The latest developments in Pre-Implantation Genetic Testing

Pre-Implantation Genetic Testing (PGT) isn’t a new science, it’s been available to fertility specialists for some time now, but last year a great step forward was made by the laboratory that Reproductive Health Group work with that enables couples to make informed decisions about their journey to parenthood.

‘In the very simplest terms, PGT gives information about embryos’ genetic health to help embryologists select the best embryo for transfer and improve the chance of achieving a successful pregnancy. Once a known healthy embryo has implanted there is a higher likelihood of the pregnancy progressing to full term.

‘We use PGTai and recommend it for our older ladies and those who have had previous unsuccessful fertility treatment. This is because as we age, it has an effect on the genetic make-up of any embryos we make, either naturally or after IVF. When an embryo is created it should have 46 chromosomes; this is known as a ‘euploid’ embryo. If it hasn’t got 46 chromosomes then it is known as ‘aneuploid’ and is genetically abnormal. In older women, we see an increase in the number of Aneuploid embryos being created. When this happens, there is a vastly increased likelihood that the body will reject the embryo, resulting in no pregnancy or a miscarriage.

‘In PGTai, we take an embryo when it is at the blastocyst stage, just five days into its development. At this point, it has a central mass of differentiated cells that would go on to form the baby, and a surrounding cell mass that would go on to form the placenta – it is from here that we extract three to five cells for testing and send them to our chosen partners who are at the forefront of this type of technology. The ‘ai’ bit refers to the artificial intelligence element of the tests, which produce quite extraordinarily detailed results. The AI is based on the test results of 1,000 embryos that went on to create healthy babies and the whole testing platform has been validated on 10,000 embryo tests and 5 million data points.

‘Until fairly recently, the results we would receive back from testing would tell us if the embryo was Euploid or Aneuploid. We would have many patients for whom all the embryos we tested were recorded as Aneuploid, meaning that we couldn’t proceed with treatment with those embryos. Now, the AI is so smart, it can in effect give us a sliding scale of ‘normality’.

‘Today, we have four bands. euploid; low level mosaic – meaning that the embryo has 20-40% of its cells showing as ‘abnormal’; high level mosaic – with 40-80% of the cells as abnormal; and finally, aneuploid.

So that’s the science, but what does this mean for patients?

‘As an example, we might have a patient with two day-5 blastocysts which both have cells sent for PGTai. The results for one blastocyst comes back as aneuploid (abnormal and cannot be used for treatment) and the other embryo comes back as a low level mosaic, which can be used for treatment: implanting a low level mosaic embryo in the womb can result in a positive pregnancy test and recent evidence has shown that these pregnancies give a 50% chance of delivery of a live baby. Previously we would have rejected both of these embryos. A high level mosaic rating offers a 30% chance of a successful pregnancy.

‘It’s really about giving couples more opportunity to decide how they want to proceed. Everybody who has embryos sent for genetic testing from RHG has the opportunity to participate in genetic counselling, where we can help them understand the science and what that means for them, personally.

‘For me, it’s very exciting. I honestly believe that this form of testing will become available for all women and that there will come a time when it will become routine for embryos to be tested before they are used for treatment. This is ground breaking technology that has improved the accuracy with interpreting the results from PGT and removed any subjectivity. This is a very exciting area of reproductive science and it’s wonderful to be at the forefront of it in the UK.’

This article was originally published on the Living Edge website here.

Fertility Coach

If you are going through infertility and your emotions are all over the place, you are not alone. In fact, this journey is a roller coaster of emotions. In a recent study, patients going through fertility challenges have reported that 90% felt depressed, 42% felt suicidal, 50% reported it was the most upsetting experience of their lives and 4 in 10 experienced PTSD after miscarriage.

These feelings may be triggered for different reasons:

  • not being able to grow your family when you want, and the way you had planned
  • stigma and social pressure
  • feelings of isolation
  • financial pressure
  • need to make/delay decisions around professional career
  • coping with recurrent loss
  • and the emotional stress of making important decisions as a couple, who may at certain times, feel differently about motivation to treatment, length and type of treatment, have different coping strategies, or different opinions on what to do when treatment fails.

The bottom line is that regardless of how complex a physical problem may be impacting on your fertility, it is actually the emotional distress that will probably make you quit treatment.

One way of getting support is through Fertility Coaching. A fertility coach is someone who guides you in your journey. Often, they have been through it themselves and can relate to the challenges you are going through. Apart from personal experience, a fertility coach also has a particular set of professional skills and competencies to provide the emotional and physical support that people require. This often includes a medical degree (to understand the physical aspects of fertility) and a CBT/NLP coaching qualification (to provide emotional support).

The support provided by a fertility coach may be emotional, covering all the aspects discussed above, and/or physical, helping you with practical aspects of fertility treatment like medication, making changes to your diet, environment etc.

Here’s 8 ways a fertility coach could help you during fertility treatment and make a significant difference in your journey:

  1. Managing anxiety, stress, depression, expectations
  2. Communication and difficult conversations
  3. Making decisions
  4. Strategies for key moments (before/after embryo transfer, two-week wait)
  5. Motivation and commitment to treatment
  6. Improving your health for fertility (nutrition, physical activity, environment, habits)
  7. Setting up goals, action plans
  8. Following up and accountability

At Reproductive Health Group we are aware most people underestimate the emotional distress that may be caused by infertility, so whatever stage you’re in, make sure you are prepared. In our commitment to support you, we are offering a Free Fertility Coaching consultation with the awarded Nurse Consultant and NLP Coach Andreia Trigo. It’s never too late to start your fertility support plan, why not start today? Book your appointment here.

Andreia TrigoAbout Andreia Trigo

Andreia Trigo (RN, BSc, and MSc) is the founder of inFertile Life, multi-awarded nurse consultant, fertility coach, author and TEDx speaker.  Combining her fourteen-year medical experience, CBT, NLP and her own eighteen-year infertility journey, she has developed unique strategies to help people undergoing similar challenges achieve their reproductive goals. The Enhanced Fertility Programme is helping people worldwide and has been awarded Best Innovation in Business 2018 and E-Business of 2018. Check her out at www.infertile-life.com

Sperm DNA Fragmentation Test

Research presented at the 2019 European Association of Urology Congress in Barcelona revealed that the DNA of sperm extracted from the testicles of infertile men might be just as healthy as the sperm found in the ejaculate of fertile men.

The research could have implications for improved treatment of male infertility.

This research supports past understanding of the role DNA fragmentation in sperm plays in male infertility, as well as how lifestyle risks from poor diets to smoking can affect infertility.

The research suggests that looking into yet-to-be-damaged sperm in the testicles could offer a solution to couples working to overcome infertility challenges.

It’s been known for the last few years that men with high DNA fragmentation rates have more difficulty initiating pregnancy as well as experience higher rates of early term pregnancy loss.

DNA damage assays are currently not considered standard of care by European and American fertility specialists, but many find them useful in certain circumstances – when patients have normal semen analyses parameters but recurrent miscarriage, when a man has a varicocele and more data is needed before a decision can be made about removing it, or when patients have had recurrent IVF or ICSI failure.

Couples whose male partner has a high DNA damage rate in his semen may benefit from a minor surgical procedure to extract sperm directly from the testicle, and this may increase that couple’s odds of a viable pregnancy.

At RHG, we are proud to offer both, the diagnostic and therapeutic elements of this new approach – DNA fragmentation testing, as well as surgical sperm extraction.

Source: https://www.healthline.com/health-news/dna-of-sperm-from-infertile-men-as-healthy-as-sperm-from-fertile-men

Varicocele and infertility

35-40% of men undergoing infertility evaluation have a varicocele. Although the damage caused might be multifactorial and the exact mechanism is not fully understood, testicular hyperthermia is probably a significant factor.

Today, treatment has evolved into a variety of techniques. There is a consensus between the European Association of Urology (EAU) and American Society for Reproductive Medicine (ASRM) in the role of varicocele treatment for infertile men with abnormal semen parameters:

  • Varicocele repair was shown to be effective in men with oligospermia, a clinical varicocele and otherwise unexplained infertility.
  • Treat varicoceles in adolescents who have reduced testicular volume and evidence of progressive testicular dysfunction.
  • Treat men with a clinical varicocele, oligo-zoospermia and otherwise unexplained infertility in the couple.

However, The National Institute for Health and Care Excellence (NICE) “recommends that men should not be offered surgery for varicoceles as a form of fertility treatment, because it does not improve pregnancy rates.”

One might wonder: is NICE guidance still up-to-date? What evidence does NICE have that is not available to European and American specialist associations? Or is this another “Procedure of Low Clinical Priority” (PLCP), rationed for NHS availability by a UK government body?

At RHG, we believe that varicocele surgery should be offered to selected men who fall into the above listed categories. In case this fails, and if female reproductive age is a time-limiting factor, we offer Surgical Sperm Retrieval (SSR) during the same procedure, as an “insurance policy”. Sperm can be frozen and used later for Intra-Cystoplasmatic Sperm Injection (ICSI).

Contact us

If you would like to contact us to about treatment of a varicocele or male fertility assessments, please call us on 01925 202 180 or contact us online here.

Surgical Sperm Retrieval at the time of Vasectomy Reversal

England and Wales have the highest divorce rate in the EU with 42% of all marriages failing. 5% of men who had a vasectomy request reversal at a later date. The European Association of Urology (EAU) issued the following strong recommendations:

  • Microsurgical vasectomy reversal is a low-risk and (cost-) effective method of restoring fertility.
  • Surgical Sperm Retrieval (SSR) and ICSI should be reserved for failed vasectomy reversal.

Vasectomy reversal affords up to 90% success rates and natural conception for couples who are not in a hurry.

However, successful pregnancy and life birth rates after vasectomy reversal can be significantly lower for a variety of adverse reasons, even if men had children with the same or other partners:

  • poor ovarian reserve in older women
  • other female-specific factors e.g. endometriosis or pelvic inflammatory disease
  • long obstructive interval between vasectomy and reversal
  • male epididymal and sex gland dysfunction
  • life style (e.g. smoking, obesity, anabolic steroids)

In these scenarios, SSR and IVF or ICSI might be the only realistic alternative. We believe that men with a poorer prognosis of successful vasectomy reversal should be offered surgical sperm retrieval and freezing as an “insurance policy”, at the time of reversal. This avoids delays and second procedures on the same testicle, although it incurs additional expenses for surgery and sperm storage. We are pleased to announce that this service is available at RHG.

Contact us

If you would like to contact us to discuss SSR or Vasectomy Reversal, please call us on 01925 202 180 or contact us online here.

Private Maternity Care

Author: Dr Koon Loong Chan, Consultant Obstetrician and Subspecialist in Fetal and Maternal Medicine

Being pregnant is an exciting time but can also be daunting for mums-to-be, especially if this is your first baby and don’t know what to expect. Antenatal care is dedicated to giving you the support and healthcare you and your baby need while you are pregnant to ensure you have a healthy pregnancy and baby. It will also give you an opportunity to plan your birth and to get any concerns you may have answered by the midwife or obstetrician (doctor specialising in pregnancy care).

Differences between NHS and Private Care

The majority of pregnant women have pregnancy care provided by the NHS and deliver in a NHS hospital. This is perfectly adequate for these women. However, some women chose to have private pregnancy care. This may be a package of pregnancy care catering for the pregnancy, delivery and after delivery or a package of pregnancy care catering for the pregnancy and after delivery but not the delivery itself – this is provided by the NHS hospital you chose to book and deliver at.

There will be women who would be adequately looked after in the NHS but prefer to have private pregnancy care so they have more choice over who takes care of them and prefer the one-to-one care that private pregnancy care offers. Women who are relatively high risk may still chose to have private pregnancy care as this may give them more reassurance to ensure a stress-free and enjoyable pregnancy.

Our Private Maternity Packages

At Reproductive Health Group, we have private obstetricians who are Consultants in Obstetrics and Specialists in Maternal and Fetal Medicine at St Mary’s Hospital, Manchester who offer care for the pregnancy and after delivery but, at present, not delivery. The Consultant package will provide a high level of specialised care which will help you feel reassured throughout your pregnancy. We also offer a Midwifery package for those women that are low risk. Whichever package you chose you will regularly see the same team of specialists for consultations, scans and blood tests. We also offer individual tailored care so that you can chose what tests and scans you prefer during your pregnancy. This tailored care can be discussed at your first visit with the Consultant or the Midwife. We offer a relaxed environment giving time for consultations and visits that are convenient.

Benefits of Private Care

  • Consultant led care
  • Appointments usually seen with a private midwife
  • No waiting lists – you will be seen promptly
  • Relaxed and calm environment
  • More time dedicated to you and your baby
  • Clean and safe private hospital
  • Free parking and refreshments
  • Professional, caring and friendly staff

If you would like to talk to us about our maternity care packages, please call us on 01925 202180 or contact us via our website here.

Egg Freezing Cycle Offer

We are delighted to announce that you can save 10% on all Egg Freezing cycles completed before the 31st December 2018. For more details about this limited time offer, please call us on 01925 202180, email us at info@reproductivehealthgroup.co.uk or contact us here.

Common Questions about Sperm Freezing

What is the sperm freezing process?

The sperm freezing process is a much simpler procedure than freezing a woman’s eggs.

Firstly, the man is screened for serious infectious diseases such as HIV, HTLV and Hepatitis B/C. Afterwards he will need to provide written and informed permission for his semen to be stored by the fertility clinic, and specify for how long.

At the clinic, he’ll be asked to produce a fresh sample of semen which is then frozen with a cryoprotectant such as glycerol to protect it from damage during freezing, in a process called semen cryopreservation. The sample is then cooled, frozen and stored in liquid nitrogen.

There is no limit to how long sperm can be stored for and the longest recording of cryopreserved semen is 24 years.

Why would I consider freezing my sperm?

There are a few reasons a man may want to freeze his sperm.

Medical treatments such as chemotherapy can affect the quality of a man’s sperm and cause infertility. Men who are aware of future treatments or procedures such as chemotherapy or a vasectomy may want to preserve their fertility by freezing their sperm.

Men who know they have a low sperm count or sperm that is deteriorating in quality can freeze their sperm before the quality deteriorates further.

Men who are transitioning from one gender to another, may also want to freeze their sperm for possible future use.

What causes male infertility or a low deteriorating sperm count in men?

Low sperm count, or oligozoospermia, is where a man produces less than 25 million sperm per millilitre of semen. It is relatively common. Low sperm count can make conceiving more difficult and is thought to be a factor in 1 in every 3 couples who are struggling to conceive.

Less common is the more serious azoospermia, which means there is no sperm in the semen and is normally caused by genetic issues, infections, or trauma.

Environmental Causes

Prolonged exposure to industrial chemicals such as benzenes, herbicides, paint materials and lead may contribute to a deteriorating sperm count. This is also the case with exposure to heavy metals.

High levels of radiation or X-rays can cause permanent damage to male fertility, as can overheating the testicles. Overheating can be caused by lots of seemingly innocuous activities, like wearing overly tight clothing, working in front of hot cookers, or working in the same position for prolonged periods of time.

Lifestyle Causes

Emotional stress or severe depression may stint the production of hormones that produce sperm. Alcohol, drugs such as steroids and cocaine, tobacco smoking, excessive weight, and occupation may also affect the health and wellbeing of a man, and in turn hinder his body’s ability to produce sperm.

Other risk factors may include medications, previous trauma to the testicles, cancer medications, celiac disease, chromosome defects, undescended testicles, hormone imbalances and infections.

A low sperm count can be caused by several factors, and while there’s many listed above, it is by no means an exhaustive list, which is why speaking to a medical professional is crucial for information specific to your situation.

If you are considering sperm freezing, please speak to one of our team for information about sperm freezing costs and further information about the process.

What To Expect From The Egg Freezing Process

What is Egg Freezing?

Freezing eggs is a fertility preservation technique offered by fertility clinics, where a woman’s eggs are harvested, frozen unfertilised and stored for later use. A frozen egg can then be thawed, fertilised with sperm in a laboratory and implanted back into the uterus (in vitro fertilization or IVF).

Why would I consider freezing my eggs?

For many women, having a child is not an option until their mid to late thirties or early forties.

But because our bodies change with age, with a decrease in our bodies’ ability to produce and maintain healthy cells, the option to remove and preserve eggs and sperm can be key. The ability to preserve eggs and sperm while they are healthy is often a highly important step for women who want to have children later in life.

Egg freezing may also be necessary if there’s a problem obtaining a sperm sample during IVF treatment. If there’s a problem obtaining a sperm sample, egg freezing is a procedure which ensures the eggs can still be used when the sperm is available.

Additionally, some medical treatments such as chemotherapy may severely affect fertility by damaging a woman’s eggs, making egg freezing a way of insuring fertility in worst case scenarios.

What to expect during the egg freezing process?

The first phase of the process is very similar to the standard IVF cycle. Ovaries are stimulated using fertility drugs, so they produce more eggs than usual. They are then monitored and collected when they’re mature.

A single cycle involves: 8-11 days of hormone injections which stimulate the ovaries to produce multiple eggs, instead of just the one. During this time, ultrasound monitoring is used to keep track of how many follicles are developing. Blood tests may also be taken to check hormone levels.

How are eggs collected?

When three or more follicles measuring more than 17mm in diameter have been produced, a hormone trigger injection which will ripen and mature the eggs is given.

36 hrs after this, the patient is admitted to the clinic for egg collection to take place. This takes around 20 minutes.

How are frozen eggs stored?

Eggs are frozen using a technique called vitrification and stored in liquid nitrogen until the patient is ready to undergo treatment using the eggs. Eggs can currently be stored like this for up to ten years.

Using Your Frozen Eggs

When the patient is ready, eggs are thawed, analysed, and fertilised using Intracytoplasmic Sperm Injection (ICSI). The highest quality sperm is injected into the egg and the best quality embryos will be selected for transfer.

If you have any further questions about the egg freezing process, success rates, or cost, please feel free to contact us and book a consultation with one of our fertility experts.

Differences Between Egg Freezing And Sperm Freezing

Fertility preservation techniques are a way of decreasing the chances of infertility affecting your chance to build a family. Not everyone wants to have a child right away, but when there’s an upcoming change in circumstances or medical treatment that can have a possibility of affecting your fertility, many people want to have the security of knowing starting a family won’t be impossible in the future.

Two of the main types of fertility preservation techniques are egg freezing and sperm freezing. Both have their distinct uses and pros and cons. Find out what the main differences between the two are here.

Egg Freezing

Egg freezing is a way of preserving eggs at the peak of a woman’s fertility, reducing the pressure to have a child before this peak is over. It’s one of the most popular fertility preservation techniques and is used in conjunction with IVF as a method of conception.

How does it work?

The egg freezing process involves screening to check for risk of contamination, the use of medication to boost egg production, and then egg collection which is carried out under sedation.

Once collected, the eggs are frozen by being cooled to a suitable temperature and stored in tanks of liquid nitrogen. A significant number of eggs are normally collected to ensure that individuals have the maximum chance of fertility in the future.

How safe is it?

Freezing eggs is very safe. The only real risks are the impact of side effects from the egg production boosting medication, and the chance of miscarriage. However, the chance of either situation occurring is quite low.

How effective is it?

The number of people opting for egg freezing as a method of fertility preservation is relatively small. Between 2010 and 2016 roughly 500 babies were born from frozen eggs. Recent research has shown that ‘fast-frozen’ eggs can have an average thawing survival rate of 90%-95%.

Generally, the figures that are given for success rates vary depending on age. They are currently quoted as being approximately:

80% chance of one live birth if 15 frozen eggs beneath the age of 35
80% chance of one live birth if 20 frozen eggs between the ages of 35-37
75% chance of one live birth if 30 frozen eggs between the ages of 38-40
50% chance of one live birth if 30 frozen eggs between the ages of 40-42

Pros and Cons

Pros Cons
It’s a safe procedure Pregnancy isn’t guaranteed
No worries about diminishing egg quality It can be costly financially
Success rates are quite high

Sperm Freezing

An alternative method of fertility preservation is sperm freezing. This is a similar concept to egg freezing but involves freezing a certain amount of semen containing sperm instead. Frozen sperm is often used in fertility preservation between couples, and it’s the method of storage for the sperm of sperm donors in IVF treatments.

How does it work?

Like egg freezing, sperm freezing patients will first have screening tests and then sign a consent form detailing how long the sperm can be kept for.

They’ll then be asked to produce a sample of sperm which will be frozen and mixed with a cryoprotectant to prevent any damage being done during the frozen period. The sample is then submerged in liquid nitrogen until it’s needed.

The sperm is held in different containers (called straws) so that not all of it needs to be thawed at once.

How safe is it?

As far as anyone can tell, there are literally no risks involved with sperm freezing. However, not all sperm will survive the process.

How effective is it?

IVF using frozen sperm is just as effective as with fresh sperm. The current figures for IVF live birth success rates depend on age, but they’re generally quoted as:

40-43% for a woman under 35 years old
33-36% for a woman between the ages of 35-37
13-18% for a woman between the ages of 40-44

Pros and Cons

Pros Cons
There are no health risks involved at all It can be costly to store sperm for a long time
It’s just as effective as fresh sperm during IVF Not all sperm survive the thawing process
Frozen sperm can be stored for up to 10 years You have to be able to produce the sperm on the day of freezing

If you’re interested in egg or sperm freezing as a method of preserving your fertility, get in touch with us today or read more about our sperm and egg freezing success rates, processes, or prices.