Genetic screening can prevent miscarriage

HALF of miscarriages in women over the age of 38 may be prevented using new screening technology, according to leading UK fertility experts.

Pre-implantation Genetic Screening, or PGS, is a powerful way of selecting embryos during IVF and has been proven to secure a high chance of pregnancy, continuing to live birth.

And lead embryologist Bert Stewart, from Cheshire-based Reproductive Health Group, says PGS should be more routinely used, preventing “wasted time, money and heartache” for older women looking to have children.

PGS allows fertility experts to look at a woman’s individual embryos, and the number of chromosomes within those embryos.

During traditional assessment, any abnormalities are invisible and routine exams do not reveal which embryos are ‘normal’.

Age is closely linked to abnormalities, with women aged 37 likely to have abnormalities in 50 per cent of their embryos. After 37, the rate continues to rise.

Mr Stewart says: “PGS gives a much more black or white result on each individual embryo.

“Essentially, the technique allows us to look at the number of chromosomes within the cells of the embryo. A normal human embryo should contain 46 chromosomes, neatly arranged in matching pairs.

“We know that in the final maturation process of many eggs, mistakes are made in the sorting out of which chromosomes are thrown out by the egg and which ones it will keep to pair up with those from the fertilising sperm.

“This can lead to eggs with missing or extra chromosomes.

“With very few exceptions, an embryo with the wrong number of chromosomes will not produce a baby.

“Most abnormal embryos either fail to implant in the uterus or miscarry during pregnancy.”

While embryos that stop developing very early during the IVF culture are easy to spot, many can still develop seemingly quite normally.

Mr Stewart continues: “Of course, if they do this we are likely to want to select them for embryo transfer or freeze them for future use. The problem is, most of these will at some point stop developing.

“This could lead to a positive pregnancy, even a viable fetus on early pregnancy scan, but a pregnancy that is most likely to end in heartbreaking miscarriage.”

PGS involves removing a few cells from blastocyst stage embryos and checking chromosome numbers.

Mr Stewart says PSG is the ‘way forward’ to potentially improve IVF success rates, and to cut the number of transfer that eventually lead to miscarriage for women in their late thirties and early forties.

He said: “The risk of having an embryo with the wrong number of chromosomes is greatly affected by the age of the mother. For women in their early thirties, about one quarter of their eggs and embryos will have the wrong number of chromosomes.

“For women in their forties, it is more likely that more than half of their embryos will be abnormal.

“So half of all miscarriages in that advanced age group may be prevented by screening.

“It saves wasted time, money and heartache, especially for women that have gone through miscarriage time and time again and have found that very hard to take.

“You can still do IVF without doing any of this. But, understandably, some people want to be more certain.

“Whilst it does not guarantee pregnancy, chromosomally normal embryos are more likely to implant than unscreened embryos, and more likely to go all the way to the most desirable outcome of any treatment, a healthy baby.”

PGS is tightly regulated by the Human Fertilisation Embryology Authority.

Data from Reprogenetics suggests that results are accurate for over 95% of screened embryos and the risks of an IVF cycle using PGS are no different from those of a typical IVF cycle.

“The important thing to get across is that an embryo is what it is,” Mr Stewart says. “We are not changing it in any way. We are just checking it.”

At Reproductive Health, experts offer Next Generation Sequencing, which is highly accurate, efficient, and comes at a relatively low cost.

Mr Stewart says: “The technology is getting more and more effective, and more accurate. Each new generation tends to be able to do more for much less.

“I can see in the next few years PGS might become routine and this should become more accessible for all IVF patients.”

Learn more about PGS

You can learn more about PGS here, or alternatively please call us on 01925 202180 or contact us here.

10 out of 10 pregnant

All of the Reproductive Health Group team work incredibly hard to make our patients’ dreams come true. Over the last couple of weeks we have seen a stream of positive pregnancies as a result of treatment at our Cheshire based fertility clinic.

10 out of our last 10 pregnancy tests have resulted in positive outcomes.

The hard work is truly paying off.

Mandy Laing

In the latest of our series of ‘Meet the team’ blogs, we introduce Mandy Laing, who is a care coordinator and acupuncturist at Reproductive Health Group.


How did you begin your career in IVF?

I am relatively new to the world of IVF and the whole process fascinates me!

I came to it after I qualified as an acupuncturist following many years working as a human resources project manager at the Bank of America.

There is lots of evidence to show how effective acupuncture is supporting IVF treatment and that is why it is a popular complementary therapy used in tandem with fertility treatment.

I’ve had a fantastic opportunity to learn more about IVF here at the Reproductive Health Group and I have been very lucky to take my understanding to a whole new level.

I’m looking forward to learning even more about the process during my time working as a part-time care co-ordinator on my two days each week, Thursdays and Fridays, allowing me to be efficient and effective in my roles as acupuncturist and care co-ordinator.

What are your main day to day responsibilities at RHG?

As a care co-ordinator, I work closely with patients who have just or are about to embark on their IVF treatment.

It is my job to help to answer all types of queries. It is very important we offer the highest standard of care possible at all times.

It’s very important to me that each patient feels comfortable and confident at every step of the journey. If they have any burning questions, they are encouraged to call in. Their peace of mind is paramount to me.

What aspect of your role is the most rewarding?

I am always enthusiastic in what I do – be it as an acupuncturist or as a care co-ordinator.

I offer a very personal service – I respect the fact that everyone is an individual and acknowledge that IVF is not an easy thing to do.

Because of this I’m very conscious that patients receive the support they need, every step of the way, during this stressful time of their lives.

Helping people feels very natural to me – so I enjoy both of these satisfying roles for a variety of reasons.

What has been your proudest moment at RHG?

I enjoy very much seeing how much patients value the acupuncture treatment sessions I perform on the day they are about to have their embryos transferred, and how my sessions help to remove some of the stress of the procedure.

As I am still very new to my care co-ordinator role, I can’t think of a proudest moment as yet. I’m still finding my feet but I hope as time goes on I will collect a few.

Watch this space!

What new services and innovations are you most looking forward to?

I believe the new maternity service will nicely complement the hospital’s varied portfolio on offer.

We have just recruited some lovely new midwives to the team. So I think it’s fantastic that – if patients want to – we can offer care from the initial stage of thinking about starting a family, through starting the fertility journey, and culminating with pregnancy.

    Fertility specialists assemble in Cheshire

    Earlier this month we welcomed some of the leading experts in the world of fertility to our Cheshire IVF & fertility clinic for the 2nd International RHG Congress.

    The two day event was titled ‘From laboratory bench to live birth‘ and was aimed at learning, discussing and debating some of the most important aspects of current laboratory and clinical practice leading to a healthy live born baby.

    The programme included presentations and debates from distinguished delegates from Spain, Austria, Belgium, Holland, Germany and of course the UK.

    Topics ranged from ovarian stimulation, lifestyle & diet, sperm selection, egg storage and embryo development, which individually are all key to not just helping couples achieve a pregnancy, but to achieving a successful healthy birth.

    This years event was hugely successful and demonstrates the far reaching respect our Cheshire based Centre for Reproductive Health maintains within the fertility community.

    We also welcomed representatives from MERCK, Vitrolife, Sophia Genetics, Finox, IMT International and Besins Healthcare, who provide some of the very latest equipment & technology in world of fertility and women’s health.

    We had many complimentary comments about the meeting itself, the programme and our facilities.

    • Very informative, learnt a lot
    • Perfect organisation and nice meeting
    • I very much enjoyed attending the conference and also the dinner
    • Outstanding organisation
    • It was a real pleasure and nice experience for me to take part in
    • A tremendously well organised meeting yet again!
    Meet the Team - Caroline Watkins

    In the latest of our series of ‘Meet the team’ blogs, we introduce Caroline Watkins from our embryology team.


    How did you begin your career in IVF?

    I started to learn about embryology during my bachelor’s degree back in 2001, this was one of my favourite modules at Sheffield alongside molecular immunology and physical methods for studying biological structures.  This is where I took a bit of a side step and completed a PhD in Immunology, more specifically looking at latex allergy and the proteins or allergens involved in initiating the allergic response.  Although I enjoyed my PhD, I realised that research provides little day to day rewards and I really wanted to go back to embryology.  It was at this point I found out about clinical embryology; it took me a year to find a trainee post in Coventry where I worked for just over 7 years gaining both my certificate in Embryology and lots of experience!

    What are your main day to day responsibilities at RHG?

    My role here is very varied.  I am partly responsible for all the workings that go on in the andrology and embryology laboratories alongside Bert and Ruth.  I am also the sperm bank coordinator, so please talk to me about sperm if you want to, I also manage the gamete and embryo storage, look at our data inputting with the HFEA and much more!  You will even hear my voice on one of our patient videos.  Myself, Bert and Ruth have worked here and achieved a lot in our time.  We helped ensure the unit achieved its HFEA licence and Bert is working hard at the moment to expand our PGS service to also allow for PGD.

    What aspect of your role is the most rewarding?

    In essence, doing a good job.

    I appreciate that not everyone entering into fertility treatment will come away with a happy story.  In the lab we do our upmost best to try and ensure as many patients as possible do have successful treatment.  But when things don’t work out and a patient or couple don’t get pregnant I would hope that the patient feels that we did our best to try and achieve success during their time with us.

    What has been your proudest moment at RHG?

    There have been a few, from gaining our licence, collecting the first egg, the first pregnancy and the first live birth.

    What new services and innovations are you most looking forward to?

    The unit has started doing PGS now with a few patients taking this up.  It has been great to do something new, to learn how to biopsy embryos and allow our service to continue.

    RHG likes to push boundaries and keep on top of latest developments.  I am keen to see the lab move towards all cycles having PGS and embryo freezing as standard.  One thing Luciano always says; we are not treating you to become pregnant, but to have a healthy child at the end of your journey.  I think PGS is a positive step for patients to take to try and achieve this.

    Fertility Check Cheshire

    Wouldn’t it be nice to know exactly how fertile you are before you start trying for a baby? Wouldn’t it also be nice if you could be offered reassurance that although you haven’t got pregnant within a few months of trying, that all is OK with you and your partner? Equally, wouldn’t it be a relief to simply know that there might be a problem and you can address it here and now?

    Unfortunately there is always the chance of infertility, but it isn’t something that many young people rarely think of, why should they?

    Fertility tests aren’t something that people casually request from their GP, they are typically something that people only consider when they HAVE to. They are perceived to be expensive and why would you need one anyway? Ignorance is bliss!

    1 in 6 couples in the UK will experience problems conceiving. That is a fact. We regularly see patients who try for many years for a baby without seeking medical advice, many couples who have no clue when it comes to their fertility.

    Our affordable new fertility health check that can be had as a one off, or more regularly if desired, is designed to provide reassurance, relief and confidence, helping you to find out how fertile you are.

    The cost of the check is £150 for an individual and £250 for a couple. Female partners will undergo an AMH (anti mullerian hormone) blood test and male partners a semen analysis. A 30 minute consultation with one of our fertility specialists will follow to review the results. If these results indicate that further investigations would be recommended, we can offer more comprehensive fertility assessment packages to complement this initial check.

    Egg Freezing

    Reproductive Health Group clinical director, Luciano Nardo, says that egg freezing using the vitrification method should be offered to all single healthy women to preserve their own fertility. “Whilst it is established that elective egg freezing doesn’t guarantee pregnancy outcome, it increases the chances of a woman conceiving her own biological child later on in life. Age is closely linked with the number and quality of eggs, therefore the probabilities of having a successful egg freezing cycle are higher in women younger than 35.”

    Ovaries do not continue to function infinitely. Fertility naturally decreases with age and unfortunately it cannot be restored. Typically you need twice as many eggs to produce a single baby at age 39 than you would at age 29. Fertility can also be directly impacted by some forms of cancer treatment, including chemotherapy and radiotherapy, with the chances of infertility being more than 90%.

    For these reasons fertility preservation is becoming increasingly important.

    Research suggests that more and more women are leaving it too late before deciding to start a family. There are many understandable reasons for this, whether it be financial position, enjoying a successful career, finding the right person, or getting on the property ladder. When the ‘time is right’ many women and couples find that they struggle to become pregnant. Whilst you can cannot always plan for every eventuality in life, you can protect your future fertility by freezing your eggs whilst they are at optimum quality and potentially undergo conventional IVF treatment or ICSI treatment later on down the line. This will provide the opportunity to conceive when the time is right and give you the best possibly chances of success.

    At Reproductive Health Group we offer a comprehensive fertility preservation programme, including egg freezing & storage, sperm freezing & storage and embryo freezing. We have the latest technologies and the multidisciplinary expertise to assist you through the fertility preservation journey.

    The fertility mantra is simple. If you are planning a family, start as young as possible. Egg freezing affords women the opportunity to start young with the possibility of finishing off later.

    If you would like to talk to us about freezing your eggs or fertility preservation, please contact us on 01925 202180 or via our website here.

    Are you looking to interact with other patients going through similar experiences? Would you like to ask us questions before or between consultations? Well we now have our own message board on Fertility Friends (www.fertilityfriends.co.uk), which is a hugely popular and the leading infertility forum in the UK.

    It is completely free to use and many of our patients are active users, benefiting from the support and experience of others at various stages of their fertility journey.

    We are in no way affiliated with Fertility Friends, but we do see it as an invaluable source of information and support from a friendly community.

    You can access our message board here.

    You can sign up here.

    Please note that only queries posted on our own message board can be answered by our team.

    IVF With Donor Eggs

    One of the most common treatments offered at Reproductive Health Group is IVF treatment using donor eggs. We regularly receive questions about egg donation, the treatment process, the donors, waiting lists and screening. Our latest blog is aimed at answering our most common questions, but if you have a question not detailed below, you can ask one of our experts.

    Frequently Asked Egg Donation Questions

    How does the egg donation process work?

    Egg donation requires a series of steps to be followed:

    • Recruitment and screening of a potential matching donor
    • Tests of the recipient to ensure she has the potential for embryos to implant and carry a pregnancy to term successfully
    • Independent counselling of both recipient and donor, as appropriate
    • Co-ordination of recipient and donor cycles, as appropriate
    • Control of the recipient cycle with the oral contraceptive pill, and /or the suppression of hormones by an injection of GnRH-analogue and subsequent treatment with hormone replacement therapy (HRT)
    • Fertilisation of the donated eggs with the recipient’s partner sperm or donor sperm, as appropriate
    • Transfer of the resulting embryo(s) into the recipient’s womb (uterus)
    • Freezing of any supernumerary embryos, as appropriate
    • Continuation with HRT support after the transfer of the embryo(s)

    Can anyone receive donated eggs

    There are certain criteria we apply before we will consider a woman for egg donation. These apply to those receiving eggs from an unknown donor recruited by the Reproductive Health Group:

    • Women’s age less than 52 at the time of treatment
    • Have no medical contraindications to pregnancy
    • Have a uterus capable of carrying a pregnancy
    • Have undergone appropriate counselling and screening tests

    Where are donor eggs obtained from

    At the Reproductive Health Group donor eggs are obtained from one of the following sources:

    Altruistic unknown donor. A woman who wishes to donate eggs for altruistic reasons and volunteers herself to the clinic. She may have heard of the need for egg donation through a story in the media or through a friend who suffers from infertility. She may also be introduced to the recipient and to the clinic via an egg donation agency. This donor will be unknown to the recipient, but will still be registered as a donor and adhere to the gamete donation’s regulations in the UK.

    Altruistic known donor. The patient (recipient) herself may introduce a prospective suitable donor to the clinic. This woman may be either a friend or close family relative. In this case the prospective donor may donate to the recipient known to her; however, she may also donate altruistically to an anonymous recipient within the clinic, if she wishes so.

    Egg Sharing. The patient (recipient) receives eggs from another woman undergoing IVF treatment who doesn’t have any known problems with her ovarian reserve and for whom IVF is recommended because of male or tubal factors of infertility. Separate information is available about egg sharing.

    How are donors screened

    Irrespective of the source of donor eggs, the screening of donors is carried out according to Human Fertilisation and Embryology Authority (HFEA) standards and agreed good practice guidelines. In addition to a careful medical and family history, the following tests are routinely carried out on all prospective donors before embarking onto the egg donation programme.

    • Full blood count and Atypical antibodies
    • Blood group
    • Karyotype (Chromosome analysis)
    • Cystic Fibrosis screening
    • HIV, Hepatitis B, Hepatitis C
    • Cytomegalovirus (CMV)
    • Syphilis
    • Hormone tests (FSH, LH, E2 and AMH)
    • Pelvic ultrasound scan
    • Chlamydia
    • Gonorrhoea

    Repeat viral screening tests are also carried out immediately before each donation at the time of the baseline ultrasound scan prior to commencing the hormone stimulation.

    Are egg donors paid?

    We do not pay donors. The law prohibits payment of gamete donors in the UK. Currently legislation permits donors to receive reasonable out of pocket expenses incurred during their donation treatment. We will arrange for the reimbursement, as appropriate, or would have evidence available that the donors have been reimbursed.

    Do you have a waiting list for donor eggs?

    In a fresh donor egg cycle, there are elements of uncertainty involved – the donor needs to comply with the treatment and to respond satisfactorily to ovarian stimulation, and there is no guarantee of the number of mature eggs that will be produced. Using frozen eggs removes these uncertainties as the eggs have already been collected and the mature ones are ready for use.

    Do you accept egg donation recipients from outside of the UK?

    We accept patients from all over the world for IVF treatment with donor eggs at our Cheshire fertility clinic.

    Is there any attempt made to match donor characteristics with me?

    Yes, as much as possible. When a donor becomes available, we would make you aware of various physical characteristics as well as education, occupation and interests. You would be able to choose whether you find that donor a suitable match to you or alternatively you could choose to wait for another available donor.

    How much information about a donor can I receive?

    In addition to the donor’s name, maiden name, date of birth, address and place of birth, we are also required to record non-identifying information such as eye colour, height, weight, hair colour, occupation and interests.

    Can the egg donor change her mind at any time during the treatment?

    The donor can change her mind up until the embryos created from her eggs are transferred in to the recipient’s uterus. Information shared at the time of consultations, selection and counselling are meant to be sufficiently clear and thorough such that a prospective egg donor will have withdrawn her offer long before treatment has even started.

    What screening tests are required for the recipient?

    A woman referred for treatment with donor eggs will normally have undergone assessment under the referring gynaecologist or in some cases by the GP. It is important, however, for us to confirm the following:

    • That you are not capable of producing your own suitable eggs
    • That you have a uterus capable of carrying a pregnancy
    • That your husband or partner has sperm which are capable of fertilising eggs, or that you have agreed to use donor sperm
    • That you are not carrier of HIV, Hepatitis B and C
    • That you agree to further investigations, including blood tests for CMV, blood group and atypical antibodies and ultrasound scans
    • Swabs from the cervix and the vagina to exclude infection

    Do you offer counselling?

    It is a requirement by our clinic that any woman who is considering treatment with donated eggs should attend counselling. We have a counsellor based at the Centre for Reproductive Health and as much as we can, we will arrange the appointment at a time that suits you. The purpose of counselling is to provide you with the opportunity to discuss, independently of the clinical staff, all the possible implications of undergoing egg donation so that you are able to make the decisions that are right for you, including whether or not to proceed with treatment using donor eggs.

    What is involved for the recipient of the embryos?

    The recipient will have to attend for 2 or 3 ultrasound scans during the treatment cycle to ensure that the lining of the uterus (known as endometrium) is developing in response to the hormone regime. The embryo transfer is a relatively simple procedure, which is almost always carried out without sedation or anaesthetic. It involves the passage of a fine catheter through the cervix and then into the cavity of the uterus. It is akin in discomfort terms to having a speculum passed and a smear test taken.

    Will I require time off work?

    No, from a physical stand point. However, you may feel some psychological benefit from a few days rest.

    How long will I have to wait to proceed with egg donation?

    Once a decision has been made to offer you treatment using donor eggs, the first task is to find a suitable matching egg donor. If you are reliant on us to find you a donor, then you will have to consider going through the egg sharing programme or being referred to an egg donation agency or alternatively be prepared to wait an indefinite length of time. If you are able to introduce a suitable egg donor to the clinic then your wait will be considerably shorter.

    How many eggs will I receive?

    This depends on the number of eggs collected from the donor. If the donor is an anonymous altruistic donor provided by our clinic or via the egg donation agency you will be the sole recipient of all eggs collected during that cycle. Although we screen donors to the best of our ability, we cannot guarantee how many eggs may be collected or that all eggs are mature and suitable for in-vitro fertilisation.

    If the donor is an egg sharer, you would receive half of the eggs collected from that cycle. We would go ahead with the egg sharing agreement if you were to receive at least 4 eggs. Please refer to our egg sharing information document for further details.

    If you have recruited the donor then you will receive all the eggs that your donor has produced. Every donor will respond differently to the drugs used to stimulate ovaries. Although a number of tests are carried out on the donor before she starts treatment we cannot guarantee the number of eggs that will be collected and those that will be suitable for in-vitro fertilisation.

    How many chances will I get?

    For each cycle you will get as many cycles as the number of available embryos, including fresh and frozen. The same applies to the event your donated eggs fail to fertilise and form embryos. Given the young age of most donors and their history of proven fertility, we would normally recommend the transfer of only 1 embryo. However, ultimately it is the recipient decision to have up to 2 embryos transferred at any one time.

    How much will IVF with donor eggs cost?

    The current charges for in-vitro fertilisation treatment using donor eggs are stated in the published RHG Fertility Fees Schedule.

    How likely is this treatment to work?

    This depends on a number of factors, which you will discuss in detail with the consultant at the time of your appointments. Available data show that the clinical pregnancy rate per cycle of donor eggs started ranges between 40-50%. The clinical pregnancy rate using frozen eggs is comparable with that of fresh eggs.

    If you are interested in learning more about egg donation and IVF using donor eggs, our first point of contact is Nikki Francis, our egg donation coordinator. Nikki can be contacted by email at nfrancis@reproductivehealthgroup.co.uk or by phone on 01925 202180.

    Nikki is available to answer any queries you may have, either before or during your treatment and is now available for informal one-on-one meetings, where you can discuss treatment options and take a tour around our clinic, the Centre for Reproductive Health, and see our state of the art facilities where your treatment would take place.

    Iona Test - Maternity Services

    A non-invasive prenatal test (NIPT) is an advanced screening test using DNA in the mother’s blood to estimate the risk of a fetus having Down’s syndrome, Edwards’ syndrome and Patau’s syndrome. There are many different NIPTs on the market, but the majority will screen for these three. Edwards’ and Patau’s syndrome are much rarer than Down’s syndrome but are very serious and many affected babies die before or soon after birth. Trisomies occur when three, instead of the usual two, copies of a chromosome are present.

    Traditional screening offered during the first trimester of pregnancy is currently called the combined test. This is an ultrasound scan to measure the nuchal translucency (NT), combined with a blood test. This is less accurate than NIPT, detecting about 85% of babies with Down’s syndrome. The IONA® test has a higher detection rate than the combined test. The IONA® test also is able to better exclude false positives. This is when the test says the baby is at a high risk of having Down’s syndrome but is actually normal. The IONA® test is much better at ensuring the babies are truly high risk. This allows the doctor to only refer the mother for an invasive test when it is likely the baby is affected. This means fewer pregnant women will undergo unnecessary invasive follow-up procedure such as amniocentesis or CVS which are stressful, painful and can carry a small risk of miscarriage.

    Full range of maternity & obstetrics services

    We are proud to provide the North West’s most progressive private maternity & obstetrics service, led by consultant obstetrician Dr Clare Tower. Our range of comprehensive maternity packages and one off scans & screening tests offer reassurance and support through individually tailored care.

    For more information you can view our reassurance packages here, or alternatively you can organise a consultation via our website or by calling 01925 202180.