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

Kate and Steven's Story

We are delighted to introduce baby Harriet Elizabeth. Congratulations to Kate & Steven from all of the team at RHG, your baby girl is beautiful. Here is a lovely note sent to us from Kate & Steven.

I just wanted to let you know that we had our little girl last night. Meet Harriet Elizabeth. Thank you so much for making our dreams come true and helping us in our fertility journey, Kate and Steven.

More positive pregnancy tests at RHG

Fantastic news to end the week with 75% of pregnancy tests this week being positive. Delighted for our patients and for our team too who work so hard every day to achieve these outcomes for our patients. Wishing all of you the very best for the exciting months ahead.

Dr Talha Al-Shawaf

We are pleased to introduce Dr Talha Al-Shawaf who is joining the RHG team as Consultant in Reproductive Medicine.

Dr Al-Shawaf has over 35 years experience as a Consultant Gynaecologist & Obstetrician and has worked in the IVF field in both the private and NHS sectors since 1987. His areas of speciality are prevention of OHSS (ovarian hyperstimulation syndrome) and fertility preservation and he has had over 80 peer reviewed publications on the subject of fertility.

He will hold regular clinics at the Centre for Reproductive Health and will also be available by arrangement to consult remotely by telephone or Skype. Dr Al-Shawaf will be pleased to accept referrals from Arabic-speaking patients.

We look forward very much to working alongside him as a member of our expanding team of consultants.

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.

Introducing Baby Felix

We are delighted to introduce baby Felix, who was born on 22nd March 2019. Congratulations to Kate & Jon from all of the team at RHG, your baby boy is beautiful. Here is a lovely note sent to us from Kate & Jon.

Hi everyone, particularly our hero Mr Nardo,

We will send you something properly once we’re organised, but Jon and I wanted to introduce you to our beautiful baby boy, Felix, born on 22.3.19, weighing 7 pounds 2 ounces.

We’re absolutely besotted by him, and very much in love.

Our treatment throughout was amazing and apart from morning sickness, the pregnancy was wonderful.

Thanks to you Mr Nardo, and your amazing team, especially Edyta and Suzanne (there were others too but names are escaping us sorry), you’ve fulfilled our long sought after dream, and we are so so happy in our little threesome.

We will come to visit you one day soon, we need a photo of Felix and Mr Nardo!,

Love from Kate, Jon and Felix xxx

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.

RHG to mark 5th anniversary with 3 day art festival

We are pleased to announce that we are planning a three day art festival and exhibition as part of our 5th anniversary celebrations.

It will be held at the Centre for Reproductive Health, Darebury, Cheshire from 9th – 11th May 2019 and will bring together artists from throughout the region to explore the theme of ‘Creating Life’ in a number of different artistic forms including painting, sculpture and music.

Professor Luciano Nardo, Consultant Gynaecologist and Clinical Director at RHG, said…

‘Creating life is what we aim to do in a literal sense every day at the clinic and I hope very much that this event will help to foster interest in the art that can be created around this as a wider theme, establish some links with our local artistic community and offer them an opportunity to showcase their talents to our patients and visitors.’

The exhibition will be open to members of the public and will be free to attend. Enquiries from interested artists are also welcome by email to aeckersley@reproductivehealthgroup.co.uk