Your questions answered by the amazing James Nicopoullos

If you missed the live Instagram Q&A the other day with James Nicopoullos from The Lister Fertility Clinic, or you’re not on Instagram, don’t worry we have listed the questions and answers here, and they really are fascinating

Thank you to James for his time and the incredible TTC community for sending questions through.

Q: Hello me and my partner have been trying for a baby for 4+ years he has 71% antibodies. We had icsi in 2018 but it didn’t work and we didn’t make transfer. I’m really anxious to go again for another cycle in case the same happens.

A:Sorry to hear that. Honestly antibodies on their own are not a big problem and some studies suggest it doesn’t require icsi. Most of us do it, but injecting sperm into the egg after washing will overcome that problem!! So maybe it’s just bad luck. If the embryos stopped growing early maybe it was an egg issue –  if you get lovely embryos on day 3 and then they stopped, then often its sperm related and I would consider a sperm DNA test. Hope that helps and don’t let it put you off trying again!! 

Q: Hello! I’ve had my fibroids removed 4 times (TCRF) and so have a lot of scar tissue. Could this be affecting implantation? I have had 5 embryos transferred in total with no positive pregnancy tests at all. TTC since April 2014. Also if my fibroids return would you recommend having them removed again or no before my next transfer? 

A:4 times has been a difficult journey! I would only remove again if submucous is within the cavity. If the lining is thickening up and more than 7mm and there is no evidence of scarring or irregularities then hopefully this should not be having any effect. I would also consider an ERA test to assess the uterine receptivity. 

Q: Hi!! I have PCOS and unfortunately suffered an ectopic pregnancy with no underlying cause and needed my one tube removing. I’m 35. What are the chances of me conceiving naturally at 35 and now having a successful pregnancy? 

A: Overall at 35, assuming ovulating and cycles are regular, there is around a 70% chance of pregnancy in a year, around 8-9% per month. Having 1 tube doesn’t halve this (and make sure you get the other tube properly checked to make sure open) so maybe down to 40-50% in a year and 4-5% per month….

Q:Hi, we’ve previously had low fertilisation (0 on IVF & 6/15 eggs on ICSI) we were told it was a sperm binding issue, would you recommend anything to aid fertilisation for our next go? Or any tests we could do to look into reasons why we have this issue? Thanks!

A:Good question. There aren’t any tests that will really change anything. ICSI will have overcome the sleek binding so that is no longer in play as a problem. Some of those that didn’t fertilise will be related to egg quality and may be better next time. You can consider sperm selection techniques such as IMSI although evidence of benefit is limited. 

Q: I’m currently in my second round of Ivf with icsi (my husband has oligospermia with low motility and varying morphology). I was told I have a high AMH level so have done short protocol both rounds. Last round I got 12 eggs, 6 fertilised with only 1 on day 5. This round I only got 8 eggs despite having 21 follicles. Why might this be? What is the likelihood of us having a day 5 embryo to transfer?

A:It’s still good with 8 eggs! Don’t lose hope!! Not all follicles give eggs, especially if smaller ones. If many of the 21 were of a good size, you  may need to consider a higher dose or different trigger injection to aid maturity. Hopefully it’s irrelevant and this will work! 

Q: I am single, 44 and desperate to become a mother. What on earth do I do first??!!

A: Come and see us or someone to get your egg reserve checked, so an amh blood test and scan and then go through the options of Iui, ivf, egg donation and relative success rates. You can then  make an informed decision. 

Q: I have just had a transfer and asked to have my progesterone checked. It was 39 which they said is fine. However I have read many conflicting views on the levels for this. What would you suggest is a healthy level?

A:This is a really topical and controversial question even within our clinic. Firstly, I can’t give an exact answer as a “correct” level will depend on what treatment you are having (fresh / natural fet/ medicated fet). There is also lots of evidence to suggest levels in the bloodstream don’t correlate with levels in the uterus where it matters and they can fluctuate during the day which is why most clinics don’t check. If it’s a frozen cycle mist Studies suggest a level of >30-35 as ok.

Q: Hi! Do you have a cut off age for patients to have ivf at your clinic? 

A:There is no absolute cut off but very geeky with our data so will show you success rates for your age to help decide whether right or wrong to try with your own eggs and we decide together. For example babies happen at over 45 but success at 46-47 is 1%.

Q: What are your thoughts of exercise during an FET cycle?

A: This is the simplest question of night! Absolutely fine and no reason not to do what your normal level of fitness allows. 

Q: Hi im currently going through ivf because of my low AMH level i have been on a strong dose of bemfola and menupure i have my egg collection on Friday I have 5 follicles I wanted to know is that a good amount to have?

A:Tricky question as simply the more the better!! But if your AMH is low then 5 follicles may actually be a good number for you and it just takes 1 to get the job done. For example average egg number for an Amh of 1-3 is around 4/5. Good luck on Friday!!

Q: After 2 rounds of failed ivf ( the second was icsi) which has been an implementation but failed near the test day for both rounds what you can suggest to me? Any analysis considering an immune negative response to my embryos? ( me & my husband have done the cariotyping analysis and we are ok)

A:Firstly, the most likely cause of any cycle not working is that the embryo itself wasn’t genetically right and your body did the right thing…But obviously if this keeps happening especially with good quality embryos we need to exclude other things. So hormonal (thyroid and progesterone levels), anatomical, flitting, check of sperm DNA, possibly assessing the endometrial receptivity with clever new tests to ensure the lining is ready when it should be. Immune would be the last thing to consider as there is less evidence based on this and more and more recommended ageists by the HFEA but can discuss. I would get your records and we can look at everything. J

Q:What dictates why someone is put on long or short protocol ivf? I’m on week 2 of long protocol and a friend of mine had short. Just curious!

A:Sometimes it’s a clinic preference but it mostly depends on age and egg reserve. Overall success rates are similar but short gives us better options to minimise risk of hyperstimulation if at risk. Good luck!! 

Q: I’ve had two pregnancies so far (36yr old.) 1) natural conception- ruptured cornual ectopic. 2) overseas IVF ICSI – ectopic. Also surgical management and now tubeless. First FET just failed and I believe this is because of lining 6mm (trilaminar) despite upping progynova to include PO and PV doses. While I await hysteroscopy on nhs to look into this, I am scared and anxious that I have scar tissue from my ectopic surgery – is this likely or more likely that I am not a responder to synthetic estrogen? I also have Hx of light periods. I honestly thought ectopics were my ‘problem’ and with no tubes left, I never anticipated lining issues. I’m just finding this all so hard. 

A:Sorry to hear about your difficult time! So if you didn’t have any surgery on your uterus for suspected miscarriage pre ectopic treatment then hopefully it’s unlikely to find scarring at hysteridvopy but worth checking. Also if the lining thickens up on fresh ivf that is a good sign too.

Options are trying a natural cycle, different cocktail of medication if medicated and if needed stimulation as in fresh ivf to make more eggs grow to increase your oestrogen they thickens lining. Also consider aspirin and vitamin E supplements as a little evidence of benefit.

Key is don’t despair as something will work!! 

Q: I have had multiple failed rounds of ivf at another clinic. I am thinking of moving to the lister. I’ve had lots of tests already, so can I just bring my notes to you or do I need to start from scratch with you?

A:Sorry to hear about the cycle failures. It’s really important to bring a copy of your notes as this can help us decide what worked well and what didn’t, to plan the next treatment and we can ensure we don’t repeat tests that aren’t needed so you don’t waste money too. Hope that helps 

Q: What ways would you recommend that you best prepare yourself for an IVF cycle? Next year, after a laparoscopy, I’ll be going into my first round and there’s a lot of advice out there … it can be hard to navigate it all sometimes!

A:It’s difficult as there is lots out there but again honestly most people aren’t doing much wrong, they need to change! Stop smoking if you are, keep alcohol intake moderate (can stop but evidence of real effect at low levels isn’t really there), take folic acid, minimise stress not because it will affect outcome but because only so many things we can cope with at once, get BMI down to <30 if above. If none of these things apply to you you are probably ok!!

Q: I was wondering if it was possible to use a known donor with the clinic? Do they guarantee a number of eggs/embryo? Do they offer a multi-cycle package? What is their BMI limit? Average waiting time for donor? So sorry for all the questions!

A: So….options for egg donation are our egg sharing program with approx 6 month wait, bringing a known donor is of course an option with no wait, can use agency’s such us Altrui or Nurture to help find a donor to bring to us and also have links with overseas clinics where we do the work up to minimise travel etc. Deciding which route to take depends on what is most important of timescale/cost/info you can get/anonymity etc. Lots to think about and I would come and go through them all to help decide. Some of our overseas partners do multi cycles.

Q:After multiples of losses … including ectopic… followed by a failed fresh ivf cycle … what are the chances of a fet cycle.. it’s a 5AA cycle x

A:It depends how young you are!! That’s a great embryo and we know frozen cycles give similar success to fresh so if under 35 around 50% and if say 37/38 probably 30-35%. Good luck!!

Q: With regards to making the move to donor eggs, would there be an initial appointment in which previous cycles/history etc was discussed and maybe further testing done before making the move to donor eggs. My AMH is very very low (0.5 when last tested in 2018) – would you make your recommendations to move to donor egg on this result alone or are there other factors taken into account?

A:Definitely as we would need to weigh up everything. 

Q: Hi. I’ve had 4 failed cycles of icsi. I have a low egg count and it appears poor quality. We are going to do 1 more round and I’ve been told that taking DHEA may help. Do you think this helps? I’ve read a lot about them, mostly saying to avoid. I don’t want to go to donor eggs yet and I have previously been pregnant naturally. Is it worth taking these? 

A:Good question and not a lot of good evidence to base it on. A few trials have suggested a benefit but all from one place. Also many more have shown no benefit. Overall some studies have shown a benefit of similar testosterone like supplements so tricky! So this has to be a personal call as this is one I’m on the fence on but if your last cycle and you don’t want to feel like you haven’t tried everything….that might give you the answer!! Haven’t seen any good evidence of a detrimental effect!

Q: Hi , how long after a miscarriage can you do another cycle ??thanks

A:Sorry to hear about the miscarriage. I would wait for your second cycle post miscarriage and good to start if you feel emotionally ready! Good luck. 

Q: If you fail ivf more than twice, would you recommend PGS testing?

A: Not necessarily. Testing the embryo doesn’t change them so if it’s normal should most of the time be successful and if abnormal then most of the time the bodys built in quality control mechanism will stop you getting pregnant but on occasion you may get pregnant and run the risk of miscarriage. So testing on its own unless lots of embryos to choose from won’t improve endpoint of chances of baby. So need to balance benefits of info it gives on embryo quality and  benefit of decreasing miscarriage rate with negative of small risk of damaging embryo and cost. Not right for everyone so very individual decision that we can help with.

Q: Hi, apart from folic acid. What vitamins should I be taking during my cycles. Is there an advantages to DHEA and royal jelly?

A:Honestly so much scary stuff out there that isn’t based on evidence so often get a long list and asked for advice but don’t have any real evidence to base an opinion on. No harm in royal jelly but no evidence of benefit. See earlier answer for dhea but definitely not unless low egg reserve. Some evidence of benefit of coenzyme Q10 on egg quality. 

Q: Genetic testing ???? Worth it at 26!???

Q:Honestly I wouldn’t at 26 unless a history of recurrent miscarriage as chances of success with a nice blastocyst are around 60% which isn’t much less then a genetically tested and normal one

And finally……

Not quite a question for James… but a heartfelt THANK YOU … as after his/the Lister Clinic’s help … we are now ( after an 11 year gap) 33 weeks pregnant with our second child xx a little boy xx words will never express the joy 💙

Keep an eye out for our live Q&As on Instagram

We hold them regularly with our experts and they really do give you an opportunity to ask your questions and get them answered straight away. In the meantime, if you have any further enquiries or questions, please do contact the Lister Fertility Clinic directly.

 

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