​When travelling any distance for treatment you need to consider what your travel looks like and how long it will take as that may play a part in where to go for treatment too. As I was reminded by a patient the other day, don’t just look at flight times but look at your journey from home to the airport and the other end as that may add on a chunk of time.
The last two years with the pandemic have been crazy for so many of us for so many reasons. Some of us have lost loved ones (I am so thankful that I did not but know how lucky I am), some of us have lost livelihoods (it has certainly been a hard slog for us over the last two years, but we are still here!) but for others, it is the loss of time on their fertility journey. In some cases, it has been a loss of funding for treatment due to a change in their age or a loss of ovarian function over those two years that might have made the difference between being able to have our own genetic child or not. Not being able to access treatment in home countries and the fear of travelling or the restrictions in travel has been huge. We are thankful that our Australian patients are now able to start planning treatment and we hope to see them and everyone else soon as more and more countries relax travel requirements. We can see more and more people looking to have treatment this year.
Vaccinations for COVID is a requirement for some countries to enter though in most cases either proof of vaccination or recent negative test is both permitted for entry. This is one question I will ask anyone I speak to so that I can ensure that getting to the country is possible as I appreciate that some people are not vaccinated and again, this is a personal choice.
I feel I have become part travel agent over the last two years, knowing the travel requirements for multiple countries with updates on a daily, weekly, or biweekly basis! It isn’t so hard now, but I can see this aspect of my role continuing for some time to come and be assured we do bear changing circumstances in mind at all points of treatment and aim to be able to alter treatment dates as necessary at short notice.

​How many embryos to replace? Wow, that is a hard one to advise on as it is again a personal choice. Firstly, bear in mind that the chances of pregnancy are based on the age of the egg, not your age so if you were told your chances of success were 10% previously that was based on your 41-year-old egg, not the donor egg you are using in this cycle. The stats will say that there is certainly a difference in chances of pregnancy if you do one embryo versus two embryos (normally around 10-15% higher chance with two) but it is also knowing that replacing two embryos carries the risk of a twin pregnancy which either physically, emotionally or financially might not be something you want to risk. It is often a decision that is not made until a patient knows what embryos have been created as I know some have decided on 1 embryo to be replaced knowing they have 2 or more as a backup so they can consider a two-embryo replacement if one doesn’t work. Those same embryos may also be still available to use in a sibling pregnancy in the future so there is that thought in the back of the mind too if more than one child is your preferred plan. If only two embryos are available, some people will replace both to give themselves the best chance of success in this treatment cycle. In some cases, you may be advised to only have one replaced due to an already known medical issue or based on your age as a twin pregnancy for a woman in her late ’40s or older will be at high risk so a single embryo is medically the safer option to choose.
By law in most countries, you can replace up to two embryos when a donor egg is used while some clinics will base their stats on a single embryo transfer as they advocate this to reduce the chance of a multiple pregnancy. I know there are also countries where 3 or more embryos can be replaced but I do not advise or recommend this as you are not increasing your chances of success once you have more than two replaced, just your chance of a multiple pregnancy with the associated risks that come with that.
Take your time in deciding what is right for you on this issue, weigh up the pros and cons for you and what you can cope with moving forward.

​Having already looked at the first two issues we then look at specific clinics and there is so much choice out there for the most, (not as much with identity released donors) but we then look at what clinics offer in terms of the number of eggs, number of embryos etc. Guarantee programs are more and more attractive to patients I find, knowing that you will get a certain number of eggs or blastocysts for the fixed fee you pay. I think it is important to state here that NO CLINIC can guarantee that they will create a certain number of blastocysts in one go (one group of eggs mixed with sperm). It is, of course, their intention and for the most part, will achieve this but if they don’t, they are obligated to create further embryos to get to the minimum guaranteed number and that might be using the eggs from a second donor. Also note that once you have had one embryo transfer, further embryo transfer will be charged as the fixed fee normally only covers one embryo transfer event. Further embryo transfer costs are normally a whole lot less and I find it varies from clinic to clinic from 600€ in the Czech Republic to up to 1500€ in most other countries.
Pregnancy or live birth guarantees are not found as often and, in some countries, not at all. These will often have quite specific inclusion criteria in terms of medical history and testing needed on both partners to be accepted onto the program. Yes, you may out a large chunk of money at the start with either a guarantee based on which program you have signed up for or your money back if not successful within a certain timeframe.
Cost is a huge issue for any fertility treatment option and may determine your choice. As a rough guide, I have found that the Czech Republic and Cyprus are the cheapest, Greece follows, then Portugal and finally Spain being the most expensive. I am often asked why different countries charge so varied amounts for treatment and I can only say it is based on the following factors in any country: wages, cost of living, building rates, cost of consumables, tax etc.
This would of course determine the location for treatment, and I often find that patients prefer to consider one country over another. Again, a personal choice.
Lastly, but not the least important is the chances of success in treatment and the statistics that each clinic publishes. I think it is very important when looking at stats that we look at a ‘like for like’ as often as possible so this needs to be kept in mind when looking at websites. Are you looking at stats based on 1 embryo being replaced or two? A fresh cycle or frozen if the clinic’s results alter between the two? Is a positive based on a blood HCG result or an ultrasound scan showing a heartbeat or a live birth? Is this a cumulative result based on more than one cycle having been undertaken? All these will affect stats and need to be taken on board. If someone does not want to risk a twin pregnancy you want to make sure as to what a clinic’s stats are for a single embryo replacement as there can be a huge drop down in stats from two embryos to one for a certain clinic while another routinely replace one embryo and their stats are based on this. Your head can spin with all the numbers, and I was never great at Math but have got a whole lot better over the years in analyzing these!
All these aspects will help to work out where is best for you to undergo treatment, we are all different and as I have said so many times over the years, one clinic cannot do everything for everyone. Everyone’s needs, wants, desires for their treatment and possible child need to be considered and that is what I can do with you so that you make the right decisions moving forward.

​So, we have decided on what type of donor and from there can determine which clinic based on the next round of options. Fresh or vitrified eggs and embryos.
There is much made about this issue of fresh or vitrified eggs and embryos. ‘Fresh is best’ I hear a lot and for the most part, I would agree BUT there are clinics where their experience and statistics show that there is no difference between the two. Most clinics out there will say that their preference is to create embryos with fresh eggs and partner’s sperm (if using) when possible and so would I, though there are exceptions to the rule. Having the greater choice of donors to choose from is highly advantageous and in this case, a non-synchronized cycle where the donor goes through treatment at a completely different time to the recipient may well be best if the male partner can go to the clinic ahead of time to give a sperm sample for freezing and use. The donor goes through treatment, embryos are created and frozen for future use. This option or even a synchronized cycle where the donor and recipient undergo treatment at the same time and fresh embryos are created and replaced is ideal but if you are travelling from a fair distance (US, Canada, Australia) a non-synchronized cycle is not possible logistically and the concern with a synchronized cycle is the ‘what if’s. What if the donor does not start her period at the expected time so treatment and travel dates have to change at short notice, what if she does not respond to the meds as expected and suddenly there is no donor lined up, what if we get as far as the day of egg collection and there are no eggs collected and by that time you are in the country ready to have your treatment.
I believe this is where vitrified eggs play their part as the reassurance of knowing that the donor has already gone through her bit and the eggs are ready and waiting, is immense. Not all clinics I work with offer this as an option, so it is about listening to what we want to achieve in a treatment cycle and with a clinic that helps me to help you in deciding where to go for treatment. COVID has of course complicated things too so non-synchronized cycles where embryos are frozen or vitrified eggs can give more options if short notice changes need to be made.
This is again a personal choice and by discussing the various options we can work out what is right for you.

"Neither blizzard nor frosty rain, nor lack of heat nor Covid stays these gallant people from getting pregnant."

The above is a version of the US postal system's creed and how resilient their postal workers are in getting the mail to its intended destination. So I thought it more than appropriate to adapt it not only in relation to the following tale of persistence but also to everyone out there who are looking to fulfill their dreams of starting a family.

I am a father who was lucky enough to be able to have a child without the aid of medical intervention. It was also a pregnancy that whilst not unplanned, came as a surprise due to planned work hopes, with a potential offer of running an IVF clinic in Riyadh. Well, you can imagine my relief when I found out that alcohol still had a place in my life and the move was forgotten.

Four years after our daughter was born we moved to Spain, and six years after that we moved to Greece where we still reside.

That move was a big decision for us and it has had its ups and downs. If you choose to try your IVF journey by going abroad for treatment, we know that it might feel scary and daunting, and things might not go the way that we all hope. The determination is there in spades, but then we have to consider other obstacles. Stuff that we have no control over, and there are plenty of those in planning any cycle of treatment, the majority of which are solvable. The difficult ones are erupting volcanoes causing massive ash clouds that ground or divert flights (we solved some of these), and most recently, a pandemic.

So as much as we plan and investigate, we can usually expect something to scupper the best-laid plans. 

In this particular case, we had a patient who had a previously successful treatment, resulting in a little boy. Wanting to extend the family, a further cycle was planned. Planning started in October 2021, including making sure that the patient was fully vaccinated. Job done.

Hiccup one. Just prior to starting progesterone, the patient tests positive for Covid. Rather than cancel everything, Ruth decided to get the patient to re-test after two days. This time the test was negative, so everything is back on track.

Hiccup two. Flight to London is all OK. Flight to Athens - canceled due to a blizzard grounding all flights. I know we occasionally get some snow, but this was a lot! Discussions with the patient and the clinic were had, and the decision to delay the embryo transfer by a day was made, due to the different timezones and when the patient actually started the progesterone working in our favor.

You will be happy to know that the patient is pregnant and that a fetal heartbeat has been seen. In her own words;
"Ultrasound went great! One baby, perfect size, perfect heartbeat. Due date Oct 14. Thanks for all of your help in making this happen, especially when I got Covid and we had to switch things up and then again when you had that snowstorm. Couldn’t have done it without you!"

​Can you imagine the stress this patient must have been feeling? Not only was she traveling from Canada, but then she gets a positive Covid test and then a canceled flight, never mind all the other stuff that patients usually go through with juggling life and everything else.

​This is the beauty of having someone like Ruth coordinating and planning your treatment. She is more accessible and is able to make medical decisions without having to refer to the clinic all the time.

Your persistence and resilience will make sure that the male and female will get through!