At the Zita West Clinic we pride ourselves on using evidence-based science and technology to improve IVF success rates. Here are just a few of the technologies we can use to help you have a baby.
Endometrial Receptivity Analysis
Endometrial receptivity analysis (ERA) is a way of finding out when the lining of the womb is most receptive, meaning we can then decide a time for embryo transfer that’s most likely to result in success. While there can be many reasons that an embryo won’t implant, sometimes there may be a problem with the endometrium which can then cause failed cycles.
What is the ERA procedure?
ERA testing can be doing either during a natural cycle or a conventional IVF cycle, with a test similar to a smear where tissue it taken from the womb lining. This is then analysed to see when the endometrium would be most effective to help decide the timing of implantation.
Time lapse technology
Time lapse embryo imaging is an additional procedure available to all our patients to help make embryo selection even more effective.
Once the eggs have been fertilised, photographs are taken of the embryos, without disturbing them, every few minutes. Calculations about what the embryo should be doing at specific points in time are then used to analyse the health of the embryo to see their chances of success.
As we know, one set of chromosomes from the sperm and one set of the egg form the first cell of an embryo, but if the cell doesn’t have the right amount of chromosomes (known as aneuploidy), this can lead to implantation failure, miscarriage or a baby born with a serious condition.
At the Zita West Clinic, we can carry out a genetic screening test called Pre-implantation Genetic Testing for aneuploidy (PGT-A) on embryos produced during an IVF treatment cycle. PGT-A helps us select the best embryo for transfer and may improve your chance of achieving a successful pregnancy.
There are many benefits to this technology, from potentially reducing the number of IVF cycles needed, to giving more confidence in transferring a single embryo.
You can find out more key information about PGT-A genetic testing, including its potential risks and evidence of success, on our Genetic Testing page.
Who should consider PGT-A?
For those who have experienced miscarriages or failed treatments then we may suggest this for you. There has also been research to suggest that over half of human eggs have chromosomal issues which increases with age, so many women who are over 35 may also choose PGT-A.
The PGT-A process
When embryos reach the Blastocyst stage after 5-6 days, they contain around 100 to 200 cells arranged into an inner cell mass and an outer ring of cells. The inner cell mass is made up of stem cells that will go on to form the foetus, while the outer ring (the trophectoderm) will become the placenta. A few of these trophectoderm cells are carefully removed by our embryologists for assessment before freezing the embryos.
For more information on any of these treatments, or to book with one of our doctors to discuss your next cycle , call us on 0808 196 4060 or email firstname.lastname@example.org
Dr Simone Rofena, Deputy Medical Director at the Zita West Clinic, answers your IVF questions.
What are the different types of IVF and who are they appropriate for?
I always think that it is critical to think of each patient as unique and it is only by considering a couple’s complete history that you can decide what is the most appropriate for them. So I don’t like labels and I never start with a pre-conceived idea and try to adapt that particular treatment to them. It is only by knowing what the patient has had in the past with regards to previous treatments, how they responded to certain things and her ovarian reserve that you can then really tailor the most appropriate way to do IVF, the choice of the right protocol and the right medications.
We have a number of younger women who have a low AMH and they have tried but aren’t getting pregnant and they have decided to have IVF. What would you say to them?
Age is still the main predictor of IVF success and AMH is not the most relevant element. Low AMH does become more of a problem with older women, as it is combined with a reduction in egg quality. However, the approach shouldn’t change too much because at the end of the day what you want to do is optimise the egg quality – either in a younger patient or an older one – and the way I approach this situation is very similar. Clearly with younger women the chances are increase because of the potentially higher egg quality.
So regardless of someone’s ‘labels’ what do you do when they first come to the clinic?
Well, firstly I am not a doctor who asks for millions of tests, I tend to just pick a few tests which will help me identify what the best approach to take would be. I normally go with basic tests such as Vitamin D and thyroid function – as they are both important to help optimise the egg quality and ensure that they are in the best possible situation. We know that both can affect egg quality and the miscarriage rate, so if the thyroid is outside the normal range the incidence of a miscarriage is more likely to happen, which is why it is important that it’s in the recommended range of 0.5 – 2.5 of TSH. In addition to the women, we also test the men as well, as Vitamin D is also very important for sperm quality too.
We are very lucky here at the clinic to have a number of great different professionals including nutritionists who work together to deliver excellence and we believe that preparation for IVF is critically important to enhancing success no matter which type of IVF you are having. We will spend around two months before treatment begins to get both the women and men in the best possible shape and, for me, this so critically important.
Since working at the Zita West Clinic with the holistic approach to IVF, I have seen first-hand how much of a difference it makes to IVF success.
A lot of women worry, particularly those having IVF for the first time, that it involves pumping a lot of drugs into your body, but we work a lot more with lower stimulation, what does that mean?
I like to use as much evidence-based methods as possible, so I look at the science; I look at what is published and what is supposed to be correct. There is a lot of evidence that giving more than 300 units of medication doesn’t actually increase the chance of having a live birth. That is why I tend to only give a maximum of 300 units as there is no benefit of giving more than that and I completely understand how this is one of the biggest fears about the IVF process.
In terms of tests and investigations to work out which IVF is appropriate for which client, what are your views on FSH?
FSH can fluctuate quite a lot as if you take an FSH sample at two different times of the day you might have different results, and as AMH is more accurate I prefer AMH over FSH. However, the most important thing is to count the number of follicles with a scan, because sometimes I see women with very low levels of AMH but when you do a scan they have a good number of follicles, or at least a much better number than the AMH levels would suggest. That is why I prefer the scan to show us how many eggs we might get rather than a blood test and nothing else.
Does having ovarian cysts affect a woman’s chances of IVF success?
It depends on the kind of cyst. You can have functional cysts, which come and go during the cycle, or you can have a permanent cyst, like endometriosis, which stays there unless you remove it surgically. The functional cysts are not much of a problem, you just wait until they are gone and you start the stimulation. Permanent cysts can be a problem as they can occupy the whole of the ovary and you therefore have no space for other follicles to develop. Clearly, if there is a cyst occupying the whole ovary then you wouldn’t expect to get many eggs from that ovary and this would need to be addressed before starting.
What is a good quantity of follicles to have?
Of course, as many as possible, but I would say that any more than 10 would be a good quantity.
Is there a guideline to what IVF is best? What is the difference between natural IVF and mild or modified IVF?
Natural IVF does not involve any medication and you just monitor their ovulation and you will tend to get only one egg, maybe two as that is what a woman can naturally produce. Modified or mild IVF is when you start adding a low dosage of medication, without being too invasive, usually from day 5, 6 or 7 of the cycle with the aim of getting two eggs, maybe three.
This follows the idea that the egg a woman produces naturally is the best possible egg, although I have to say that the data does not support this theory and the success rate of this approach tends to be very low. Patients are often not told this at the start from the clinics they are having treatment with which might lead to waste precious time and money. What we tend to find is that a lot these women see the word ‘natural’ and think that this is going to be the best option for them, but the data just doesn’t back it up unfortunately.
In fact a recent properly conducted study including thousands of patients has shown that there is no difference in the genetic viability between eggs produced naturally without stimulation and eggs obtained with an appropriate dosage of medications (FSH), so therefore the more eggs we can obtain with the help of the medications the better. I do agree though that the dosage must always be appropriate to the needs of the patient.
I believe that what gives patients the best success is the perfect combination of quantity and quality. Quality tends to go hand-in-hand with the preparation and undergoing the best protocol for patients and as regards the quantity, we try to maximise the number of eggs that the patient produces by choosing the right amount of dosage appropriate for them and the right treatment protocol.
One of things that I know you’re keen on is progesterone testing, tell us about that…
There is a huge debate on progesterone at the moment and there is still no consensus on what the optimal way of administering it should be and what the optimal levels are. However, there is a threshold under which the incidence of miscarriage appear to be higher. At the clinic we measure progesterone with a blood test on the day of the embryo transfer and if patients are below the threshold we give them extra progesterone to try and help overcome that deficiency. If the progesterone levels are above the threshold after the egg collection that is no problem at all, in fact we want it to be as high as possible. Where it can be a problem is when progesterone levels are above the threshold before ovulation, as this can negatively affect the implantation. At this point we would then recommend freezing all of the embryos because we know that the chances of success are lower if progesterone levels are high before ovulation.
Should you always be putting two embryos back?
No, not always. The most important thing is to consider the age of the patient and if they are below 38 and have good quality blastocysts then you should only put one back because you want to try to reduce the chances of multiple pregnancies as they can be more complicated.
Preparing for FET – what you need to know
While the techniques have greatly improved over the years with a process called vitrification, which helps make it easier to freeze eggs, there remains a number of factors for women to consider around preserving their eggs.
The success of a healthy pregnancy achieved through the Frozen Embryo Transfer (FET) process has increased substantially in recent years, which has helped make the procedure an increasingly popular option for patients to consider before making the decision to proceed with another fresh IVF cycle.
The Zita West Clinic now has a Clinical Pregnancy Rate per embryo transferred with frozen cycles using the patient’s own eggs of 34% (the HFEA UK national average is 29%).
The embryo transfer is the final step in a long journey toward building your family and every path is unique, although each will all involve planning, injections, appointments, and usually some ups and downs. Preparing for this day and knowing what to expect can decrease your worries and maximize your chances of success.
Preparing for your Embryo Transfer
- The best way to prepare for your embryo transfer is to follow all directions from your clinic and learn more about what to expect on the day of the transfer. Whether you are doing a fresh embryo transfer or a frozen embryo transfer, you’ll likely be on progesterone and other supportive medications, so make sure you have enough of them and that you follow directions from your clinic on how to take them.
- Plan ahead for getting to the clinic on time – think of traffic, weather, and other issues that may cause a delay. If you have a long drive to the clinic, consider staying in a hotel near the clinic the night before the transfer to decrease your risk of being late.
- Ask about logistics for the day of the procedure – what time you should arrive, who you can bring to the appointment (usually it’s one adult in the room at a time), and how long you should expect to be at the clinic. Try to ask questions beforehand – the day of the transfer is exciting and emotional, and you may forget to ask what you wanted to if you wait until the day of the transfer to ask.
- Research suggests that acupuncture may help in various areas relating to assisted conception, including during the lead-up to a cycle and immediately before and after embryo transfer (though, as with most research related to complementary treatments, this can’t be considered proven). We believe that it contributes to our very high levels of IVF success.
- Prepare for a relaxing evening after the transfer – have your favourite meal ready (or plan for delivery), get a new book to enjoy, have a few films picked out that you’ve wanted to see, and in general, just plan for pampering.
After your embryo transfer
A lot of the time, women feel anxious about getting up and moving around in case the embryo ‘falls out’. The natural instinct is to want to rest a while after the procedure, and this is completely fine! The most important thing to do is to listen to your body and do what it dictates.
There are a few dos and don’ts that we would recommend when it comes to your post-transfer routine:
- Exercise excessively – gentle movement or walking is fine
- Lift heavy objects
- Drink caffeine
- Have sex
- Have hot baths – excessive heat may damage the embryo, so stick to showers until the pregnancy test.
- Listen to anyone who has a bad IVF story! Try asking them if it has a positive ending before they start their tale, as there’s no point indulging in negative energy.
- Get support from your partner, family and friends.
- Get your feel-good hormones circulating! Play uplifting music, laugh and do what makes you feel good.
- Think carefully about work. Many women say that work is a huge distraction for them, and so immersing yourself in it may be great to keep your mind active whilst you wait. But it all depends on your job, the travel and how supported you feel as an individual.
If you are considering IVF with the Zita West Clinic and would like to have an initial Skype consultation with one of our experienced team members at our clinic in London, then call us on 0808 196 4060
We are delighted to share that the Zita West Clinic’s latest validated results (Jan-Dec 2018) show a Clinical Pregnancy Rate (CPR) of 46% for women under the age of 35 per fresh embryo transferred*, using their own eggs, which is the highest in London.
We believe that our unique approach sets us aside from other fertility clinics as we believe that fertility is a whole body event and many factors contribute to getting pregnant. at the Zita West Clinic we assess all of the factors that can impact on success and believe that every couple is different – you cannot have a one-size fits all approach with fertility.
The IVF programme we have developed is highly individualised. We start with getting to know you, your lifestyle, your nutrition and even your mindset so we can develop the right plan of action for you.
We excel in three areas: –
- Firstly, our holistic approach to IVF. When you use our programme (which can be used individually or as a package) you are making sure that you are preparing in every way – nutritionally, emotionally, psychologically and integrating it with the best of medical science. Our clients like this approach as IVF is very medicalised and the fact that we take time to look at all the other aspects of their nutrition and lifestyle that can impact on their chances of success gives them confidence that they have ‘ticked all the boxes’
- The second thing we excel in is helping and understanding why IVF fails. Our Medical Director, Dr George Ndukwe, world specialist in IVF failure and failed implantation consults with our clients and comes up with an individualised treatment plan.
- Finally, the third thing we excel in is the exceptional nursing team who clients really value, not only for their medical attention but also for their kindness, support and hand holding they give and this is reflected in the lovely emails we regularly receive from our clients.
We see so many women that have unsuccessful IVF cycles with other clinics who become pregnant with us using this unique approach.
If you’d like to find out more, you can register for our next online open evening or call 0808 196 4060 to speak to our team.
*In line with HFEA guidelines, our results are based on Clinical Pregnancy Rates (CPR) per Embryo Transferred. For comparison purposes, it is important to note that a clinic’s CPR per Embryo Transferred is likely to be significantly lower than CPR’s per Embryo Transfer which many clinics still use for their published data
Inflammation and fertility
Inflammation is your body’s natural response to injury or illness. However, prolonged inflammation can lead to insulin resistance and studies suggest it is linked to many conditions that may affect fertility, such as endometriosis, PCOS, implantation failure and recurrent miscarriage.
One of the greatest obstacles to successful implantation of the embryos and the reason why IVF fails in some women is an inflammatory environment, which can be caused by autoimmune and other pro-inflammatory conditions of the immune system. If there is inflammation in the body, it could damage embryos and prevent successful implantation. At the Zita West Clinic we do specialist blood tests to see if this is the case or not. If inflammation is detected, we don’t simply rely on medication to reduce this; the internal environment can also be optimised through appropriate nutrition and improvement in lifestyle. It is also extremely important to reduce the effect of stress, which can impact the immune system, and we use other, holistic treatments – such as acupuncture and hypnotherapy – to help with that.
Reducing inflammation through diet
There are certain foods that are inflammatory and others that help reduce inflammation in the body. Let’s start with the good stuff. Try to increase the following in your diet, because these foods are anti-inflammatory:
- Oily fish – levels of omega-3 fatty acids in oily fish help to counteract the inflammatory effects of omega-6 fats that are found in most meat.
- Certain nuts, like macadamia nuts, which are high in omega-9 fats and seeds like flaxseed, chia and hemp.
- Fruit and vegetables – high antioxidant foods help stem the action of free radicals, which cause inflammation. Orange and dark green vegetables are especially important for their beta-carotene levels.
- Olive oil, which in its raw state contains omega-9 healthy fats and a chemical called oleocanthal, both of which have anti-inflammatory actions on the body. However, once you heat olive oil it becomes pro-inflammatory, so opt for seed oils for cooking instead.
- Spices such as turmeric, garlic and ginger help to prevent pro-inflammatory enzymes from acting on your body.
- Green tea
- Propolis (honey bee resin) is a source of caffeic acid phenethyl ester (CAPE), which has been found to inhibit NF-kB, which promotes inflammation.
- Apples, onions, berries, brassicas and capers are a good source of quercetin, an important anti-inflammatory antioxidant.
- Fermented foods, such as kimchi, sauerkraut, kefir, kombucha and yoghurt, should be included regularly in your diet. The gut is an important site for the development and maintenance of immune health and modulating inflammation. Therefore maintaining a healthy digestion is important for addressing long-term inflammation.
- Vitamin D-rich foods, such as oily fish, shellfish, egg yolk and mushrooms.
- Coconut oil contains a beneficial fatty acid called lauric acid, which is also found in human breast milk. Lauric acid converts in the body to a compound called monolaurin, which may help support the immune system. Other fatty acids include capric and caprylic acids, which have antimicrobial properties.
- Vitamin A-rich foods, such as organic liver and eggs.
In addition, try to eat more white fish, beans and pulses as your main protein sources, rather than poultry and red meat. Although turkey and chicken are fine in moderation, in general animal protein is considered more inflammatory for the body than fish and plant protein. You may wish to limit your intake of red meat and dairy products, as they contain arachidonic acid, which the body can use to make inflammatory eicosanoids.
Unsurprisingly, the pro-inflammatory foods in our diet comprise refined carbohydrates and sugars, excess saturated fats, processed foods, junk foods and hydrogenised (or partially hydrogenised) fats. Avoid them as often as you can. Caffeine and alcohol are pro-inflammatory, too.
Finally, avoid stress. Although this isn’t a dietary cause of inflammation, stress is almost certainly contributing to inflammation in your body. Support all the good work you’re doing with your diet by adapting your lifestyle to reduce stress, too.
For a detailed nutrition consultation tailored for you either in the clinic or by phone, contact us here.