The Fertility Podcast

Earlier in this series, we spoke about the Corporate world of IVF and how clinics around the world were consolidating, and what that meant for you the patient. In this episode, we’re looking at the future of IVF and our first conversation is with Stuart Lavery, a senior consultant gynaecologist, a well-respected member of the global human fertility community, and a founding director of Aria Fertility, our second guest is Professor Nick Macklon, Medical Director of The London Women’s clinic and Medical Advisor at Verso. 

What we discussed: 

• IVF Changed over the last 10 years
• The biggest provider of IVF in the UK is a private equity 
• What we can learn from the US
• Fertility is an illness becoming demedicalised 
• How his clinic Aria - competes with the big chains
• Most of the big groups had the same success rates, same treatments - but mediocre customer experiences
• Using technology to enhance the patient experience. 
• How important it is for a patient to feel confident and comfortable 
• Tech changes that are here now and a huge amount coming tomorrow
• Tech companies who believe tech will trump biology
• Developments in the lab are around automation and minimization 
• IVF at Home - saliva test at home replacing coming into the clinic for blood, e- consenting, and home ultrasound 
• Important not to exacerbate inequalities in access to treatment
• There’s no reason that the NHS can’t be at cutting edge of technology given the patient volume it has coming through. 
• NHS clinics shouldn’t access less, it should be the same standard whether you pay or access the NHS. 
• The decline in ‘Gentle IVF’
• Automated robotic ICSI
• The decline of IUI  - need to make sure the right treatment goes to the right patient
• Professor Nick Macklon explains how the incubator or the Uterine environment hasn’t really been studied until now
• What is device monitoring?
• How research shows how much it fluctuates between women
• How does it impact embryo transfer
• How oxygen levels can change which can affect implantation
• How Secretions can also affect implantation
• What this means for the future of IVF treatment 

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Welcome to another episode of The Fertility Podcast bitesize, with The Centre for Reproductive and Genetic Health (CRGH) in this snippet, we’re going to be hearing from Xavier Brunetti, Deputy Head of Embryology to talk you through the lab set-up at CRGH. It’s fascinating getting to understand more about what happens post egg collection in the lab and how the Emrbyologists work and how they feel about sharing the news of what is going on with your precious embryos. So have a listen to Xavi explain more about the process. 

We discuss: 

• What happens after egg collection 
• How they are prepared for IVF or ICSI
• What ICSI is, how it is prepared for treatment 
• How the embryos start to divide over 5-6 days
• What the embryologist is looking for and what it looks like when an embryo develops abnormally
• The speed at which the embryo divides and what it shows
• When a biopsy happens
• Egg freezing 
• What happens during embryo transfer and what the patient is told
• What happens when it is a frozen embryo transfer 
• Embryologists contact patients and how they are always happy to explain things as much as the patient needs
• What it feels like when a patient names their baby after the embryologist 

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This episode of The Fertility Podcast Bitesize is a conversation with Dr Matt Prior, a doctor in Newcastle, and an NHS consultant one of 143 experts is answering more of your questions over at fertially.com who we've worked with to make this bitesize chunk for you. In this episode Matt explains what tests you can expect prior to starting IVF treatment, how you can prepare for your first cycle and he also explains why it might not work. Nothing can take away the heartache of a failed cycle, however hearing an expert validate that it's not your fault can sometimes ease the pain, which is why we wanted to share this bitesize snippet.

What we discussed:

• Tests you should expect before starting treatment: 3 most important are an Ultrasound to check womb, and counting follicles, AMH to check egg reserve, Male would have a sperm test to check any issues to make sure you don’t go through collecting eggs and then there being an issue with the sperm. Other tests might check blood - for anaemia, thyroid function, also both partners would be advised to check for Hepatitis and HIV. 
• Statistically first cycle is most likely to work, but IVF isn’t the most successful of treatment. 
• For most people whatever age - its not likely to be successful 
• Ahead of IVF take folic acid good, eat a sensible diet, don’t limit the amount of alcohol that you drink, look at different lifestyle factors.
• It’s important that even if you do take into consideration a change in lifestyle factors, if your treatment doesn’t work it’s key not to beat yourself up that you  might not have stuck to the diet that google told you or the book you bought. 
• Know that actually, most of it is out of your control and while you can do everything to try and prepare to make the IVF cycle successful, it might not happen.
• Consider IVF as a funnel - of those starting will have an egg collection 95% or nearly all of them will have embryos to transfer. 
• 30 to 40% of women all become pregnant
• After a positive pregnancy test, about 70 to 80% of women go on and have a baby so really IVF fails the most between embryo transfer and pregnancy test.
• Issues with embryo grading, putting back a perfect embryo still doesn’t guarantee success
• Transfer process could be problematic
• There could a problem with the womb lining - there is still a lack of evidence. 

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This is a timely episode as the HFEA has just announced a change in the law for the storage of our frozen eggs, embryos, and sperms. From 1 July 2022, all patients can store their eggs, sperm, and embryos for their own treatment for up to 55 years, you just must make sure you provide consent every 10 years. Frozen Embryos are a topic that I do find quite triggering to be honest, as we didn’t go on to use ours. We donated them to science which is something I have spoken about on this podcast before.  Frozen embryos cause a lot of anguish to fertility patients when they don’t know if they can handle more treatment or if they can’t afford it, but it feels so unfair not to hold on to this precious material. But then as the popularity of IVF continues to grow and become more aware of it and have more access to it and sadly need it, there ultimately becomes more and more embryos in storage. We speak to embryologist Giles Palmer about this issue 

What was discussed: 

• The anguish having frozen embryos has on people 
• How it feels 
• Reference to paper Giles wrote 
• How each country has its own laws on the storage of embryos 
• The growing inventory of eggs and sperm around the world and every clinic is talking about 
• Storage fee that is attached  -how that is communicated with the patient 
• Compassionate transfer 
• Single embryo transfer, fertility preservation - all leading to a growing inventory
• 300% increase in embryos stored over 5 years 
• If you weren’t pregnant 75% of patients go back for the embryos
• If they were pregnant to live birth 16% go back 
• Giles spoke about how a new Dewer bought every year  - to store the embryos and he had to kn0ck down a wall to store them. The problem for many clinics - problem do they store in-house or off-site at a bio depositary 
• How to deal with issues when storage time is up
• Can’t store samples after consent is up
• Paper said 25% of samples - never be used 
• Embryos are yours to take elsewhere if you want to move them from your clinic 
• Seed Ships 

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We’re in a conversation about what happens to our frozen embryos and the future of cryo storage with Cynthia Hudson, VP of Clinical Strategy & Specimen Services at TMRW, and Elizabeth Carr, the first IVF baby born in the United States. To give you a bit of background, Cynthia is an embryologist and medical technologist with over 20 years of experience in reproductive technology she has worked in, and founded, a number of leading IVF practices and designed multiple IVF laboratories and Natalie met with her in London to get a live demo of their technology. Elizabeth works with the company as part of their marketing team and shared her experience of life as the first  IVF baby in the US, and her decision to become work in the world of ART. 

What was discussed 

• Explaining the TMRW system in the Cloud
• Opportunity to have lots of backups and a cynic’s inventory is updated in a real team 
• How the system speeds up a lab and makes an embryologist's life easier 
• Cryo beacon - holds up to 8 cry devices - standard to what exists. It has a cap, so devices can’t full out and it has a chip on it so it can be identified hands-free. 
• Explanation of freezing and how if the cells aren’t treated before the temperature is lowered it will damage the embryo, so the water must be removed and replaced with a cry protectant. 
• How the freezing process has changed in the last 10-15 years. Taking the temp from 37 deg C to -1.96 in under 1 second 
• Previously walked around with buckets made of styrofoam and never had a purpose-built tool to move tissue safely around the lab. It has a see-through lid to never lose line of sight to the specimen. 
• How it is frozen, using iris recognition and then frozen. 
• Know the exact location of the beacon within the system 
• Numbers  - take the storage capability vertically. 
• In a standard clinic, they have to be manually filled, liquid nitrogen has to be at the right temp
• Some have over 100 dewers - has to be filled and monitored regularly. This tech does it automatically. 
• Overwatch 24 hours to make sure they know everything going on in every system. 
• Taking a lot of risk out of the process. 
• Elizabeth talks about how her parents had to leave the state they were living in to travel to a different one as it was illegal in the state they lived in. 
• Her childhood was shaped by the need for her to ‘look normal’ as the topic of IVF was so she went into journalism  - because she was fed up with people asking stupid questions and decided at 10 years old she could do a better job 
• The conversations she has with the clinic conversation about cryo storage
• How the volume of specimens has increased, meaning the embryologists have to do a lot of extra processes - to manage them 
• How clinics become an accidental storage facility 
• Patients now are so much more educated and are asking more questions 

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Welcome to the latest episode of The Fertility Podcast Bitesize. We are in conversation again with Kirsty Lee Wright and Joycelia Green, two Senior Nurses at The Centre for Reproductive and Genetic Health explaining how valuable getting emotional support during your treatment is, whether it's from professionals or from your friends. Plus the importance of setting boundaries. 

What we discussed: 

• Find your tribe
• Talk to someone 
• Tell the nurses about your good and your bad days as the forums and online groups can be helpful but you shouldn't compare yourself to anyone else. 
• Our bodies do different things and sometimes info online can be confusing and conflicting 
• If you decide you need a nurse and you want to talk - or if you want to be left to your own devices do what is right for you 
• Self-care - destressing with exercising, or decompressing is important 
• You are having hormone treatment, so don’t apologize as you will experience a range of emotions and that is why you need the right support network. 
• Set boundaries with friends and family as you might not want to tell them much 
• Speak to the counselor at your clinic, if you want to do that before starting, it can be. Don’t wait until things go wrong no matter how strong you are, sometimes that objective opinion is what you need. 
• Your nurse can support you in how to talk about this at work, you can bring your work diary into the clinic, to work out a treatment plan so scans fit around your schedule. 
• Use work as a distraction but also you need to give yourself time for yourself. 

You can find out more about CRGH here

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In this episode of Behind the Scenes of IVF, we’re looking at who owns the clinics, with there being more groups, more venture capitalists, and more private equity. What does this mean for you, the patient? How might it impact your decision-making? What might the benefits be? We’re in conversation with James Nicopoullus, Medical Director at The Lister Fertility Clinic, Peter Reeselv - Founder and CEO of The Fertility Consultancy, and Griffin Jones founder of Fertility Bridge

What was discussed: 

• How the HFEA is still in charge in the UK as the regulators
• VCs who have bought clinics as they see it as a good business prospect and will have a master plan to make money  - therefore there will be pressure, however word of mouth will always ensure the clinic is a success 
• How clinics must make it absolutely clear where the ownership is on their website 
• Finance packages are separate from the clinical decision making 
• Whether prices will change and become more regulated
• Where does the buck stop when something goes wrong 
• What is happening in Europe and how developments in the fertility space are changing because the pioneers are retiring so international networks can combine and offer more opportunities for patients.
• How fertility tourism is going. 
• How Sweden, Norway, and France are now enabling single women and same-sex couples able to have treatment, yet in Poland, this is the opposite  
• How consolidation should put more pressure on clinics to improve services 
• Shared best practice
• Networks enable clinics from different countries to  come together and share best practices and research 
• The global reach of IVF
• Private equity within the IVF sector
• How Branding has changed over the last 20 years 

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In this episode we’re talking to some incredibly passionate people who absolutely love their jobs - meet the Embryologists and learn about the highs and lows of their work as we talk to 3 female and one male embryologist - in a field that is over 75% female. We hear from Alease Daniel, Victoria Wigley, Dani Smale, and Giles Palmer about what makes them happy and sad in their work. 

What was discussed: 

• Why Alease chose to share her work on social media to dispel the mystery about the lab and how it can empower patients 
• How Labs can be understaffed and embryologists are undervalued and their opinions aren’t valued. 
• Burnout but it’s still a job - they don’t want to be worked to death and the human aspect of the embryologist isn’t considered. 
• Lack of training in delivering bad news
• How when Victoria was working as a lab manager meant she could spend more time with patients - not been able to do that previously, so didn’t have the opportunity to build rapport 
• How she realized there was a gap in the info from the lab side - eg. lots of questions from patients about add-ons that make patients feel vulnerable 
• The benefit of having someone impartial to go through them to make an informed decision to go back to the clinic and feel more in control 
• WHow being an Emrbyologist is always a topic of conversation at dinner parties always fascinates people. 
• How you go on the journey with patients so when it doesn’t work or they lose the baby, it’s heartbreaking 
• Embryologists are scientists and aren’t trained in the emotional side 
• Talks about a study of over 1k embryologists - looking at mental health and presented as a poster at Fertility 2022
• Job needs a lot of skills, as there is little automation. 
• Need good hand and eye coordination
• Often work alone  but often don’t do the whole cycle
• Can be very stressful 
• Daily appraisal - why didn’t this person get pregnant 
• Time Commitment - every weekend, on a rota, often on call - mission-critical equipment is on alarms 
• Job changes all the time
• About 75% are female to male in embryology 
• The embryology population is ageing out 

This series of The Fertility Podcast is sponsored by TMRW

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Welcome to the latest episode of The Fertility Podcast Bitesize. We are in conversation with Kirsty-Lee Wright and Joycelia Green, two Senior Nurses at The Centre for Reproductive and Genetic Health who are sharing some top tips for your IVF cycle that they gathered from the 28 strong nurse team at the clinic. The nurses are always on hand to hold your hand, literally as well as answer any questions you might have in between your consultations and stages of treatment and these tips are really handy. 

What we discussed: 

• Bringing in your own dressing gown 
• Remove all piercings, especially the intimate ones 
• Bring a snack for after egg collection
• Plan a treat for that post egg collection breakfast 
• Read all your discharge information once you’ve gone home and had a sleep and if anything doesn’t make sense - ring/email the nurses with any questions 

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Welcome back to The Fertility Podcast, yes it’s been a while since our main series was published and with this one, we’re going Behind The Scenes of IVF and in our first episode, we’re starting a conversation about the IVF sector’s green credentials. We hear from locum Embryologist Dani Smale, who started her training at CARE Fertility London where she undertook small research projects, including looking at the environmental impact of IVF, mainly plastic use. We also talk to Annemette Arndal-Lauritzen, the CEO of the European Sperm Bank about the Communication on Progress (COP) report and talk about how whilst their primary focus is on creating healthy babies, they also want to make sure that current, as well as future generations of donor children, grow up in a healthy world and that their families are on an equal footing with any other type of family.  You will also hear a snippet from Dr Emma Saunders and  Ricard Ledin da Rosa, Sustainability Specialist at Vitrolife. 

What was discussed: 

• With almost 2.5 million IVF cycles completed around the world every year and the number is constantly rising - can IVF go green? 
• It’s possible that per cycle / per consumer portion of greenhouse gas emissions could be higher than any other healthcare-related procedure
• Dani Smale study with Care Fertility in 2018 looking at the number of cycles and the average number of different consumables for each procedure
• 69,500 consumables about 22,800 pieces of packaging
• Difficult for a city-based clinic to recycle. 
• Lab mentality - just get another one, rather than recycling 
• NHS Labs are much more conscientious in thinking about costs 
• Using reusable caps , but not that many units use them. 
• People are worried about infection control so they use disposables. 
• Repurposing = Glassware might be used in arts and crafts, schools, Girl Guides 
• The Sustainable Development Goals from the UN to choose which applied to the European Sperm Bank  - 3 Good Health and Well-being, 5 Gender Equality, 16 - Peace, Justice, and Strong Institutions  
• Recycle tanks  - don’t use dry ice as it requires a lot of plastic
• Use large tanks that can be recycled and optimised for usage 
• Aiming to become zero neutral in 2025 in 2022 - attempting to reduce by 50% by minimising as much as possible and for the rest, they are offsetting, by planting trees. 
• Importance of working with a company that takes pride in protecting the environment  - perception this gives to patients.

We talked about the International IVF Initiative and a session they held called ‘How Green is your IVF’ which you can watch here

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This episode is sponsored by TMRW