Undergoing IVF: A Q&A with Dr James Hopkisson

IVF has allowed individuals and couples to create families when they thought it was impossible. We understand that the journey can be overwhelming, and it's normal to have questions about the process.

From failed cycles to dietary concerns, TFP Nurture Fertility’s Medical Director, James Hopkisson, answers your questions on IVF and what to expect.   

Q. I have endometriosis and have unfortunately experienced two failed rounds of IVF. What do you recommend going forward?

"Contact an expert to go through your treatment options moving forward. When we look at endometriosis, we know that it may affect how you respond to the fertility medication used in IVF, and that's a determinant of your ovarian reserve. We'll want to determine your ovarian reserve test results, so we can decide whether a higher dose of medication used to stimulate the ovaries in IVF is necessary. We'll also look at how your embryos have developed previously in the laboratory. So, getting as much information during your follow-up consultation is key.

If you've had treatment at another fertility clinic, it’s important to bring this information with you. Having baseline tests like an antral follicle count scan, which assesses the number of follicles in the ovary and any other pathologies that may impact your fertility treatment, implantation and stimulation, is worthwhile.

So, my advice when you're looking at repeated cycles of IVF is to get as much information as possible so we can tailor the treatment to you."

Q. What should I be eating and drinking after an embryo transfer?

"My rule of thumb is to have a balanced, healthy diet. Many recommend following a Mediterranean diet. You should also continue taking your supplements, folic acid and vitamin D. Other supplements that may be useful for endometrial thickness, egg and embryo quality, may have been advised prior to treatment, and you should continue taking these until you are recommended to stop. Some supplements, such as melatonin and coenzyme Q10, may be discontinued at embryo transfer."

Q. On AMH alone, at what level would fertility treatment not be recommended?

"AMH is an anti-mullerian hormone, which indicates how many eggs you may produce in a stimulation cycle. With a low AMH, you may only produce two to four eggs, but with a high AMH, you may produce more.

When you're undergoing treatment with low AMH levels, age is the most important factor which influences the success rate. It’s important to note that AMH on its own won't tell us how likely you are to conceive.

At TFP Fertility, we will explain what to expect from an IVF cycle and the likelihood of a successful outcome. To one person, a 5% success rate may be acceptable; to another, it may not. When you're looking at low AMH and response to stimulation drugs during IVF it isn't absolute. However, it may impact the outcome, including the number of fertilised eggs and embryos that get through to day five."

Q. How common is early miscarriage in IVF with a euploid PGT-A tested embryo?

"Pre-implantation genetic testing for aneuploidy (PGT-A) is a technique where we take a biopsy of embryos and see if they are chromosomally normal. So, through a microscope, we can see how well it's developed over the five days in the laboratory. These tests indicate quality but will not determine whether an embryo is genetically normal, often referred to as euploid. As you get older, the number of chromosomally abnormal embryos increases.

PGT-A can help reduce the miscarriage rate. With some, it will increase implantation and improve your chances of having a baby. When you're putting back an euploid in the uterus, there is still a 5% to 10% chance of miscarriage.

Miscarriage rates vary across age groups. At age 35, the chance of experiencing a miscarriage is 20 to 25%. By the age of 40, the risk increases to 40 to 50%. So, by screening embryos, hopefully we reduce the time it takes to achieve pregnancy, decrease the likelihood of miscarriage and improve implantation.

If you are over 38, have experienced several miscarriages, or have had several IVF cycles without successful implantation and are interested in PGT-A, it is worth discussing it with your consultant."

Q. Does TFP Fertility offer split fertilisation using both donor and non-donor sperm?

"Yes, if it's appropriate. If somebody wishes to use their partner's sperm alongside donor sperm, we can do that. Obviously, we can't replace an embryo that is conceived with partner sperm, alongside an embryo conceived with donor sperm. We have to balance out the most successful route of treatment for you. We do that with your wishes in mind by tailoring treatment to you as an individual or a couple. We want people to make informed treatment decisions. So, we'll discuss all available options."