Best London clinic for MFI / Sperm DNA fragmentation / Balanced translocation

[giraffesauce]

Hello,

I am looking for some advice as I'm in a really difficult spot at the moment and considering switching clinics.

Background story
I am 34, husband is 40. We have been doing IVF with City Fertility in Farringdon/Barbican for a little over 1 year. We chose the clinic because of the good reviews and proximity to where we live. Husband was diagnosed with high sperm DNA fragmentation (33%) early on in our investigations, no issues with me.

Round 1 of IVF - lost our baby at 10 weeks to Monosomy X (Turner syndrome).

Round 2 - I got pregnant again and everything looked perfect. Now at week 13 we have just had confirmation the baby has Trisomy 21 (after NIPT, NT and CVS). I will have a termination next week.

We had a consultation with Jonathan Ramsay. He thinks DNA frag might not be the only issue behind the chromosomal abnormalities and that one of us could have a balanced translocation. We have arranged testing for both of us. We will definitely PG test our embryos in the future.

Even though we have been overall quite happy with our experience at City, at this point we're not sure we want to stay with them for a couple of reasons 1) I feel they have been a bit superficial in their approach, especially after our first loss 2) we are moving to north-west London in a couple of months and the location won't be ideal.

Ramsay mentioned Evewell, Lister and CRGH all do a lot of PG testing (I think especially CRGH seem to have the best genetics lab of all?). I've done some research and CRGH also seems to have the best live birth stats out of all of them.

Does anyone one which of these has the most experience/best success rates at treating MFI, DNA frag/sperm quality and chromosomal issues/balanced translocations? Or if you know of other clinics that do?

Again it doesn't look like we have issues with me producing eggs, achieving implantation or maintaining a pregnancy which is what most folks on the forums seem to be discussing when recommending clinics.

Thank you so much in advance for your help

Hi @giraffesauce I'm so sorry for everything you've been through, and that you're in this position now.

From a clinic perspective, I've been with CRGH for a while now - I'm doing IVF for genetic reasons. I've found their genetic services to be excellent, and the embryologists in particular are both so knowledgeable and lovely. I think you'd be in good hands at CRGH from a genetic / chromosomal perspective.

I can't speak for CRGH in respect of male issues. To be honest, it seems pretty standard for fertility clinics not to be very focused on male investigations. If you can combine a clinic like CRGH with an ongoing relationship with an andrologist then that's possibly the best approach.

Hi @Rosemarypots thank you for your reply. I think you're completely right that clinics tend to overfocus on female fertility. I feel that we are in good hands with Dr. Ramsay so hopefully the two pronged approach will lead us somewhere.

Have you found the CRGH approach quite medication heavy?

Following. We have severe MFI and currently under Mr Ramsay. He is trying to help us qualify for IVF on the NHS but I'm looking into our options privately just in case. I understand Mr Ramsay is linked with the Lister so am considering here (as DP may need a micro-TESE). The Lister also do the access packages too which work out a little cheaper.

Hi @giraffesauce yes, I've found CRGH medication heavy, but that's standard in my case when doing IVF for genetic reasons, because you need to maximise your number of embryos available for testing. Getting only one good blastocyst each round isn't really going to cut it.

They are very good with their monitoring - after they worked out in my first round what drug regime works best for me, they've been great at getting mature eggs and a high fertilisation rate. Anecdotally, that seems to be the same for others at the clinic as well.

@giraffesauce Hi @giraffesauce

We have just finished our second full cycle at the Lister. I am 32, husband is 40 (yesterday) and we have MFI- poor DNA frag, one small varicosele, and poor motility and morphology.

Cycle 1 in Jan- 9 eggs collected, 3 fertilised, 3day ET, no pregnancy, nothing in the freezer.

Cycle 2 in April- 24 eggs collected, 14 mature, 4 fertilised, 1 poor quality day 6 blastocyst transferred as not good enough to freeze. No pregnancy and nothing in the freezer.

We haven't found the lister great for MFI, we were initially told we we're a very "easy case" because of my age, AMH, AFC. But as someone else said, frustratingly all the focus seems to be on the female.

Consultant hasn't really done anything with all the tests and scans my husband has had done.

Nurses are excellent and provide outstanding care, but that's not why you pay the big bucks. We are going to either leave to Lister and go to the Evewell for cycle 3 (most likely) or change consultants at the Lister.

Good luck :)

First of all, I’m so sorry you’re going through this. TMFR is a heartbreaking experience and I’m sending you love and strength for the coming weeks and months.

Regarding my experience of clinics, I’ve been in touch with two of those listed and we settled on The Evewell. I’ve just finished my first round of treatment for egg collection and got 10 eggs, 9 mature, all 9 fertilised and 7 were good for biopsy. We get PGT-A results in 1-2 weeks.

They heavily focus on quality and while I was wobbly about “only” getting 10 eggs (I had higher expectations and I suppose there’s this idea that more eggs equals more chances) I’m now feeling quite relieved with the outcome. Now to hopefully get some healthy embryos on ice as I have a history of recurrent miscarriage and that’s our biggest hurdle.

My partner is also under the care of Mr Ramsay. He had 37% fragmentation so did a urine culture and was treated for an infection before giving his sample. We both spent three months focusing on nutrition and supplements with the support of Mel Brown (we actually worked with her colleague Anna Firth as Mel has quite the waiting list) before I started treatment.

I’ll be back down in 6 weeks or so for hysteroscopy and endometrio to check the environment but it doesn’t sound like this is necessarily a challenge for you.

Happy to answer any questions xx

@Rosemarypots would you mind sharing which consultant you are seeing at CRGH? Feel free to DM me if you don't want to post publicly

@KLS2222 sorry to hear your treatment isn't going as you were hoping. It's so tough to deal with disappointing results isn't it. Did they try anything to improve your fertilization rates (IMSI, Zymot?). Zymot is supposedly very effective at selecting sperm with good DNA, and very few clinics in London offer it, which is one of the reasons the Lister is in my shortlist.
Would you also mind sharing with consultant you are seeing? It definitely doesn't sound like their level of care matches the clinic's reputation.

@MyEasterEggs thank you for your kind words.

I know what you mean re quality vs. quantity. In my first round I had 9 eggs (was disappointed) and 4 blasts. Second one we increased the meds and I got 16 eggs but only 2 blasts. I was crushed and wished we had stayed with the lighter protocol.

7/10 is an amazing results, I will keep everything crossed that the PGS results are positive as well. Keep me posted.

What do the Evewell do to improve egg quality aside from diet/supplements? Did they recommend a specific medication in your protocol, or just lower med dosage?

I had an informational call with one of their embryologists last week, she was incredibly helpful and thorough in her answers but she said they don't use any sperm selection technique (PICSI, IMSI, Zymot) due to lack of clinical evidence. This is the first time I've heard of this, every other clinic offers at least one I think. With our DNA frag I would be extremely anxious to just let them inject any sperm into my eggs without further selection... did you and your partner just do ICSI with them?

Hi Giraffesauce

I'm so sorry about what you have been, and are going, through.

We have MFI and have had a good experience with IVI London on Wimpole Street - have you considered them? They have an excellent lab, a fantastic embryology team and they specialise in PGT and other genetic testing. They also do Zymot.

We have had one full cycle with them - we did ICSI with Zymot and then PGT-A testing. Though I have had two failed PGT Normal embryo transfers, that is probably because we've discovered I have a progesterone metabolising issue. We considered CRGH and Lister and decided we like how small IVI was and more personal. I have heard excellent things about Evewell too. Though we have three mosaics in the freezer, we have decided to do another full ICSI cycle before doing another transfer, but we have had some Karotype blood tests done (these test for balanced translocation etc) and currently waiting for results.

Wishing you so much luck x

@giraffesauce interesting you mention PICSI, IMSI and Zymot as I hadn’t heard of any of them until my treatment commenced. Unusual for me as I research everything, which sometimes gets in the way of me moving forward and taking action! But from the panic research I did at the time I was satisfied that they wouldn’t massively change the outcome for us. From what I read every clinic washes the sperm and the good and bad sperm then separate to some degree. The specimen is then placed under high-magnification to select the “best looking” sperm so there’s still a method for visual selection. Goodness knows how! It was definitely in the back of my mind though.

The Evewell put me on Metformin, partly due to having mild PCOS symptoms, but evidence suggests it also improves quality. I also took inositol, which they supported, along with a specific supplement protocol for egg quality. I gave my diet 80%. My partner is very focused and can somehow put any emotion and cravings to one side and gave it 100%!

I don’t know if my medication protocol was considered low or high dose. I put my trust in them in that respect and it’s one area where I went with the flow because they knew my history and the protocol was tailored based on that. My meds were:

CD 2-5
AM: Dexamethasone 2mg
PM: Gonal F 250iu injection (for 3 days)

CD 5-11
AM: Dexamethasone 2mg, Fyremadel 250iu
PM: Pergoveris 200iu injection

Triggered with ovitrel.

So I was on meds for 10 days in total. How does this compare with lighter or heavier protocols?

Hi @giraffesauce

I'm sorry to hear everything you have been through. I just wondered what clinic you decided on in the end?

@alt22 we ended up choosing Aria Fertility and we are very happy with our experience so far. We saw Jonathan Ramsey for my husband’s DNA frag and he mentioned this new clinic to us. A lot of the embryology team come from CRGH. It’s a much smaller clinic than CRGH/Lister so you are given much more attention, and they have a state of the art lab.

We followed a pretty strict protocol of diet + supplements for 4-5 months, then did an ICSI cycle with Zymot and PICSI. Retrieved 11 eggs, 8 mature, 6 blasts. We had those blasts PG tested alongside the 4 that were previously frozen, and we have 6 euploids. Unbelievably grateful and waiting for FET.

Aria have a top notch team, from the embryologists to the doctors to the nurses.
I’d be happy to share more details if helpful.

Hi @giraffesauce may I ask what your diet and supplement regime was? Thank you xx

@Anonbaby of course.

We followed an anti inflammatory diet, which included lots of berries, rocket/watercress, cruciferous veggies, legumes, beta carotene-rich veggies like squash and carrots, healthy fats (avocado, nuts, olive oil). Lots of protein (eggs, chicken, nuts, legumes, fish). Things we reduced as much as possible: red meat, sugar, caffeine, unrefined carbs, and obviously junk food/fast food.

Other random things:

My husband ate a jar of nuts a day (almonds, walnuts, hazelnuts and Brazil nuts).

I took collagen powder every day in my coffee.

During stims I upped my protein intake significantly, adding in a protein shake a day.

For supplements I was on vitamin D, folate, a prenatal, fish oil, NAC, açaí powder, Truniagen, Ubiquinol, PQQ, a probiotic. Off the top of my head my husband was taking Impryl, vitamin D, Ubiquinol, a probiotic, punalpin, açaí powder, fish oil, and l-carnitine.

I know it all sounds a bit nuts, and when we were given this plan we definitely felt very overwhelmed. But ultimately we wanted to give 100% to this cycle to see if it would improve our outcomes. So we introduced these changes gradually and over time it felt manageable. The DNA frag did reduce, but there’s no way to know for sure what had the biggest impact (I was also on a different protocol).

I hope this helps!

@giraffesauce thank you so much. We have secondary infertility. One of four SA (the latest) has come back under threshold on every measure so we’re not sure if this is our issue or not. My OH has been on a healthy regime since November. No alcohol or caffeine, cutting right down on sugar, junk food etc, proxeed, vitamin d, omega 3. I guess I would like the outcome to be natural conception but I think it’s unlikely regardless of any changes because it’s been 2 years now and we still couldn’t conceive again when the SA was normal! X