Ask the Embryologist! Your questions answered

What happens to your precious eggs, sperm, and embryos in the lab?

We are in awe of the precision that goes in to a round of IVF treatment, thanks to incredible experts like embryologist Danielle Breen from The Thames Valley Fertility, but understanding the process you are going through and how the experts are precisely managing your treatment can be confusing.

So, we visited Danielle at the clinic’s lab for the most incredible and detailed tour, armed with your questions.

Topic: Cryopreservation

Is there a time limit on how long embryos/gametes can be frozen for?

Embryologically speaking no; this is the magic of freezing, the clock stops. The key factor for frozen embryo success is the method of freezing/thawing as this what impacts embryo survival. The success rates now seen with vitrification (rapid freezing) means the duration of storage has no impact. However, the important consideration is that advanced maternal age is associated with increased obstetric risks e.g. preterm labour, hypertension, diabetes.

Thoughts on refreezing a thawed embryo?

The method that is now used to freeze embryos (vitrification) has much higher survival rates and pregnancy rates than original freezing methods in the earlier years of IVF. Subsequently, due to improved survival rates with this freezing method there was a sudden surge in supernumerary viable embryos being available for re-freezing after frozen–thawed embryo transfers cycles. As a result the number of embryos required to be thawed for a frozen replacement cycle has drastically reduced (normally the number to be replaced is the same as the number thawed). More importantly, there have now been many successful pregnancies from re-frozen embryos and this has enabled us to introduce specific thaw-refreeze treatments such a thawing to perform embryo biopsy and then refreezing to await results.

Is there a potential of abnormalities if you freeze on day 6?

Having blastocysts suitable for freezing is the priority, the day they are frozen on is less significant than the quality. For example, a Day 5 embryo may not have been frozen because it was still in the early stage of being a blastocyst on Day 5, but after a few more hours by the morning of Day 6 it could have grown into a top quality expanded blastocyst. This is supported by biopsy results which have shown that the incidence of chromosomal abnormalities is not related to the day of development.

Can you explain the order of thawing?

Usually we thaw in the order frozen i.e. D5 first, followed by the order of embryo quality at the time of freezing i.e. the highest grade first. However, generally speaking for a blastocyst to be frozen it must have met the freeze criteria and therefore all frozen blastocysts from the same cycle will have roughly the same potentially as each other.

What is the freeze criteria?

For optimal survival rates most clinics freeze at the blastocyst stage (unless otherwise indicated). The freeze criteria at this stage is therefore based on embryos being graded as a fully grown blastocyst with adequate cell numbers and being graded as above average. The specific criteria may vary slightly between clinics in reflection of their own survival rates and subsequent pregnancy rates with relation to freeze criteria.

Variation between embryos stored – if previous FERs failed can the last one work?

As with the questions regarding the order of thawing and freeze criteria, only embryos that have met the freeze criteria are frozen. Therefore even if it is your last one frozen the chances should be similar as with the rest of that batch/cycle and often the chance of a pregnancy continues to increase with the number of cycles performed. A close friend of mine fell pregnant with her last embryo that she had in storage

Use of frozen Surgical Sperm Retrieval (SSR) sperm samples vs a fresh SSR

The purpose of an SSR is to retrieve and store sperm when there is an issue with producing ejaculated samples suitable for use. Although fresh (unfrozen) ejaculated sperm remains the primary preference, a SSR is normally performed in the instance when an ejaculated sample is not obtainable. As this is a surgical procedure the doctor performing it will attempt to retrieve adequate samples in order to avoid repeating the procedure again as this carries risks, as with any surgical procedure.

Topic: Genetic screening

Can you screen for anomalies i.e. Down’s syndrome?

Unfortunately, an embryo biopsy (Pre-implantation Genetic Screening – PGS) has proven that the appearance of an embryo does not always reflect its genetic status. For that reason, unless you are undergoing PGS, there is no sufficient way for us to screen embryos for anomalies in the embryology laboratory.

Topic: Sperm

Failed fertilisation with IVF vs ICSI

Regardless of the insemination method the risk of failed fertilisation persists. If the cause of failed fertilisation after IVF is indicative of a likely sperm issue (i.e. sperm binding) then ICSI may overcome this. In cases of failed fertilisation with ICSI, the embryology observations are used by the doctors to review future options.
After any case of failed fertilisation it is recommended that you have a consultation with one of the doctors to assess for risk factors including lifestyle parameters. Important embryology observations to discuss include the number of mature eggs available, the status of the unfertilised eggs i.e. did they fertilise abnormally or not at all and also the sperm quality and survival.

How is sperm quality assessed?

Routine semen analysis (SA) testing looks at the number, movement and appearance of sperm in an ejaculate sample. These parameters can then be used to plan the insemination method i.e. normal parameters would be ok for IUI or IVF and any reductions would be recommended for ICSI. More recently, advanced sperm testing methods have been utilised, such as DNA fragmentation testing which looks at the level of sperm DNA damage, which is not identifiable in a routine SA. Sperm DNA damage has been shown to impact pregnancy and miscarriage rates.

Identification of sperm quality issues – are the NHS tests 100% fool proof?

Unfortunately no test is 100% fool proof. As with most things, we are limited to what we conclude on quality/viability purely from simply looking at sperm. Newer tests like sperm DNA fragmentation tests look at the quality of the sperm DNA which is independent to the motile count reported in standard semen analysis. Despite often finding it difficult to solely attribute a finding to specifically either the eggs or the sperm, it is known that sperm DNA damage can result in reduced fertilisation rates and higher miscarriage rates.

Topic: Fertilisation & Embryo grading

Failed fertilisation with IVF and successful ICSI. What are the chances of natural conception now?
I am very pleased to hear that following your initial failed cycle that all worked out well for you after the following ICSI cycle. Regarding future conceptions, that is very difficult to predict as ultimately it only takes one sperm …. The keys factors to predict this would be the observations after that failed IVF cycle and the current semen analysis.

Poor Fertilisation with ICSI

The reason(s) for poor fertilisation cannot always be easily identified, with ICSI occasionally the embryologist may observe factors likely to impact fertilisation ability, such as significantly reduced sperm quality, reduced egg maturity, abnormal egg appearance or abnormal fertilisation.

Can you explain the different methods of embryo grading?

The way each lab grades an embryo is essentially the same, however, the way this is documented may vary slightly between labs. In essence the basis for embryo grading (up until Day 5) is based upon 3 factors:

• Cell number – this should definitely increase from day to day (i.e. Day 2 = 2-4 cells & Day 3 >6cells)
• Appearance of the cells – are they even in size?
• Overall appearance of the embryo – i.e. is there any fragmentation (break down between cell divisions).

When it comes to blastocyst grading the grading system changes from cell number to cell masses/populations. Grading at the blastocyst stage is based upon how expanded/grown the blastocyst is, followed by the quality of the Inner Cell Mass (ICM = ball of cells) and the quality of the Trophectoderm (TE = outer layer of cells).
Pre and post freeze will be same grading however the factors used to assess post freeze survival are the re-expansion status of the blastocyst and the overall cell survival rate.

What does dark fragmented eggs mean?

This observation relates to the appearance of the eggs surface (the ooplasm) and is documented in order to link any subsequent embryo observations back to the egg. Sometimes by the time an egg has fertilised and undergone its first division the ‘darkness’ observed is less significant and other times this persists throughout the embryo development. Fragmentation refers to how cells divide and the little fragments that get broken off after each division. Ideally you want minimal fragmentation.

How do you pick embryos for ET?

Ultimately the decision for which day to replace the embryo(s) on comes down to the embryologists ability to confidently select the one or two with the best chance for pregnancy (generally this is based upon the embryo grade). Each day in the laboratory is like a developmental checkpoint for the embryo, so with each checkpoint the embryologist can assess if the embryo is still doing what it should be or if it has stopped/failed at one of these steps. When we cannot easily pick between the embryos we culture for longer i.e. to Day 5 (though more checkpoints) in order to be able to select between the embryos at that final stage. In the instance of either reduced embryo numbers, or reduced quality we often opt to do an earlier transfer as we do not need to use all of the checkpoints to test the embryos in order to be able to pick between them.

Why do embryos stop growing after day 3: sperm or egg factor?

Initial division is driving by the egg’s potential and is almost like a momentum for the egg (once it divides once it divides again and so on) however, at D3 the development switches to embryonic control, this requires a level of energy and viability for the embryo to proceed beyond this. Therefore roughly 50% of all embryos can make it past this developmental checkpoint and make a blastocyst depending

Is the size of the follicles linked to egg/embryo quality?

Generally speaking the larger follicles are more likely to contain the mature eggs and therefore have a better chance of fertilising. Whether these eggs are more likely to produce a blastocyst or better quality embryo is unclear. It is also very difficult for the embryologist to monitor as the focus at egg collection is to quickly and efficiently retrieve the eggs and get them safely in the incubators and as such the doctors and embryologists do not separate eggs at the collection procedure on the basis of the follicles.

Topic: Embryo Transfer & Implantation

How do you get embryos to attach?

This question encompasses a large body of ongoing research. Implantation is a complex process regulated by a large number of factors from embryo viability (morphological quality and genetic status), endometrial receptivity, uterine lesions (fibroids/polyps), and previous medical history. The field of reproductive immunology is currently expanding. The current methods that would target implantation range from PGS, the use of special media such as Embryoglue, endometrial scratch, additional medication such as aspirin, blood thinning injections and oral steroid tablets. It is important to note, that the body of evidence behind most of these interventions has yet to highlight a definitive method able to improve implantation for all patients. The studies regarding this have often yielded conflicting results, therefore when considering the use of any additional techniques these should always be discussed with the clinical team at your clinic.

Is embryoglue worth it?

Embryoglue is a media used for ET that consists of the naturally occurring molecule found to be increased in the female body during the implantation window. Its use for the embryo transfer procedure is thought to aid embryo implantation by coating the embryo(s) that are replaced in the molecule in order to improve embryo recognition and binding with the endometrium. Based on the available published data to date, most but not all studies have shown that embryoglue may confer a small benefit in initial pregnancy rates.

What advice do you have post ET?

Generally we advise patients to return to their normal routine following embryo transfer. During the procedure itself we would advise against strong perfumes etc. as while the embryo(s) is out of the incubator/body it can be vulnerable to strong smells. Many clinicians advise women to avoid bathing or swimming following EC/ET, although admittedly there are no large studies to confirm the impact of this. However, we do know that bed rest following ET is not associated with better outcomes.

What is the impact of a difficult ET procedure on the embryo?
The impact of a difficult transfer procedure on the embryo itself is minimal as normally the embryo(s) would only be removed from culture and loaded into the catheter once the doctor or nurse had established access. However, a technically difficult transfer may induce some uterine cramps or mild bleeding which would decrease the chances of an embryo implanting. In extreme cases this may result in abandoning the transfer and freezing the embryo(s) instead until access has been reviewed and improved.

Topic: Medical Treatment

What is DHEA?
DHEA is a very weak androgen that is naturally abundant in the female body, to date there have only been very limited studies on its use in people with a low ovarian reserve to try and improve egg yield. Some but not all studies have shown a potential small benefit to its use, it is important to note that the results of bigger studies are needed before its use can be routinely advised.

Why are partners allowed in the room during ET but not EC?
During egg collection we would normally sedate the patient under the care of a trained medical professional, in cases where patients are sedated or anaesthetised it is not advisable for partners to be in the room to ensure that we can minimise the incidence of infection. This does not apply for embryo transfer which is a much easier procedure, lower risk, not requiring sedation and also much faster.

Do AMH levels have an impact on embryo quality?
No – anti-müllerian hormone (AMH) represents the ovarian reserve as it is released by the resting follicle in the ovary. This hormone level can predict the likely number of eggs left in the ovaries and fertility lifespan but unfortunately cannot be used a predictor of embryo quality or fertility itself.

What are the risks after EC?
The risk of significant bleeding from a blood vessel injury requiring admission to hospital occurs in 1-3/1000 cases and remains a recognised complication of this procedure.

Topic: Personal

What is the most difficult part of your job?

I love my job and if you ask any embryologist in any clinic, in any country, I have no doubt you will find that we all share the same passion. Ultimately, embryology is not a job you could do if you didn’t love it, as we have a lot of responsibility, expectation and pressure on us. If we didn’t have that passion then most embryologists would quit after their first failed fertilisation call or after the first time they witnessed a patient cry because you and your hands couldn’t make it work for them. It is that level of personal responsibility that you have to battle with, feeling like ‘what if I had picked a different sperm to inject would it have worked’, or ‘what if I picked the other embryo to transfer would it have avoided the miscarriage’ etc. etc.

I guess for embryologists, being the breed of perfectionists that we all are, the most difficult part of this job is not being able to make it work for every patient.

However, the down days can never supersede the good days … after all who else at my age (or any age for that matter) can say that they have already made hundreds of babies (and counting) and for that reason this is the best job ever!

Huge love to Danielle for her brilliant work and advice. You can follow her on @breeniedz

To read more on the wonderful Thames Valley Fertility (part of The Fertility Partnership) visit here

The post Ask the Embryologist! Your questions answered appeared first on IVF Babble.

IVF BabbleRead More

Generated by Feedzy

Association of Reproductive Reflexologists - Raising Standards in Reflexology for Fertility

Reproductive Reflexology (or Reproflexology™) can be used as a stand-alone treatment to enhance your natural fertility, or with all forms of assisted conception including Clomid, IUI, IVF and ICSI. It can also be used to support individuals and couples using surrogacy or donors in IVF cycles.

The Fertility Foundation

The Fertility Foundation is a UK Charity which aims to provide support and help to individuals and couples with advice, information and ultimately , practical assistance in accessing fertility treatment. The Foundation was created with the overwhelming desire to help as many people as we can to either start or extend their Family.

With the NHS funding cuts showing no signs of stopping they are creating a fund to provide financial assistance to individuals and couples who are struggling to afford treatment. They are more than a Charity that provides IVF Funding as they also run educational events across the UK.

Caroline Biddle (Med)

Caroline worked as a secondary school drama teacher for 9 years. During a period of three years, she went through fertility treatment before becoming a mother to her son. She experienced two very different styles of support, where neither school had a fertility policy in place which left her feeling both vulnerable and frustrated.

Caroline is committed to changing the way fertility issues in teaching are managed.

Since her career in teaching Caroline has gone on to deliver training to staff across NHS Trusts. She is also a visiting lecturer at two Universities.

Caroline blogs weekly about fertility issues. She supports a community of teachers across various social media platforms and regularly interacts with them.

Lucy Livesey

Lucy Livesey is the founder of Relax with Lucy & Co. Lucy is a bereaved mother, a Mindfulness Meditation teacher, Mental Health Nurse and Well-Being Practitioner. Her work within the mindfulness field is becoming widely recognised around the globe and she has been using her own experience of suffering to help others. Lucy’s experience of bereavement from the loss of her twin brother and also her daughter, motivated her to help others. It was through her own self discovery that Lucy went on to complete additional training to be able to teach people to find a sense of calm and balance.

Nicola Carter

Nicola Carter

I work to provide you with high quality fertility, birth and postnatal doula services across Nottinghamshire and Derbyshire, as well as online.

I am passionate about supporting you with your emotional wellbeing. I offer non-judgemental support along with unbiased, evidence-based information, so you can make the best decisions for you, your baby and your family. I am also the founder of Fertility, Birth & Beyond.

Nishta Patel

Nishta Patel - “The Gut Expert” Nutritionist

Helping patients regain their health after years of misery resulting from various ailments and diseases is my passion. I help people overcome their health problems by identifying and treating the root cause.

Using integrated Functional Medicine and Nutritional Therapy, my speciality is in gut related problems, which include Ulcerative Colitis, Diverticulitis, Crohn’s Disease an IBS.

Kelly Da Silva

Kelly Da Silva is a Fertility Support Expert, Writer, Speaker, and Founder of The Dovecote: Childless Support Organisation. Inspired by her own personal experience of infertility, Kelly specialises in developing and delivering ‘Emotional Support’ for those experiencing infertility either during treatment or in their own childless journey. Working with a leading UK Fertility Provider, Kelly has developed and continues to deliver a range of emotional and support offerings to improve the ‘Patient Experience’ to a level recognised by the HFEA as a ‘Gold Standard for Support’, using the knowledge, strategies, research and tools attested through her own personal journey.

Fertility, Birth & Beyond

Giving birth and/or the early stages of parenthood should be your biggest achievement, not your biggest fear.”

Welcome to Fertility, Birth and Beyond.
Birth Doula, Postnatal Doula, Hypnobirthing Teacher, Placenta Remedies Specialist and Holistic Fertility Coach across Nottingham, Derby and Online.

They provide 3-Step Rewind sessions for Traumatic Birth Recovery.

The Dovecote Fertility Support

Supporting, enabling and inspiring people dealing with involuntary childlessness to reconnect with their daily lives and rediscover a passion and purpose.

Relax with Lucy & Co

Relax With Lucy & Co was set up to offer well-being and mental health support through the provision of mindfulness & relaxation interventions. The organisation was set up by our founder Lucy Livesey – mental health nurse and bereaved mother following the loss of her daughter Ellie in 2017.

Lucy and her team of instructors deliver projects to help support the baby loss community through the development of mindfulness & relaxation resources. They offer both well-being baby loss tailored support in addition to general well-being support to help people improve their overall sense of wellbeing.

Nurtured Munchkin

Nurtured Munchkin offers antenatal classes and Hypnobirthing courses as group sessions, private classes in Woking and surrounding areas, and online all over the world. All the courses are run by Paula Lavandeira, senior midwife and DipHB(KG) hypnobirthing teacher with more than 13 years of experience.

Fertility Issues in Teaching

Fertility Issues In Teaching

Fertility Issues in Teaching are the first and only organisation that delivers specialist consultancy and training exclusively for schools. Raise awareness around the mental, emotional, social and financial impact of staff experiencing infertility and pregnancy loss in an environment where 75% of teachers are women.

Desi Radio London

Desi Radio is a registered Charity working to promote the Punjabi language, culture and the integration of the Punjabi Community in the UK. It airs Educational topics for its listeners and Fertility First UK will be sponsoring and featuring in their Radio Listener Call-ins focusing on Infertility and the A-Z Journey of IVF.

Andrew Coutts - CEO of the International Fertility Company

Andrew Coutts is one of the fertility industry’s best travelled individuals having visited and worked with over 180 clinics worldwide. He is a regular speaker, writer and commentator on cross border fertility treatment and male fertility. Andrew is the CEO of the International Fertility Company (IFC), an independent consultancy which offers a concierge service to patients seeking Fertility assistance both overseas and in the UK. He is a PhD researcher at the Centre for Reproduction Research at the De Montfort University (DMU) in Leicester, UK, working on his specialist area, male factor fertility.

Best Fertility Now Logo

Best Fertility Now

Best Fertility Now is a fertility media company, writing all about male and female fertility factors, global and personal interest stories, science, mental and physical health, all to give access to support and advice on fertility journey.

Your Trusted Squad

Your Trusted Squad is on a mission to transform the experience of infertility for women and couples who are trying to start or grow their family.

​Your Trusted Squad was founded by Dr Belinda Coker, an experienced GP and Medical Director with a wealth of expertise in fertility, women’s health, customer experience and clinical quality spanning 20 years.

Many of Belinda’s personal experiences of seeking healthcare for infertility, recurrent miscarriages, endometriosis and adenomyosis were difficult, disappointing and sometimes traumatic. After speaking with so many women who complained of their experiences when trying to receive help for fertility and matters related to their reproductive health and after following her heart, Belinda decided to build a unique service that delivers on excellence, quality and encompasses a personalised, holistic experience for clients.

Enhanced Fertility Programmes Logo

Enhanced Fertility Programme

Enhanced Fertility Programme was founded by Andreia Trigo RN BSc MSc, Fertility Nurse Consultant. Their vision is to improve global accessibility to personalised fertility care, at minimal cost to populations. Enhanced Fertility use research, clinical skills and technology to create products with global reach to make personalised fertility care accessible to all.

Ian Stones

Ian Stones is considered one of the UK’s leading fertility experts helping couples wishing to start a family. Ian has extensive experience and training as a fertility acupuncturist with over 15 years in practice. Ian also works as a male fertility coach offering 1:1 support to men allowing them to properly understand their fertility and options.

Through his unique system, Ian helps couples to improve their lifestyle, diet and overall health to enhance their fertility. Ian is a passionate campaigner for equality in fertility services, recognising from over 15 years’ experience the unspoken toll on men going through fertility treatment.

Ian is also co-director of testhim, a unique platform offering men essential guidance around their fertility, testing and treatments.

Examen

Examen is a world leader in male fertility testing, based on its heritage of over 25 years in male reproductive health and fertility treatment research. We specialise in measuring sperm DNA fragmentation (known as sperm DNA damage) to help predict the likelihood of conception, miscarriage and the success of fertility treatment.

Sperm DNA damage is one of the most important factors causing male infertility. Examen has developed the Exact test to empower men to take control of their own fertility.

The Mancave

Kevin Button - "The Mancave"

‘The Mancave’ @them_ancave was created through personal experience and was to help break the stigma around male infertility. Why should we suffer in silence?!

“I believe anxiety and depression go hand in hand with fertility issues, and I honestly believe men have taken their own lives due to the fact they have had very little or no help or support after being told they are infertile. Because of this, I plan to make a difference and I want you guys to come along on this journey with me. Let’s do this together; for us, for those that have suffered in silence before us and for the men of the future, who hopefully won’t have to suffer alone.”

Kevin drives “The Mancave” project and is an Ambassador of Fertility Network UK.

ExSeed

“We’re on a mission to change fertility. At ExSeed Health we’re male health experts on a mission to address the 40% of all infertility that’s male related but currently remains largely neglected across the globe!

We built our company to utilize the latest scientific advances in fertility and health research to offer a range of innovative products, enabling men and couples to take ownership of their reproductive health in the comfort of their own home.

We’re also proud to break unnecessary taboos and create awareness around male fertility in the process by making the conversations on the male part easier and straightforward – as they should be.”

UR Vistahermosa

UR Vistahermosa is part of the UR International Reproduction Group, which currently carries out more than 11,000 reproduction cycles in Spain and boasts clinics in Alicante, Madrid, Malaga, Valencia, Murcia, Granada, Almeria, Cadiz, Jerez de la Frontera, Zaragoza, Oviedo, Cartagena and Lerida. It also has international units in Latin America in Managua and Mexico City.

At UR Vistahermosa we have multidisciplinary teams made up of gynaecologists, embryologists, geneticists, andrologists, anaesthesiologists, psychologists, nursing staff and assistants, so each case can be approached uniquely to achieve our goal – pregnancy.

When it comes to international patients, we know that setting off on the journey towards pregnancy means adapting to their needs. Our entire team works together to make the process as smooth and efficient as possible.

Tambre Fertility Clinic Madrid

More than 40 years of experience, our extensive career in the world of reproductive medicine has allowed us to achieve the highest success rates not only in Spain but throughout Europe. The latest technology to guarantee you a healthy baby. We have the latest technology in assisted reproduction: GERI, Time Lapse, Fenomatch, PGS, Chip Fertile, RI Witness, ERA, etc.

Dr Belinda Coker

Belinda has had an extraordinary career overcoming adversity whilst shattering the glass ceiling. Belinda completed her medical degree at the prestigious Imperial College School of Medicine. After spending three years training in obstetrics, gynaecology and sexual health at the highly-regarded Chelsea & Westminster Hospital, Belinda then spent two further years working in sexual and reproductive health and community gynaecology before training to become a GP.

A few years later, Belinda started to work in healthcare management, specialising in service design, patient experience, and safety, alongside her clinical practice. She was soon promoted to senior leadership roles within the NHS. After completing an Executive MBA program in Innovation, Entrepreneurship, and Design at Imperial College Business school and winning the IBM prize for innovation, design and entrepreneurship, Belinda reached the executive level and became a board director.

During the last 10 years, Belinda provided advice and expertise to highly reputable healthcare organisations and innovative digital health companies that have created tech apps, gadgets, products, and online healthcare services. Throughout this time, she continued to practice as a GP in London.

Yemi Adegbile

Yemi Adegbile

 I am a Fertility Clinic Lead nurse with over 20 years in the fertility sector. I have worked in both the NHS and private sectors, including 17 years at Barts Centre for Reproductive Medicine and 5 years at the Assisted Conception Unit of Guy’s and St Thomas’.
My area of interest and passion is raising awareness in the black and minority ethnic communities about fertility issues, accessing fertility care and organising local forums to help singles and couples B.A.M.E patients navigate through their fertility journey.

  • Executive member of Nigeria Nurses Charitable association UK.
  • Organiser of bespoke packages for BAME patients who need Egg or Sperm donation both home and abroad.
  • Founder of Fertility Support Hub, a charitable organisation who raises awareness to the ethnic community about fertility issues.
  • Executive member of London Fertility Nurses Forum.

Dr. Zara Hosany - Psychologist, HCPC - Clin. Psych.

I am Dr Zara Hosany, a Clinical Psychologist with over 20 years experience working in mental health. I offer a range of interventions: individual work with adults, young people, parents, couples, family therapy; supervision for qualified professionals and trainees; coaching and mentoring, consultation work with organisations, and reflective spaces for groups.

I use a variety of approaches in my work, which includes CBT, DBT, IPT, Systemic, Narrative, Solution-focussed, Psychodynamic, Play and Attachment based therapies. I welcome explorations of race, culture, spirituality, sexuality, and other aspects of identity.

Andreia Trigo

Andreia Trigo

“My name is Andreia Trigo and I am a nurse consultant, researcher and founder of Enhanced Fertility. My passion for working in this area comes from my own diagnosis of infertility at a very young age

The journey to finding out what was happening in my body took years, several medical appointments, blood tests, invasive treatment and even surgery.

My goal is to help people be diagnosed sooner, get referred to fertility specialists that can help them and create a personalised treatment plan that increases their chances of conception.”

Natural Fertility Healthcare

Have you been trying for ages with no success? Have you had poor fertility test results? Are you feeling desperate and like you left it too late? Maybe guilty for having a career or not looking after your body? Do you feel like hope is fading and in a panic to find a solution quickly? Do you feel alone and fearful much of the time? You’ve tried so much as a couple and feel you failed in some way?

Do something really positive now to overcome the challenge and desperation you feel.

​Mama Be works with and through these issues to help restore your body’s natural health and fertility.

Regardless of whether you have suffered from unexplained infertility, secondary infertility, low AMH results, failed IVF, PCOS endometriosis, hormone imbalance, have poor hormone and/or sperm results, or even miscarriage issues treatment is possible.

International Fertility Company

The International Fertility Company (IFC) is a concierge based service assisting patients to identify and access the most appropriate fertility treatment at home or abroad. Working across 24 countries and with 180 clinics. IFC has an experienced team of former patients, medics, therapists and coaches who provide bespoke packages of care, support, treatment and information.

Natalie Coghlan

Having encountered my own fertility struggles in my mid-thirties, I took a deep dive into understanding how diet and lifestyle can support my desire to start a family. This resulted in me having two healthy children, one via IVF and one natural conception. Now a nutritionist and fertility expert, I help women going through their own fertility struggles, to realise their dream of a healthy pregnancy.

Work with me to gain the knowledge and strength to take back control of your fertility and feel empowered in knowing you are doing everything you can to increase your chances of a successful pregnancy.

Sarah Laver

After working as a clinical embryologist for many years, seeing couples struggling with their fertility, Sarah was driven to find alternative ways to support them on their journey. Through studying Psychology, and Personalised Nutrition, she discovered the transformational impact that diet and lifestyle changes can provide, especially when behaviour change is supported. She is now on a mission to share her knowledge, supporting those trying to conceive.

Sarah is now a BANT Registered Nutritionist and Registered Nutritional Therapist, specialising in fertility. She is the founder of The Embryologist Nutritionist, helping couples, and single females, regain control of their fertility, and maximise their chances of a healthy pregnancy. Sarah takes a holistic view of a couple, or client’s, situation and, together, they create a bespoke, personalised plan that works for them and their needs.

Alex Davies MP Pontypridd

Alex Davies-Jones - MP for Pontypridd

Alex Davies-Jones is the Labour MP for Pontypridd, and has been an MP continuously since 12 December 2019. She currently undertakes the role of Shadow Minister (Digital, Culture, Media and Sport).

Alex is a supporter of Fertility First UK and the work we do and was kind enough to mention us in the House of Commons on the 26th October 2022. We hope to be there with Alex when she meets Kemi Badenoch the Minister for Women and Equality to support her in finding out how the Government can better help Individuals undergoing Fertility Issues and needing support. 

Vanessa Hurrell

I am a psychotherapist registered with the International Council of Psychotherapists.
I have a Diploma in Transpersonal Therapeutic Counselling from Clearmind International Institute and a Certificate in Psychodynamic Counselling from Chichester Counselling Services.
I have attended local and international workshops on leadership and purpose and have supported others in their workshops.
I am currently studying and working towards incorporating shamanic healing into my therapeutic work and I am training as a trauma informed specialist. I have been through my own fertility journey and have come to understand that my experiences have been a gift to me and have given me an awareness of some of the challenges that life can bring.

Cherish - UK

Diana and Jacqui are Consultant Nurse Sonographers and Directors of Cherish-UK.  They specialise in Gynaecology, Fertility and Pregnancy and both worked for the NHS for 30 years. They recognised a gap in care and decided to start trading as Cherish-UK in April 2011. Since opening the Cherish-UK team have helped hundreds of clients during their fertility journey.  They pride themselves on their professional, efficient and hassle free service which aids clients treatment requirements.  Many clinics abroad and in the UK recommend Cherish-UK to their patients as they recognise the high-quality service which is provided.

Prof Peter Hollands

Professor Peter Hollands PhD (Cantab)

Peter trained at Cambridge University under the supervision of the co-inventor of IVF and Nobel Laureate Professor Sir Bob Edwards FRS. His PhD was in stem cell technology with a focus on the transplantation of stem cells from the developing mouse fetus. His post-doctoral position was as a Senior Embryologist at Bourn Hall Clinic which was the first IVF clinic in the world. Peter has been the Scientific Director of Cells for Life in Toronto and Smart Cells in the UK and was HTA Designated Individual for Smart Cells. He has carried out research and clinical practice in stem cell technology and IVF and has written numerous papers and book chapters on stem cell technology and IVF. Peter has written a book on stem cell technology for the general public called ‘The Regeneration Promise’ which was published in December 2020. This is the first of a series of books on medical science. His second book ‘The Fertility Promise’ was published in 2021 and is an explanation of IVF and assisted reproduction for the general reader.

Professor Joyce Harper - Author/Educator/ Academic /Scientist

Joyce Harper is Professor of Reproductive Science at the Institute for Women’s Health, University College London. She is head of the Reproductive Science and Society Group and leads the International Women’s Day events at the Institute. She has worked in the fields of fertility, genetics, reproductive health and women’s health for over 30 years. She is passionate about education and discussion of all aspects of women’s health but especially at three key stages: puberty, the fertile years and the menopause. She regularly appears in the press, on radio and TV. She is the mother of three sons born through IVF. Her latest book – Your Fertile Years – was published in 2021. She is founder of the International Fertility Education Initiative.

Sheila Lamb

Sheila Lamb - Author of the 'This is' series and Co-author of 'Infertility doesn’t care about your ethnicity'

“As a previous fertility patient who finally had my rainbow baby through donor egg ICSI, I am writing and publishing the ‘This is’ series of books sharing honest, raw emotions of those going through infertility, IVF/IUI and loss for three different but connected audiences.”

Marcin Smietana - Reproductive Researcher

As a sociologist, I have been doing research with LGBTQ+ families in the UK, US and Europe for almost a decade and a half now. To further the cause of reproductive justice, I have also been using my research for the benefit of LGBTQ+ families as well as people who help them have children, such as surrogates, donors and others. I am a senior research associate in the Reproductive Sociology Research Group at the University of Cambridge, where I have been since 2016, following my postdoc research at UC Berkeley and PhD at the University of Barcelona. I have done research first of all with gay men who create families through surrogacy and adoption, but I have also worked with lesbian and trans parents. I’m also part of the LGBTQ+ community myself. I’m happy to share my knowledge and experience with LGBTQ+ intended parents and families, or direct you to relevant resources and organizations, so do feel free to email me at ms935@cam.ac.uk.

Lisa Allison - Fertility First Surrogacy Ambassador

Surrogate mother, specialist fertility counsellor in training, surrogacy mentor and advocate.

Passionate about practically assisting and emotionally supporting those struggling to make families or suffering with fertility issues. You can email me at Lisaallison@hotmail.co.uk

Two Dads UK

We (Wes and Michael) are Dads to our children, Katie, Talulah and Duke. Talulah and Duke were born with the help of our amazing Surrogate Caroline, (and our incredible egg donors). We’re on a mission to help raise awareness of Same-Sex Parenting and help normalise our own modern family, as we hopefully help shine the spotlight, positively on families like ours, with either two Mummies, two Daddies, one Mummy or one Daddy.

The foundations of TwoDads UK were firmly created by us speaking out, and campaigning for change for not only us, when we were on our quest to become Daddies, but for all those that follow us on their own route to parenthood or fertility journey. We also believe that through our work on social media – we can use those platforms to raise awareness of particular causes, charities or interests – which later become our missions.

My Surrogacy Journey

Michael and Wes are the co-founders of My Surrogacy Journey and are Dads to their two children born via UK independent Surrogacy- Talulah in 2016, and Duke was born in 2019.
They understand that there is a growing need for Surrogacy support globally, with surrogacy births growing year on year in the UK, and parental orders of those children born abroad also reflecting similar increases.
Michael and Wes are also no stranger to campaigning for change, in relation to the Surrogacy Law Reform in the UK , Government policy related to surrogates and intended parents and also educating Healthcare professionals in relation to UK Surrogacy.

Claire Caldow

Emotional health and wellbeing support whilst trying to conceive can be incredibly valuable to reduce overwhelm, to regain hope, process feelings, build resilience and improve relationships and to move more peacefully through medical investigation or procedures.
For individuals and couples who are pregnant following a difficult fertility journey, with experiences of loss or ready to take a healing journey to parenthood, emotional wellbeing support offers a safe, growth filled space through to the fourth trimester.

I offer a blend of coaching, counselling and therapeutic support with embodied and expressive approaches for those who wish to explore this way. My training and background is in Psychology, Counselling/ Psychotherapy and Coaching working in the UK and overseas for over 15 years. Experiencing my own fertility challenges, IVF and pregnancy loss led me on my own healing and therapeutic process.

Sian Elizabeth

Sian is the founder of Renew Holistic Health and takes a keen interest in helping women restore their metabolism and support hormonal health. This can mean finding relief from issues such as PCOS symptoms, Endometriosis symptoms, addressing digestive issues, supporting clients to sleep better, have more energy that’s sustained throughout the day, create better habits, mitigate stress as much as possible and learn to manage it, improve mindset to reach goals, help clients show up better for themselves and their loved ones and achieve overall vitality in a non-restrictive way. Supporting our hormone health, breaking through these barriers, preparing our bodies for pregnancy, birthing a nourished baby; everything from conscious pre-conception to birth and the years after, requires this whole-body health approach. As a qualified Health Coach Sian’s role is to motivate, empower, and educate along the way, so clients feel empowered to improve their reproductive and overall health.

Sarah Byrne

I am a Menstrual Cycle Coach who teaches women business owners how to harness the power of their natural energy cycles to avoid overwhelm and burnout and create more success in their lives and businesses.

Joanna Sinclair, FF UK Founder and CEO

I am a lecturer, fertility coach and practitioner that helps support and educate both men and women on a journey to create a family. Helping to optimise your physical and emotional health and wellbeing, enhancing your fertility to give you the best chances of conception and a healthy pregnancy. I have lived and experienced a long fertility journey, I remember only too well the emotional impact and the pain. I help reduce the stress and anxiety, maximise the benefit of nurturing the physical and emotional health together, share tools and techniques for this journey, and beyond to reach the goal of a family. 

Jo Dalziel

I am a fertility coach and hypnobirthing specialist. After facing my own uphill struggle to conceive, many aspects of my life were affected and during this time no emotional support was available. I believe the mind body connection and your emotions play a crucial role in your fertility success, be that naturally or through assisted conception. When I heard about the Freedom Fertility Formula I wanted to train so others could feel less anxiety on their own fertility journey.

Jodie Hughes

I’m Jodie and I am a Health Sciences Research PhD student that is focussed on Health-Related Quality of Life in people with Endometriosis (crazy I know right) and founder of the charity Endometriosis South Coast.

In 2014 at the ripe old age of 30 after spending the entirety of my adulthood as a chef, I drunkenly applied for university because Endometriosis changed my life. I couldn’t work, I was a single mum. And quite honestly, I was at the lowest I had ever been with depression eating at my very core.

I am researching how Health Related Quality of Life differs in a range of sample groups of Endometriosis patients.

Nadine Baynes

As Director and Head Psychotherapist of not-for-profit organisation, Lighthouses Therapy Services, I have met with and supported hundreds of bereaved parents of baby and infant loss. Grieving the loss of a pregnancy or a baby can be very complicated – parents can feel confused, angry, isolated, mis-understood and overwhelmed. I can relate to this having been through a miscarriage many years ago.

With therapy you will realise you don’t have to suffer or feel alone with your pain.
Whether you are grieving an early pregnancy loss, still-birth, failed fertility treatment, ectopic pregnancy or compassionate induction, we can help and are here with open arms and big hearts.

Member of National Council of Psychotherapists (Accredited)

Steven Britton

Steven Britton

Fertility intelligence coaching can directly impact egg health, improve sperm mobility, boost fertility, healthy pregnancy and much more.

How does this work?
The process starts by firstly assessing you and your partner mental & physical wellbeing.
This is then followed by eliminating any misconceptions of actions and influences that hinder your fertility, thereby also revealing the genetic setpoint to influence/control positive outcomes.

At this point the foundations are set, we then focus on optimising relationships with yourself and others (romantic or otherwise) emotionally, mentally, spiritually and physically.

Finally diet and nutrition can play a very important role in the quest to getting pregnant so I will make sure that even this area you will feel confident and more in control of your body.

Salma Khanom - Counsellor and Psychotherapist (BACP)

Life events, experiences and relationships can have an impact on how we feel within ourselves making it difficult to cope day to day. Therapy can help us understand these experiences, helping one gain insight and perspective. Finding understanding can be powerful in prompting change. I work with my client to identify issues within their life that may contribute to distress or problems.

I am BACP accredited Counsellor and Clinical supervisor. My core training is in the Integrative model, since qualifying I have completed further training in CBT, CfD, EMDR (all nhs approved) models. I take a flexible approach when working with clients adjusting my approach according to my clients needs. I aim to work in a collaborative way with clients as I believe this can help my clients feel safe and held.

Aisha Balesaria - mindbodyrevival_coach

Aisha is a Certified Transformational Coach and the founder of mindbodyrevival_coach Aisha spent ten years trying to conceive – she underwent surgery for endometriosis, had over 11 failed rounds of IVF and multiple miscarriages. Eventually, she left the process without a baby. “Involuntary childlessness is very misunderstood and most individuals don’t receive the support, empathy and acknowledgement they deserve”. Moving forward, Aisha wanted to use her experience to empower others on a similar journey to her own. Aisha is a writer and Co-author of the book entitled, ‘We Are One in Eight’ she has written numerous blogs and articles about her personal healthy journey and experience with infertility. She has spoken on global platforms and several podcasts to raise awareness about childlessness.

Theresa Davies

Theresa is a fully qualified Counsellor and is registered with both the British Association of Counsellors and Psychotherapists (BACP) and the British Infertility Counselling Association (BICA). Each fertility journey is unique and different people respond to fertility issues in different ways. In fact, the way you feel may change over time – sometimes even hour by hour – which is why the fertility journey is often described as an emotional rollercoaster. Our counselling sessions will help you to understand these feelings and gain a sense of acceptance of your feelings whatever they may be.

Paula Lavandeira

Paula is an International Fertility Coach and Hypnobirthing Teacher, and a Diabetes Specialist Midwife. She has been a passionate midwife for over 11 years now and with another 10 years as a nurse previously. Her passion is to help mums to overcome their fears and preconceptions about childbirth and motherhood so that they can have the best experience. Hence, she founded the Nurtured Munchkin, to provide full antenatal and postnatal courses for parents. Paula worked as a Senior Research Midwife at UCLH for 5 years, participating in multiple studies, including a pilot study NIPT which was later introduced to the NHS. She also offers baby massage and yoga. Paula recently received an award for Best Antenatal and Hypnobirthing Courses Provider 2020.

Manali Hirani

Manali Hirani - Fertility Coach and Podcaster

Helping women and couples get pregnant naturally, in a healthy way and with minimal medications to enhance their fertility.

“Women accessing a supported mind-body program were over twice as likely to conceive as those who didn’t. Of those women that got pregnant, 76% did so naturally (without medical intervention) within 12 months despite their age, the number of years of trying and diagnoses” – As per the study conducted by Harvard University.

Manali is also the head of IVF Babble in India.

Lighthouses Therapy Services

We are here to offer support to those who have been through miscarriage, still-birth, neonatal death, SIDS, ectopic and molar pregnancy and for those who need support, post-termination.

For women, men, couples and grandparents just like you who are hurting and feel that no one understands the deep psychological pain you are experiencing, we are here.

Theresa Davies Counselling

Sometimes life can feel overwhelming and often, when we speak with our friends and family, we worry about how being honest about our worries, thoughts and feelings may effect them.

​I understand that for many people, seeking out a counsellor can feel very daunting. Maybe you feel that you should be able to cope on our own, or that other people have worse problems that are more worthy of counselling. However, sometimes we all need some extra help, and I am here for you during those times.

Belle Birth & Fertility

Fertility coaching – Your Fertility Journey Is Unique.
Leave anxiety behind & hold on to your dream.

Hypnobirthing – Calm & Relaxed Antenatal Education.
Embrace the beauty of birth with confidence & composure

The Embryologist Nutritionist

Harness the power of nutrition and lifestyle to regain control of your fertility.
Stop feeling exhausted, alone, and frustrated with your body. Are you embarking on IVF / IUI and desperate to maximise your chances of it being successful, but feeling overwhelmed about how to do so?

​We hear you!

​After seeing many individuals go through assisted conception treatments, as an embryologist, we can empathise with what you’re feeling. We are here to share with you the transformational impact that nutritional and lifestyle changes can have, so that you can maximise your chances of achieving a healthy pregnancy, naturally or through assisted conception, even if you feel like you’ve already tried everything.

Nua Fertility

Deborah Brock the founder of Nua Fertility states her mission is “To provide education and innovative products with a microbiome focus which will support people on their fertility journey. We focused on our nutrition, lifestyle, fitness, emotional and overall, well being. This combined with the help of science (and some amazing doctors), culminated in the arrival of our beautiful daughter.

My experience gave me an insight into the reality of fertility problems that many of us face. My search for solutions grounded in science led to the importance of nutrition for fertility and the amazing world of the microbiome and microbes and how they are a key determinant of our fertility health.”

Endometriosis South Coast

The charity Endometriosis South Coast was born out of a need for support on a grass roots level. We have online support groups and now the world is opening up again we are going to train support group leaders to provide in person groups.
We regularly hold educational webinars, and make sure we are at all of the conferences to ensure we have the most up to date information about endo.
We are developing educational resources for businesses, schools, and GP’s.
But our ultimate goal is to ensure all people with Endometriosis and Adenomyosis are receiving the best holistic care and support for their conditions, and know that there is more than just surgery needed to help.

Dr. Amina Hersi

Dr. Amina Hersi - General Practitioner and Expert on PCOS

“When I was diagnosed with Polycystic Ovarian Syndrome (PCOS) over 10 years ago I remember it being such a confusing time. Through my years as a doctor, I came to understand the importance of diet and lifestyle in managing such a complex condition.”