioned the word PGTA.

What does that mean?

PGTA is pre-implantation

genetic testing for aneuploidies,

which we can get onto if

anyone wants to talk about that later.

But that's just another tool

that we use to iron out

that bottom of that funnel

to see how many of the

embryos are usable.

Definitely in women over 37, 38,

we start to use that quite a lot more.

Got it.

Great.

Hopefully, Cheryl,

that helps answer your question for now.

But yeah, keep them coming.

If there's more questions

off the back of what Emma's sharing,

keep them coming.

Okay, so we have Jennifer J. Thank you,

Jennifer.

Will all fertility clinics

have this data available?

I guess... Yeah, they must have.

They must have.

And the problem is they

absolutely must have.

We have...

Like, so imagine your life.

So my life birth data, for example,

I've got everything up to mid 23,

because you're still

waiting for babies to be

born in the latter part of 23.

But I've got all my clinical birth data,

which is heartbeats from

embryos transferred right

up to March of this year.

So that sort of data is

something we're monitoring

I mean,

I'm doing it weekly or every other week.

That's part of my role as a

director of two clinics is

I have to keep an eye on all of this.

But every quarter we will do

fertilization rates and stuff like that.

And I think it's really important to, yeah,

we have it.

So like I said,

but whether or not they'll

share it is another matter.

So there's no like, what is it?

Sort of the GDPR kind of

data requests where people

can actually say, no,

you have this information.

um I guess it's not on it's

not the patient's

information it's just

information you've you've

collected through your

treatment so so a data

request they can't make

their requests because it's

not on so what's really

interesting is about all of

this the hfea have it all

because every time we make

an embryo every time we

collect an egg every time

we make an embryo every

time we transfer an embryo

a form goes off to the hfea

it's called a treatment form and um they

have all the information

from every single clinic.

So why can't they release it?

Because they can't pull data

together properly.

I didn't say that.

Okay, that's an unofficial line from Emma.

Maybe we can get on to the

HPA and data a little bit later.

But that's a good one to dig into.

Thank you, Jennifer, for your question.

So comment from Hannah.

Thank you.

We've not heard of this until last week.

We've been going through

fertility treatment on offer nine years.

We have gathered so much

information since following you.

Thank you.

You're very welcome.

And that makes me really sad,

but thank you.

And that's why, I mean,

it's comments like that

that make me realise how

needed this all is.

You shouldn't be going

through fertility treatment

for nine years without actually, I mean,

someone that's been going

through fertility treatment

for nine years can probably

tell me I have to do my job because it's,

you know, you've done it so much,

you understand,

but I think it's the real

nuances of how that then

equates into how many

embryos anyone ends up with

and I think it's it's

trying to change that

mindset that we are not all

created equal the skill set

is different and I get it

not everyone gets to choose

a clinic and I think that's

really important that we do

touch on that I get it we

debate this a lot about

that yeah but you still

have a right to know what

your particular chances of

conception are and what

challenges you're going to

face regardless um and I

think that data should be

readily available I mean things like

Maybe you should,

because I'm just going to

keep talking otherwise.

No, no, no.

Go for it.

We've got another 40 minutes.

We're all good.

So, yeah.

So I think it's,

I'm not saying any of what

I'm presenting to you is easy,

but I do think it's

relevant to understanding

what goes on behind that lab door.

And KPIs have the effect of

changing people's outcomes.

And there are always going

to be dependent on,

let's talk about NHS clinics.

They are,

the NHS is chronically underfunded.

Um, and I feel desperately sad about that,

but it does mean that their

ability to monitor patients

through stimulation is not

as good as say someone like ours,

where we've got a mixture

of consultants and we've

got access to more care and

we've got access to the

bigger and better

incubators and all of that.

So, and yes,

it pisses me off that that's

the way the NHS is,

but that's the reality.

So I think if you are in a

place to choose your clinic

and you're actually delving

into that private fertility world, then.

you should know this yeah

absolutely yeah just more

transparency and I think

that you know your whole

point about education it's

just because there's a you

often talk about how

overwhelming it is for your

patients or potential

patients it's horrible

And like, yeah,

you go on Google and you

get scared and you're

like... Don't go on Google.

Don't go on Google.

Please don't go.

That's why I do it.

Please don't go on Google.

There's a really awful

grading chart on Google

that I want ripped down and

I can't seem to get it

taken down because it's so awful.

Oh, really?

Yeah.

It's so awful and people

keep quoting it and it

makes me so sad because

it's not even an acceptable publication.

But it's like if you type in

embryo grading,

it's the first thing that comes up.

Please don't.

Maybe we could do a post on that.

I've done one before and I

will do it again because it's really bad.

Anyway.

So do not trust this data.

Well, I mean, that's the thing, right?

If these things get

attention and the search

engines start surfacing them,

then we've got to find a

way to counter that by

sending out information

that's actually correct.

Got it.

Okay, so thank you for that, Hannah.

So Adele Johnson, from what you said,

does that mean that the

results are not available to the public?

Yeah.

Could the public get access to this data?

Okay, let's bring up on screen.

Great question.

Thank you.

I mean, great question.

The answer is you can't, the

The HFA are five years

behind on their live birth

and clinical pregnancy rate data.

They are in a bit of a

pickle is a very polite way

of putting it at the moment.

What's happened to give you

some background is in the

last five or six years,

they have changed their

data submission platform to

encompass all the different

electronic or medical

record systems we are using.

Now, when I started embryology, which was

in ancient times 2002 we

used to have to fill out

for every single patient

imagine the transcription

errors if you can like

imagine just for a minute

they were these forms that

came as triploid we used to

carbon copies we used to

have to fill out every

single patient cycle

on these like hfea forms and

it would be name patient

number how many eggs you

collected how many

fertilized how many embryos

were so manually

handwritten manually

handwritten and this is all

about like but basically

you've got to track every

embryo that we make because

then we've got to talk

about how many fertilized

embryos were discarded

because they didn't grow x y and z

We used to do that manually

and one carbon copy would go in the notes,

one carbon copy would go in

the archive and one would

go in a sealed recorded

envelope that went to the HFVA.

So over the years what's

happened is finally clinics

are starting using

electronic medical records.

We use Meditex,

there's something called Ideas,

there's something called Baby Sentry,

there's another one called

MB App and all of this.

And what's happened is

because we're all on

different platforms but

we're all collating the same data,

The HFVA have had to change

their data submission platform.

So what we should be able to

do is put all your data

into our electronic records,

which is what we do under

your name as your patient record.

And then we should be able

to press a button that says

send and it should go off

to the to the HFVA and they

should be able to collect that data.

Now,

what we have to send them is when you

start treatment,

we have to tell them that you go back.

We have to tell them that

you've registered with us as a clinic.

Oh, really?

We have to upload all your CD forms,

consent of disclosure.

We then have to tell them

that you've started treatment.

We then have to tell them if

that treatment went ahead

with an egg collection or

an IUI if it's with donor sperm,

for example.

The reason I say that is IUI

husband partner isn't licensed treatment,

so that's not reportable.

IUI?

What does that stand for?

IUI, intrauterine insemination.

It's only reportable if it's donor sperm.

because you're using a donor

gamete by the by.

So you have to tell them

when you've had treatment,

you then have to tell them

what that treatment happened.

So how many eggs, how many were mature,

how many fertilized, how many embryos,

how many frozen, how many discarded?

Did you biopsy them?

Were they normal?

All of that goes into the

form that goes off.

And then if there is an embryo transfer,

we then have to do what's

called an early outcome form,

which is positive negative test.

And then if there's a clinical heartbeat,

it then generates a

treatment outcome form that

we're then expected to fill

in within 52 weeks to tell

them whether a baby was born or not.

Okay, does that make sense?

So there are like eight forms.

So what's happening,

we're all working on these

different medical systems

and the HFEA are a

government entity who are, again,

chronically underfunded.

I'm not blaming anyone in HFEA by this,

by the way.

They're actually wonderful humans.

but it's the it's the

practice that's just really

badly managed and what's

happened is the data

submission isn't going off

as supposedly streamlined

as it should and from what

I've been told we are going

to be nearly six years

behind before you as

patients get any published

data now I think the aim

from what I've heard is to

make all of this quite

transparent I think it's

what we all want we want you to know that

like I actually would like things really,

really highlighted about

multiple birth rates in clinics,

because some clinics are

over inflating their stats

by putting more embryos back.

So they look like they're

getting higher life birth rates.

But when you actually click

in the right place,

and see that 30% of those are multiples,

you then need to question

whether you want to be in a

clinic that's ethically not

practicing in my mind correctly.

So the risks of multiple is massive.

Yeah, yeah.

So that's what I think is happening.

That's what I know is

happening to the data submission.

But whether or not this will

ever catch up in a place

where we can answer your question,

Adele that says,

will it be available to the public?

I think that is aspirational

at the moment.

I really hope we get there.

Because they've got it all.

They've got every we have to

tell them what happens to

every single egg that is collected.

wonder it makes you think

like how as as the general

public we can lobby this

stuff like and I know you

know you have respect for

hfea and they're

understaffed underfunded

like many many institutions

out there but I wonder if

you know through our local

mps or through another body

we could all lobby and just

keep saying come on like

give us an update on we do

that quite a lot well yeah

but of course clinics do of

course you do but as the general public

you know come at it from

both sides and just kind of

push to say look how you

know what is the roadmap

for your you're getting

your data up today and just

keep on asking like what is

the roadmap give me at

least some sort of idea

yeah I've been told it's

this year but I also know

that there's so many

problems I don't think it

will be this year

Yeah.

Good question there, Adele.

Thank you.

Right.

Let's jump on to the next one.

So Kelly HP.

Here we go.

So if we had 18 follicles,

but only seven eggs,

what could the reason be?

Would that be considered low

by the standards set?

31 year old.

So this is a KPI.

So the KPI for this which

you're talking about is

part of the Vienna

consensus is eggs collected

from follicle seen of over

a certain diameter.

And I think, off the top of my head,

it's 12mm.

So, again,

you've got so many reasons that

you are...

not getting eggs from

follicles right so there's

this is what I said about

close monitoring so you've

got 18 follicles there that

will hopefully grow

together in a pattern um

but we sorry I'm just

reading down simon show me

you've said something yeah

I'll lead on to that that's fine so what

The follicles can actually,

if you're not closely

monitored or your body just doesn't do,

I mean, I'm not, like I said,

this isn't me sat here

saying no one's doing their job properly.

That's not what I'm saying at all.

There are reasons that if you do not have,

I think you should have

four or five scans during an IVF cycle.

There are some clinics that

will do two and don't even do any bloods.

I think that that is the

scale where things can be

quite detrimental.

What's the reason for that number?

Why four to five?

So because you would have a baseline.

You then have one at day six.

You have one at day eight, ten, eleven,

maybe even one at day twelve.

Anyone that's done stim, stimulation here.

I don't expect you to understand it.

We'll understand that that's

why I was watching your

follicles and trying to

tweak your drugs to make

sure the group of 18 that

Kelly's got are growing together.

If you don't monitor carefully,

what you end up with is

pools of follicles, some up here,

some down there,

and these do not ever mature.

So Kelly,

what might have happened is you

had a group of seven or

eight good ones and they

got those out and then

unfortunately the others were just not.

I see.

grown enough or they

couldn't access them I

don't know whether that's

ever been discussed if you

can't access an ovary that

does happen again this is

something that should be

discussed before you go to

egg collection um I don't

believe in empty follicle

syndrome there's not enough

evidence for it there

you'll definitely have the

odd one or two that doesn't

have anything in it but no

so my my thought would be

that just maybe the

hormones that they were giving you were

didn't grow them together in

the right diameter.

But this is a KPI.

So one of the KPIs we have

is percentage of follicles

collected and eggs retrieved.

That is one of the first

Vienna consensus KPIs.

And I think in a competent clinic,

it's 80%.

And I know in ours, it's over 90.

I think it's 94.

So yes, Kelly, I think it's low,

but I think there's too

many questions in my head as to why.

However,

what you've gone on to said is

that six fertilized,

which is an exceptionally

good fertilization rate.

but they haven't worked,

which I'm really sorry about.

So it'd be interesting to

know how many embryos you

ended up with because the

grade of your best one looks fine.

And if you've heard me talk before,

it's all about day five, day six.

Anyway, we won't go on to that.

What questions could Kelly ask?

um their clinic at this

stage exactly that why did

you only get seven eggs

from 18 follicles I was I

was straight up just be

really really really frank

get them to show you the

images or the that we use

normally we use like a plot

a plot on a chart to show

where the follicles are

what was your oestrogen on

the day that they triggered

you was it you know if you

had seven eggs for me it

would have been around

eight thousand if it was

higher than that then there

should have been more eggs

there all of these questions ask them

Why did I only get seven eggs?

What is your understanding of that?

If you did this again,

what would you do differently?

So ask how many scans you had.

Was it two?

Was it three?

Should there have been more?

Challenge it.

But not, I mean,

this isn't about anyone doing, like,

this isn't about people saying,

I'm telling you everyone's

doing their job wrong.

I'm not at all.

We're working our hearts out

to try and make this work.

But you have a right to say,

is that comparable to what

I would have got somewhere else?

Yeah.

I could imagine those are

tough questions to ask,

but everyone should have

the right to ask them.

And the good clinics out

there would be like, okay, yeah,

let's show you the data.

Let's show you the comparables.

Yeah, that makes sense.

Hopefully that helps, Kelly.

So Adele, follow up question.

Thank you, Adele.

Are there any KPIs set too

low in your view?

Good question.

It's a great question.

It is a great question.

Oh,

now you're going to get my Emma

opinionated head out,

which is always a little

bit touchy and a bit in no filter.

I think that the competent

damage rate for ICSI is...

is way too high.

So it's a damage rate.

Give me a minute.

Seriously, don't work with animals,

children, or your husband.

So when we do ICSI,

a certain number of eggs

unfortunately will not

tolerate that procedure.

Now, there's many, many reasons for that.

The first one is bad stim.

So bad stimulation protocols

will give you poor quality eggs,

which then link into the

lab of what we can and can't do them.

And once we put a needle into them,

they can degenerate and

they can become damaged.

Eggs within ICSI should...

And if you look at some of

my videos on my Instagram,

it's actually incredibly

straightforward after

you've been doing it, obviously,

for as many years as I have.

But they should tolerate it.

It's not...

It's not this massively,

what everyone thinks is

massively invasive procedure.

It takes about 28 seconds.

It's very quick and they

should tolerate it.

They should have a membrane

is bouncy enough to tolerate it.

You are always going to get

the odd patient that has

just drastically poor quality eggs.

Okay.

And I'm not,

they are a different demographic.

You have to move them aside.

But again,

I go back to averages are

averages because we're all

seeing the same demographic of patient,

right?

So eggs that are damaged,

for me should be less than

5% in any setting.

And if it's not, why not?

Is it the stimulation that's

causing the eggs to be poor?

Is it the practitioner skill?

So the embryology skill

that's not trained enough to manage it?

Is there something wrong

with the equipment in the lab?

All of these little things

can add up to eggs becoming damaged.

And I think if you're

running at a clinic with

over 10% of damage,

I don't think that's okay.

Because that means every

patient with 10 eggs is

losing one or two just to damage.

I think that's way too high.

I think what Adele meant,

is there any other KPIs

that I don't think are fit for practice?

That one I would like to see tightened up.

And how do you get that tightened up?

Training.

for everyone for the clinics

of course but if you went

to the hva and you said

look we need to make a

change how do you lobby for

a change to the vm consent

so I'd have to go yeah it

would just be one of those

conversations so that was

2017 yeah so they're going

to do it when's the next

update 2025 okay so what's

that eight eight years uh

yeah something like eight

years okay why do you think

it takes so long because

it's taken that long for us

to get new standards of

practice so things like

We've obviously moved into

the realm of what we talked about earlier,

PGTA.

We've now moved into the

realm of the time-lapse incubators.

And I think because of the

integration of artificial intelligence,

I think we are going to

have to all sit down and

make some new competent

benchmark values that

encompass the new

technologies that we're all using.

we didn't have a time lapse wasn't around.

It was but it wasn't used in

the way it is now.

Yeah.

You speak highly of time lapse.

Yeah.

So that's that one.

What other ones do I think

are set too low.

So I actually think the

implantation rate with

cleavage stage embryos is quite low.

I think 25% is I think that's quite low.

Again,

I don't really like that stat

because I don't think it

gives you any wiggle room for age.

But I think if you go for

gold standard patients,

we always use gold standard

patients as under 35,

which is what the Vienna

consensus is leaning

towards without telling us that.

I think that's too low.

But again, that's my opinion.

So the Vienna consensus,

I think you mentioned this earlier,

it doesn't take into account age?

It doesn't adjust for age.

It talks about gold standard patients,

which is patients under 35.

Okay, okay.

But we talk often about age

and the impact that can have.

So why is it just because

they just wanted to start

off with the consensus and go, right,

let's see.

OK, OK.

So eventually the new

version you think in 2025

will bring in ages.

It has to.

Yeah.

OK.

That makes sense.

Right,

hopefully that helps answer your question,

Adele.

Okay, next up.

So we have John.

Thank you very much, John.

I'm helping a relative look

into egg freezing.

How lovely of you.

Yeah, very cool.

In terms of Vienna consensus,

what statistics should we

be asking clinics to help

compare how good a clinic

is at not only freezing eggs, but how?

But how?

Oh, I love that question.

And I love that you're doing

that for someone.

So the really important

statistics for egg freezing

is the one in the Vienna

consensus that is eggs

retrieved from follicles.

So are the eggs and the

follicles mimicking the

numbers that you're getting?

So what you see on scan, are they?

At the end of the day,

egg freezing is all about

getting as much out of a

patient in one cycle,

so that you don't have to

put people through multiple

cycles to achieve

the end outcome,

which is enough eggs in

storage to protect your

reproductive future.

So if one clinic can give you 15,

20 follicles and get all of

those eggs and get them into the lab,

and then they're all mature,

In egg freezing,

we can only freeze mature eggs.

Immature eggs do not tolerate it.

Maybe the mid range ones do,

but most of the time they don't.

So we don't generally as a rule in the UK,

don't freeze immature eggs.

So I would say your best

stats for clinics is your

relative needs to be asking

what potential number of

eggs are you gonna get in

my demographic with my,

how does it look before

with her hormones and her situation?

And then what percentage of

your eggs overall are

coming through as being mature.

Now that again is a Vienna consensus.

And I think competent is, oh God,

I should know this off the

top of my head.

I think 75%.

Well, my maturity rate is 89.

So it's massively broad.

So if seven,

like that's the difference

between 15 eggs making 11

or 12 mature eggs and 15

eggs being 14 mature eggs.

Yeah.

so and then obviously the

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