5 Things I Want Everyone to Know Before Starting IVF

00:00:00 Any embryo that's good enough to freeze or transfer has the potential to give you a baby. I've seen textbook quality embryos that don't result in a pregnancy and a life birth. And I've seen ugly embryos that go on to make gorgeous, healthy babies. Stop worrying about grading, okay? It's not likely going to be 20% excited or 27% excited or 37% disappointed, it

00:00:26 It's not likely going to be 20% excited or 27% excited or 37% disappointed, it just doesn't work that way. Either going to be 100% pregnant or 0% pregnant. Either going to be 100% excited or 100% disappointed. There's no middle ground, so stop worrying about grading. After here, women say, well, I've had a 4AA blastocyst transfer, it's a perfect embryo,

00:00:57 there must be something wrong with me. Well, no, this embryo still could be chromosomally abnormal, or there could be Well, no, this embryo still could be chromosomally abnormal, or there could be something else going on that we still haven't discovered. I mean, we have done IVF for the past 40 years, but there's still things about conception that we don't know about.

00:01:18 Success rates, they're funky and they're not what they seem. And understanding them is virtually impossible. So let's say clinic reports, we have 40% success rates. So let's say clinic reports, we have 40% success rates. What does that actually mean? Most people jump to say, well, that means that we have 40% chance to take home a baby. But an actual fact, it could mean how many people got a positive pregnancy test

00:01:43 per embryo transferred, or how many people got a positive pregnancy test per collection, or maybe how many people got a heartbeat per embryo transferred, or how many people took home a baby after home a baby after the whole IVF journey, whether it be one cycle or 10 cycles. All these numbers mean completely different things and it's virtually

00:02:09 impossible to compare them. Another factor, you might come across a claim that has quite high success rates , and then you realize most of the patients are 35 years or younger, right? And then you see another clinic next door that has lower success rates, but you And then you see another clinic next door that has lower success rates, but you realize

00:02:30 they take on older patients, harder cases, and their clinic is more equipped for that cohort. So if you fall into that category, I would absolutely recommend you go to the clinic with the lower success rates, but protocols that are suitable for you, rather than the one next door with high success rates, but younger patients.

00:02:56 I often hear the phrase, conceive naturally or conceived via IVF, like they're I often hear the phrase, conceive naturally or conceived via IVF, like they're completely different things, but nature still has a big role to play in your IVF cycle. These clinics, they're not taking over completely. There's no such thing as embryo staple gun. What these clinics do is they help you jump hurdles. So if we take conventional IVF, we will put eggs and sperm together in a dish

00:03:23 to leave them overnight to fertilize. The sperm now have shorter distance to swim, but there's still some swimming The sperm now have shorter distance to swim, but there's still some swimming that needs to be done. So the analogy I use is swimming marathon, right? So if an marathon, a man usually would have to swim six to seven miles, he now

00:03:42 needs to swim .5 miles, a shorter distance. Now both the egg and sperm providers have a job to hand over the best quality raw materials, so the raw materials are the egg and sperm to the lab, because if they hand so the raw materials are the egg and sperm to the lab, because if they hand over poor quality eggs or poor quality sperm, defertilization rate, and ultimately the

00:04:08 take home baby rate will be compromised, no matter how experienced the staff are. So work on your eggs and sperm, which brings me to the three months prior to your IVF cycle. It's an important time to optimize your overall health, see if there's any fireworks going off anywhere in your body, any disbalances or inflammation, because the way we

00:04:28 off anywhere in your body, any disbalances or inflammation, because the way we work is, if there's something else going off, our body is going to deprioritize reproduction. Reproduction is the last thing on our priority list, when it comes to focusing the energy and efforts, right? And so taking care of the rest of your body is very important as well, to help

00:04:59 with ultimately with ultimately egg and sperm health. For men, men are very lucky, they produce a fresh batch of sperm every 68 to 74 days, so they can work on their last batch before the IVF cycle, and what I recommend is during that time, while they're working on their last batch before they produce the

00:05:23 sample for IVF, is to practice regular ejaculation every two to three days. for IVF, is to practice regular ejaculation every two to three days. Abstaining for five days or longer is not a good idea, it's a bad environment, not a healthy environment, because sperm crowd themselves and they start producing DNA fragmentation, and that's a big no-no.

00:05:46 Every implantation in the egg testing has improved a lot in the last decade, it 's a more sensitive testing system, and because of that, we're picking up many more mosaic embryos. Now I'm a very visual person, and so are a lot of my clients, so I have made a Now I'm a very visual person, and so are a lot of my clients, so I have made a model here. This is a model of a blastocyst, a blastocyst is a day five to day seven embryo

00:06:15 in culture. The cells you see here on the outside are called the trifectin cells, and when we do embryo biopsies, we take cells from this layer, and these cells go on to form the placenta. I cut a whole model, and inside you see a clump of cells, those are called I cut a whole model, and inside you see a clump of cells, those are called inner cell

00:06:34 mass, and those cells go on to form the baby. Now when we take biopsy of cells for genetic testing, like I have done many times, we take about five to ten cells from the outer layer. As you can see, some of the cells here that have painted blue, they are unemployed, they have abnormal number of chromosomes, too few or too many. have abnormal number of chromosomes, too few or too many.

00:07:01 And white ones are uploid, which is normal number of chromosomes. Now let's say I take cells from this area, where majority are blue. The result will come back as high level mosaic, so most of them are abnormal. If I take a sample from here, this is just one abnormal cell, this can come back as low level mosaic, if I take cells from here, where there's no abnormal cells, low level mosaic, if I take cells from here, where there's no abnormal cells, this result

00:07:37 will come back as you ploid, no abnormalities detected. And so as you can see, depending on where I take the sample of cells, the result will come back different. Now a great study has come out, and they were donated many embryos, blastocysts . And so what they did is they took biopsies from the outer layer, as you And so what they did is they took biopsies from the outer layer, as you

00:08:02 normally do in a live case, as well as the inner cell mass, those cells that go on to form the baby, which we don't touch, right? What they found is, those embryos that came back as low level mosaic from the outer layer, 50% of the time, the inner cell mass was absolutely normal, no abnormal cells. And those embryos that came back as high level mosaic, right, from the diffac

00:08:29 ulum layer, ulum layer, the inner cell mass was normal 40.2% of the time. So what this tells us is, when we take these samples for genetic testing, it's not telling us the whole picture, just the picture of that sample from the outside layer. It's very complicated. Taking home a baby via a sister of production can take time.

00:08:56 Taking home a baby via a sister of production can take time. It takes around three IVF cycles to have an 80% chance to take home a baby. What that means is you need to transfer all the embryos that are frozen in each of those cycles before you have an 80% chance to take home a baby. It's not a quick fix. So my job is to ensure that those IVF cycles, each one of your rounds, as productive as possible.

00:09:27 And that they don't stretch into an eight grueling cycles without any answers. And that they don't stretch into an eight grueling cycles without any answers. I'm not here to guarantee your baby, but I'm here to support you and guide you with clear science so that you can make progress and get answers sooner rather than later. Danging up to date with scientific advances is a huge part of my job. Fatilly doctors are wonderful, but they're also incredibly busy.

00:09:55 And many of them don't have the time to look through new studies and evolving approaches. approaches. And for some of doctors, they have people breathing down their neck to pump out as many cycles as possible. It's sad, but true. So it's my responsibility to bring out any red flags and make sure they're

00:10:14 resolved between my client and their doctor. So I recently worked with a couple who were advised by their clinic to transfer three to five embryos on day three. Now I haven't heard of such advice in many years. Now I haven't heard of such advice in many years. It's archaic and frankly dangerous.

00:10:34 The clinic claims that the chance of multiples is low, but there's still a chance and there's a lot of complications that come with a multiple pregnancy, both for the mother and the babies. And so I advise that they do not transfer so many embryos on day three. I follow the guidelines of the European Society of Human Reproduction and Embry ology. They go by their previous name of Asher.

00:10:58 They go by their previous name of Asher. Now they are the gold standard in our field. Asher brings together leading fertility specialists, embryologists and research scientists to go through data and publish evidence-based best practices in human reproduction. And so those are the guidelines that I follow.