What we had to supply to the fertility clinic
We knew from our first experience with IVF back home in Ireland that fertility clinics require a number of blood and other test results from both partners before treatment can properly begin. The Czech clinic was comparable to our previous clinic in the test results they requested.
Test results we were asked supply (results to be no older than 12 months):
From both partners:
- HIV 1, 2
- Syphilis (BWR, TPHA, RRR, RPR, VDRL)
- Hepatitis C
- Hepatitis B (HbsAg, anti HBcIgG)
From Male partner
(if using his sperm):
- Spermiogram. To include: concentration, motility, morphology parameters
Sperm quality is best after 2 – 5 days abstinence
From Female partner
(if using donor egg):
- PAP smear (not older than 12 months)
- Updated ultrasound from your gynecology doctor with comments from the physician (in case that the patient does not attend our clinic for the initial consultation in person) this is to show up any structural problems such as polyps, fibroids, polycystic ovaries, bicornuate uterus, etc.
Over the preceding three years I had had a lot of other tests done, many as a result of our Recurrent Pregnancy Loss (RPL), and as I wanted our new clinic to have a full medical history, I also sent them the following:
- My full file from the failed IVF attempt. This included the protocol I had followed, all blood tests that had been performed during the cycle, and the embryologists notes from our PGS
- My Anti-Mullerian Hormone (AMH) test results*
- A hormone profile (to include FSH, LH, Oestradiol, Prolactin, Testosterone, DHEA & SHBG)
- A complete biochemistry blood test
- Cytogenetic test results (from the three miscarriages we had been able to test for chromosome errors)
- Cytogenetic test results for both David & I to rule out genetic abnormalities which we might individually be carrying (which can be a factor for some couples with RPL)
- My anticoagulant test results (which can sometimes be a factor in RPL)
- A Lupus screen (sometimes a factor in RPL)
- A Thyroid screen (sometimes a factor in RPL)
- Results from my MTHFR screen (showing that I had tested heterozygously positive for a common genetic mutation, MTHFR C665T (previously known as C677T), sometimes linked to RPL)**
We had to fill in quite a lot of paperwork, most of which took the form of a general health questionnaire, to include fertility information, examination details, any allergies, current medications, previous pregnancies (whether or not they resulted in live birth), any previous serious illnesses or current chronic ones.
As we were also requesting donor eggs, we had to fill out and sign some extra documents relating specifically to that too.
At this point we had still only paid our €100 consultation fee, and no further request for payment had yet been received. Already this was in marked difference from our previous IVF cycle at home, when a request for all monies to be paid (almost €8,000) was made upfront.
I was sent a protocol detailing my treatment schedule, which was to begin from the second week in July 2016, and I was sent a prescription for the medications I would need to take (bear in mind, if you are planning to buy prescriptions in a different country from that where the prescription was written, you may need a local doctor to re-write it for you before a pharmacy will dispense – this was certainly the case for me). I was also asked to begin a monophasic birth control pill, so that the clinic could begin to sync my menstrual cycle up with that of our egg donor – we would need to be at the same point in our cycles for my body to be prepared to receive a fresh embryo.
Now that we had our dates, we could begin to book flights and accommodation for Prague for our treatment in three months’ time.
Then all we could do was wait.
* Anti-Mullerian Hormone (AMH) is an interesting hormone for a few reasons, but recently it has become the favoured method of many fertility clinics to measure Ovarian Reserve (ie, an estimation of how many eggs a woman has left, and therefore how fertile she is likely to be).
It can be measured at any time of the month which also makes it a flexible test. Bear in mind that different laboratories may report AMH results using different measurements (pmol/L or ng/mL).
AMH levels are generally accepted to remain stable throughout the month, and steadily decrease with age and waning fertility. AMH levels are not supposed to rise once they have fallen to a low level. However, this has not been my personal experience. Following some lifestyle, supplement and dietary changes my AMH levels increased from 2.6 pmol/L (Sep 2015) to 9 pmol/L (May 2016), a 345% increase.
You can read more about my experience of this here.
** MTHFR mutations can (amongst other things) inhibit the body’s ability to convert folic acid into a bioavailable form which the body can actually absorb.
Due to a family history of spina bifida, I had been prescribed a very large dose of folic acid (5mg daily) right from my very first pregnancy. However given my MTHFR mutation, what I should have been prescribed was the bioavailable form of folic acid (known as Folate or L-methylfolate).
Folate is the natural form of this essential B vitamin. Adding this to the fact that there is such a high prevalence of MTHFR mutations in the general population, I believe that Folate should be considered by all expectant mothers (and those trying to become pregnant) in place of folic acid. In fact, some organic and premium brands of pre-natal vitamins have already begun making the change to Folate.
A very good article on this subject was published in the medical journal Obstetrics and Gynecology in 2011, Multivitamin Supplementation During Pregnancy: Emphasis on Folic Acid and l-Methylfolate.
Another interesting article on the possible effects of MTHFR mutations was also published in Psychology Today in 2014, entitled A Genetic Mutation That Can Affect Mental & Physical Health.