Our live Instagram Q&A with the Lister Fertility Clinic’s James Nicopoullos

Our live instagram Q&A last week with Dr James Nicopoullos from The Lister Fertility Clinic was so informative, with so many people asking questions, that we thought we would share some of the Q&As with you, in case you didn’t get a chance to see them, or, if you haven’t signed up to Instagram yet.

These live sessions are so important

They give you the opportunity to ask the questions that you just somehow never seem to ask your own consultant. We, the ivf babble team, know from our own experiences  that when we used to sit in front of our  doctors, we would see their mouths moving, but not actually listen to a single word. We were in such a hurry to just GET PREGNANT that we were almost wishing them to just GET ON WITH IT!! It was always after a failed round that we wished we’d been more thorough, and asked some more questions!!

We haven’t included all of the questions and answers from the Q&A with Dr Nicopoullos, as there were just so many, but here are a handful for you to look through.

Q: We are a same sex couple looking to use donor sperm for IVF. Looking at banks in the UK and abroad, it is evident that there is a wide range of motilities available abroad, whereas in the UK, most clinics guarantee a minimum of MOT10-20, without committing to anything higher. In the case of IVF, how does the success rate vary between the different motilities? What is the preferred motility that you advise patients to choose?

A: It is getting harder and harder to choose as different banks use different criteria. Most clinics in the UK prefer to use unwashed or unprepared seem as prefer to use their own preparation techniques so as long as the sample is IUI or IVF compatible then once prepared should be fine to use. Ideally an unprepared sample should have >30% progressive motility but number and shape matter too so don’t focus on just motility. As long as it’s IUI or IVF compatible that’s fine.

Q: What should my BMI be when starting IVF?

A: There is a little bit of evidence that miscarriage rate increases as BMI rises above 30 and more so above 35 as well as some pregnancy risks. So ideally <30 but its a balance between losing weight and the decrease in success with any delay in treatment as I know how hard it can be.

Q: Before starting fertility treatment with my clinic, do you think the NHS should have referred me to a urologist? We started fertility treatment 3 years ago but have only just found out I have DNA damage and very high ROS. We have had multiple miscarriages and believe my issues could be a factor.

A: Ideally I think a urologist is a key part of work up for couples and the make investigation often gets forgotten. So to find any cause of the DNSA damage and get it down before treatment is sensible.

Q: Any food and exercise advice for women post frozen embryo transfer ?

A: Honestly so many old wive’s tales out there and realistically nothing will change the genetics of the embryo which is what will decide. So exercise, lifting, work, intercourse, swimming all fine at normal levels you can manage. Do as much or as little as you need to get you through the difficult 2 weeks and keep well hydrated.

Q: Do the grades of embryos actually mean anything when an a grade can still miscarry?

A: The grading is a morphological or eye ball assessment all be it an expert one by the embryologists. Yes on the one hand many top quality embryos don’t succeed and some poorer ones do but we know that the better the quality / grade given the better the chances of success as the higher the chance of an embryo being genetically normal. But frustratingly no certainties either way.

Q: What could be the cause of a miscarriage at 5 weeks even after PGD IVF?

A: Thats horrible for you after going through treatment and PGD. There may be some subtle genetic cause that we are yet to identify but the key things to exclude are thyroid issues, anatomical issues (polyp / fibroid etc) and most importantly a clotting issue (thrombophilia) that can cause miscarriage and all easily testable.

Q: Once your embryo transfer has taken place, what is the procedure for the TWW? Should you continue with your normal lifestyle or are you required to be more stationary? Thank you!

A: Don’t be stationery. I gave a talk at the annual training course on embryo transfers and looked at the recent research and there is good evidence that the old recommendation of bed reset may in fact decrease the success rate. So live life as normal.

Q: We have been diagnosed with low sperm count 3million but have been able to get pregnant naturally 6 times in the last three years, but miscarried all 6 babies very early on. Are there any vitamins you would recommend to help improve his count? Thank you for your time

A: Sorry to hear that. Firstly make sure you get a full investigation for any underlying cause of the miscarriages. In terms of the vitamins lots of options and not a whole lot of evidence to support them but I recommend Proceed Plus (can get from Amazon Prime believe it or not) as lots of the essentials in one sachet rather than having to pop lots of pills.

Q: What are the standard required tests that all clinics must do before they start any form of IVF for both the male and female? In other words, what tests must be done under clinical guidelines and what are the extras that can be helpful but are not ‘musts’?

A: HIV / Hep B / Hep C are legal requirements and Chlamydia if you are having a transfer recommended. I would also advise thyroid function as can impact in outcome. Scan and test of egg reserve such as AMH also vital to plan treatment

Q: I have been TTC three years, we are classed as unexplained, is it time to go down the IVF route?

A: Probably yes. Depends to a certain extent on age but at all ages most women will conceive in the first couple of years. So for example at 35, 70% of women are likely to get pregnant in a year, and if not 50% of those who don’t in the 2nd year and probably 20-30% of those in the 3rd. So chances naturally plateau.

Q: Can blocked Fallopian tubes become unblocked without surgical intervention?? I’ve had surgical intervention that failed 4 yrs ago and the doctor won’t do it again

A: Unfortunately not very likely especially after surgery that can often increase the scarring if unsuccessful IVF probably best bet. Sorry!

Q: I am having a stent put in to my left ureter as have a build up of fluid near my kidney due to endometriosis scarring that is blocking the passage. I’m due to start ‘short protocol’ ivf after this procedure and wondered how long you would advise I should leave before starting? Additionally, besides diet are there are further ways you can suggest in helping prepare the body for ivf?

A: Sounds like it’s been a difficult time. If it’s just a stent then you could honestly start the month after. Beyond folic acid, a sensible diet, not smoking and moderating alcohol intake not a lot else.

Q: Hi we’ve had two failed cycles one fresh and one frozen. Had a successful cycle in Nov after another fresh cycle but miscarried at 8 weeks. At what stage would you suggest having further tests carried out? We have ovulation issues. Last cycle added in Aspirin.

A: No absolute right or wrong time and depends on the quality of the embryos and age. So if for example a couple are 44 with average embryos the expected success rate after 2 cycles will be very low but if 34 and top quality blastocysts then expected success rate would be 70-80%. So 2 cycles with top embryos at a younger age would warrant further investigation. That’s the right thing though rather then randomly adding things. Ideally should go with tests with a reasonable evidence base. Check out the HFEA traffic light system on “add-ons” and we have aversion that will be on our website in the next day or so.

Q: We had our first round of IVF in January last year, unfortunately it resulted in our baby girl being stillborn in August last year. At the time of implantation the clinic mentioned that my lining wasn’t as thick as they’d normally like, but perhaps it was as thick as my lining got. Our daughter was stillborn due to placenta issues, had a growth restriction that was picked up as early as the 12 week scan. Could the lining of the womb have been what caused the placental problem? (I am currently working on reducing my BMI to 30 again and I’ve started acupuncture ready for our next round of IVF – in the hopes it improved the thickness of the lining)

A: I’m so sorry to hear that. Must have been an awful time for you. I don’t think that the thin lining caused the placental issues as such but the likelihood is there may be some underlying issue that is causing both a thin lining and the placental problems possibly related to blood flow in the uterus. Acupuncture seems reasonable but would ensure you have a plan for your obstetric care as there may be preventive measure such as Aspirin from the start of treatment that may minimise these.

Q: I am due to be starting my IVF cycle in less than a week. My BMI is just under 30, but I want to fill my body with nutrients and the right foods before and during the process. Any advice on foods to avoid / eat in order to improve chances of success? Thank you!

A: Good question but difficult one to answer!! Not a great deal of evidence to support one diet over another to improve IVF or fertility outcome and no great evidence of one diet versus another in terms of weight loss as long as it comes down. I would recommend an appointment with our nutritionist Komal Kumar at the Lister if coming to us or someone like Melanie Brown who is independent and great too….they will give you a better answer!

Q: I’m 28 and have an AMH of 2.8 pmol with normal FSH. Is there anything that could have caused my AMH to be so low? There is no history of early menopause in my family. I have periods every month, usually my cycles are about 25 days and I bleed for approx 2-3. I’m in a same sex relationship and my fiance is currently doing IVF, it is not the right time for me to also do it. I’m aware the number will drop more with time so would it be better in the future to use my fiancées eggs as apposed to mine?

A: Tricky one as depends on how old your partner is. Classically family history is important but the things that we would obviously ask are any chemo, radiotherapy, any weird and wonderful medications, any surgery to the pelvis or ovaries. If one of those then can run a couple of genetic blood tests to rule out anything subtle that could impact ion ovarian reserve. In terms of you are your fiance, obviously time is of the essence in you so the sooner the better but in many ways the success is as much if not more about quality over quantity so 4-5 eggs at 28 will give way better success rates than 14-15 eggs at 42 for example.

Q: I have been diagnosed as having low antithrombin levels and also low Von Willebrands (apologies for the spelling if it’s wrong 😬). I know that these are both clotting factors but don’t have my haematology appointment just yet. Do you know how this is likely to affect my next round of IVF and if it could be a reason for my repeated implantation failure (5 excellent embryos transferred and still no positive pregnancy tests)? I also have fibroids and have had fibroid surgery 3 times in the past so I’m feeling a bit up against it all! Thank you!

A: Hi and yes you have been through it! Antithrombin III deficiency is one of the clothing issues I mentioned earlier that increases clot risk and this group of disorders has been associated with miscarriage predominantly and to a lesser extent to implantation failure so I would treat with a blood thinner such as clexane if treating you. If the lining of the womb is thickening up and the cavity is clear then hopefully fibroids no longer an issue. Have you considered an ERA test (Endometrial Receptivity Array) to assess whether your lining is receptive at the right time. Check it our on our website or IGENOMIX site

Q: We are due to go for our initial appointment with our GP in April to discuss our fertility as we have been TTC on and off for approx 4/5 years, would you suggest that I have an AMH test prior to our appointment? We’re feeling a bit apprehensive about what our initial appointment will involve any advice would be appreciated. Thanks in advance 🙂

A: Definitely worth getting as much info as possible so scan, semen analysis and AMH the best start. GPs frustratingly will still often do FSH to test egg reserve which isn’t overly accurate so may have to get AMH done privately but that is the key. Don’t be apprehensive, The more info you have the better to make decisions.

Q :I’ve had two failed ivf fresh transfers. I’m due to have a frozen transfer later this year, is there anything I can do to improve chances of implantation?

A: If too quality embryos then possibly worth considering an endometrial scratch (although evidence is mixed), ensure thyroid is OK. lining is thickening up and of that doesn’t work maybe look at some other factors (genetic / sperm DNA etc) before any fresh cycle)

Q: Hello me and my partner have been trying for a baby for nearly 4 years now we have been for testing I have PCOS but I ovulate on my own I am now trying metaformin for 3 months my bf has sperm antibodies his sperm morphology was 3%. We went for ICSI but it failed we didn’t make transfer we got 15 eggs and only one fertilised by day 5 we didn’t have an embryo. We have been told to have a DNA fragmentation test done. X any advice would be a great help Thank you on where we go next

A: Trickiest question so far as so much info I would want to really answer the question. Once you are doing ICSI, as long as there is 1 sperm of good quality per egg, that 3 per cent figure shouldn’t matter. Embryo quality is driven more by eggs to Day 3 so if poor quality already by then likely to be egg related. If great on Day 3 then poor then stopped related and definitely worth looking at sperm DNA and trying to improve if high. Have to also remember can’t make sweeping generalisations based on 12 cycle and maybe fine next time.

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