If you’ve found your route to parenthood hasn’t been straightforward, The Fertility Podcast is for you. From how to optimise your fertility to getting pregnant naturally, navigating IVF, understanding donor conception or surrogacy to how to prepare for a life without children. Whatever your situation, you are not alone. Join me, Natalie Silverman, as I share insight as a former fertility patient and my co-host Kate Davies, an independent fertility nurse consultant plus chats with experts and people just like you. We’re here to hold your hand, on your route to parenthood including how it impacts you at work.
In February 2021 we relaunched this feed as having launched in 2014 we had over 300 episodes and we wanted to make it easier for you to find useful content. Our archive is being relaunched in February 2022 on new podcast feeds called: Getting Pregnancy Ready, Infertility Support, Male Fertility, Alternative Routes to Parenthood and Pregnancy Loss. Just have a look in your podcast search.
Bitesize: What to expect at your initial consultation at CRGH
Welcome to the latest episode of The Fertility Podcast Bitesize. We are in conversation again with Dr Theodorou, a Consultant Gynaecologist and Specialist in Reproductive Medicine at thehttps://crgh.co.uk/ ( Centre for Reproductive and Genetic Health) explaining what patients can expect during their first consultation with a fertility consultant
What we discussed:
Reasons why people come to the clinic
People want to be confident before they start trying, others might have tried with no success for some time. This varies from a few months or years.
People who have had failed cycles elsewhere and want another approach
Couples who need a donor - heterosexual, same-sex or solo
Fertility Preservation - male or female, for medical reasons eg. treatment that could impact fertility or social reasons eg. when people want to preserve for the future. Another reason is to avoid a known genetic disease.
Surrogacy - due to medical reasons or same-sex males
Initial investigative tests - male would be semen analysis and for a female ultrasound to check the uterus, ovary and fallopian tube and blood tests to check AMH, FSH and ovulation
Depending on circumstances they may go got specialist tests eg. recurrent miscarriage or a medical issue which could affect fertility
The stress of fertility treatment and the importance of counselling and support along the way
Explanation of implications of counselling and when it's needed.
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The Future of IVF
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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Bitesize - Inside the Lab at CRGH
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.
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
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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Bitesize: Why an IVF cycle doesn't work
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 http://fertially.com/ (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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What happens to frozen embryos when patients don’t want to be found?
This is a timely episode as the https://www.hfea.gov.uk/ (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
https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0039-1678597 (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
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
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https://www.hfea.gov.uk/about-us/news-and-press-releases/2022-news-and-press-releases/new-law-comes-into-force-giving-greater-flexibility-for-fertility-patients/ (HFEA press release )
What happens to our frozen embryos?
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 and 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
To find out more visithttps://www.tmrw.org/ ( TMRW )
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From TTC to parenthood
Love that you hold people’s hands from TTC to parenthood!! What a great podcast to keep coming back to.
I just started listening and I already feel so supported by these women. So great to hear you all chatting about these topics that are often not spoken about. It’s easy to feel discouraged and alone when struggling with fertility issues. So helpful. Really love this podcast, thank you
Great info! So helpful