​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!

​The first biggest decision that needs to be made is what type of donor you want: anonymous or identity released/non-anonymous. This decision is often based on whether it is your intention to tell a child about the use of a donor egg or not but also whether you want them to be able to have contact with a donor in the future.
When I first started helping patients undergo egg donation treatment it was in the early ’90s (yes I am showing my age!) and we only did about half a dozen egg donation cycles per year. Some were anonymous donations, and some were known and in most cases a sister donating to a sister. Over the years more and more donation cycles occurred, and most were anonymous with the understanding that the information given to you about your donor is all that you or any resulting child would be permitted to have. For most that was sufficient but as the years have gone by, the rights of the child in knowing about their heritage and genetic origins has become more of an issue that some countries have addressed. Also, the advent of genetic DNA testing and worldwide databases means that anonymity is not the guarantee that it previously was and should therefore be considered too.
As of now, egg donation is still anonymous in most countries in Europe (I will base this on Europe as that is where I am based though I am aware that the US offers both anonymous and known). The UK and Portugal offer identity released donors where a higher level of information is provided on the donor prior to treatment and a child has access to contact the donor through the relevant authority once they reach the age of 18. Photos of the donor are not permitted or shared with the patients. Georgia also provides a higher level of information on potential donors and photos are shared with the patients ahead of time. The other countries we have worked with most (Greece, Spain, Cyprus, Czech Republic, and Albania) give limited information on donors such as age, blood group, height, weight, hair and eye colour, complexion, and in some cases also ethnicity, level of education and hobbies and interests. Exactly what information is given seems to vary from clinic to clinic and country to country so knowing what you want to know about a donor can guide me as to where is best to consider for treatment based on this aspect before we look at anything else!
It is a very personal choice and I do not stand in one camp or the other as I feel it is your choice as prospective parents to decide what is best for you and any future child. This question helps me to help you and that is what I am here to do.

I was working at a clinic in Harley Street, my first job in this field and there was so much to learn! IVF and all that comes with it; in those days it was ultrasound scans and 24-hour urine collections. Yes, women had to collect all their urine throughout the day and bring it to the clinic so we could test it for various hormones. We were very glad when blood analysis became the norm instead! Then I was told about another form of IVF where a woman could donate those eggs collected to another who didn’t have any. Wow! What an amazing thing one woman can do for another whether they know them or not. To help someone else experience being a mother must be one of the most life-affirming things you can do.
So, who is egg donation suited for:

1. Those who suffer from primary ovarian failure (never had periods so never had eggs to achieve a pregnancy with) or premature ovarian failure (menopause happened way sooner than is normal).
2. Those who want to achieve a pregnancy later in life (mainly in their 40’s but in some cases, 50’s) when their own egg quality is compromised, and the use of a younger egg gives a much higher chance of success.
3. Those who know they have a high chance of passing on a genetic condition should they use their own eggs.
4. Those who have had cancer or autoimmune diseases, have undergone chemotherapy or radiotherapy, and have caused irreparable damage to their ovaries.

Compared to IVF the preparation in most cases is a whole lot easier with the use of medication as follows. Clinics will often use the combined contraceptive pill to regulate hormones and help plan treatment dates. Some will then use a down-regulation injection such as Lupron or Prostap to fully suppress the hormones before making a bleed happen and then starting on the estrogen preparation. This is done with either tablets or patches to give the body estrogen and create a freshly thick womb lining (endometrium). Five days prior to the embryo transfer progesterone is started in the form of pessaries or injections to give the second hormone that the body needs to support the womb lining and possible pregnancy. These medications continue through till the pregnancy test and then if we get the positive pregnancy test result, for a further 6-8 weeks.
Whatever is needed we will provide detailed treatment plans to follow through treatment.

​I have been working in the field of fertility treatment for over 30 years and egg donation has been part of that from almost the beginning. In Harley Street first and then as the lead nurse at Bart’s Hospital where I was handed a sheaf of papers and told ‘This is the waiting list for egg donation, sort it out and create a program’ (which I did!), to Spain where there were donors waiting for recipients which I was able to provide using my UK contacts and create a thriving egg donation program again, to now where I help patients decide which clinic or country is best to fulfil their wants and needs in treatment.
Because of all that went before, egg donation has been a passion of mine and is the one treatment we do the greatest proportion of as IVF Treatment Abroad. I have thought for a while that a series of blog posts explaining some of the main decisions that need to be made and we talk through with you on this pathway would be of help for people to see. I am not saying what people should do but providing you with some of the choices that you will need to make along the way.
So, the next 6 blog posts will cover the following:

1. Egg donation, what is it and who is it helpful for?
2. Anonymous or identity released; Information provided on the donor.
3. Fresh or vitrified eggs or embryos.
4. Choosing a clinic: egg guarantee, embryo guarantee, pregnancy guarantee, stats, costs, location.
5. One versus two embryos.
6. Travel in general and travel in these COVID times.
   

I hope you follow us to read all these as they come out.

How do we grab your attention? Really draw your focus to the fact the services we provide are unique, personal, and made just for you. I mean let's face it, everyone out there is doing their best to sell you "the dream". Who do you believe and who can you trust to have your best interests at heart. It really is a bloody (expletive watered down) minefield out there.

As a team, I know that what we have to offer is so individual that there is nobody else out there doing what we do, at the price that we do it. But as the person who feels compelled to write about our patients and ourselves, I always feel that I tend to second guess myself in what you want to know and hear. I can't do anything about what you choose to believe of other companies or clinics, but you can believe and trust in the following.

If you need to consider IVF options outside your own country - contact us.
If you need independence of choice with the above - contact us.
If you need someone with over 30 years of ground roots experience - contact us.
If you want the truth - contact us. 
If you need someone 7 days a week - contact us.
If you want a fresh perspective - contact us.
If you need clear explanations - contact us.
If you want or need a shoulder to cry on and to be understood - contact us.
If you have any questions or worries outside of clinical hours - contact us.
If you want to start or continue your family - contact us.

I left this one till last, and there is a reason for that. Your starting or continuing a family is our first priority, and it always will be. It is just that for whatever reason, we are sometimes considered to be a last resort option and this doesn't always seem fair for us or for you, but we accept it because of who we are and because of what we can achieve on your behalf. 

Most of our patients are not first-timers. We truly wish that they were because we could have saved them so much time, stress, and money, but the reality is we don't fit into that category regardless of the wealth of experience and dedication behind us. As Ruth's husband and co-director, this annoys the hell out of me, because unless you get to talk to her, you will never get the experience that you deserve. But at the same time, if we weren't here, who would be.

A slight digression!

I just heard a line on a TV show that said "who wants to find a way to fix the world when all the fixers want it to stay broken". Regardless of the best intentions and overtures of our world "leaders", we must all be looking to our own futures. None of us know how long we have to enjoy our lives. Maybe for some, the word enjoy is not applicable on an everyday basis, and I am sorry if that is too dark, but to face any type of darkness head-on is the greatest show of light and strength no matter how small that action might be. I believe that. I have to dig deep sometimes for my own reasons. It hopefully, makes me a better human, a better person, father, and husband.

We know that you dig deep every second, of every minute, of every hour of every day to achieve your dream of becoming a parent, and last or first resort, we are here for you, heart and soul.

There are so many amazing ways to get in touch these days and we are truly here for you. If you are looking at any form of IVF treatment abroad, give us a minimum of five minutes. We almost guarantee that this small amount of time will double, triple, and beyond and will be what you have been looking for.

​When I first started working in the fertility field 30 years ago, I was unable to discuss or comment on my work with my parents due to their religious views. My father is a Church of England priest and at that time, fertility treatment was very much seen as messing with what God has created. The church and science were just not on the same page so though they knew what I was doing and never actually said for me not to chat about my work, they never asked either which was hard to deal with.
I loved my work (and still do) and wanted them to be able to see the positive side of what we were doing; the families we were creating and the hope we were giving to others who we just knew would make the most amazing parents but for one reason or another were not able to have that happen naturally.
About 3 years in, I was planning a party for my husband’s 30 th birthday, a surprise party (which I will never, ever try to plan again! The stress of the day and getting him to it was a nightmare!) My parents would be there and a wonderful couple, Fiona and John, who I had helped through treatment and had become friends were also coming with their 6-month-old son, William conceived through IVF. I spoke to Fiona about the problems I had discussing my work with my parents and she just said, ‘Leave it with me!’
Day of the party and my parents were already there sat in chairs when Fiona arrived. She picked out my mother quite easily (yes, we do look alike) and walked up to her, plopped William onto her lap, said ‘Hi, here, see some of Ruth’s work’ and walked off leaving my mother literally holding the baby!
William, bless his heart, was at the adorable happy, smiley stage and looked up at my mum and dad and grinned. How could you not love this blonde, blue eyed gorgeous child?! And that was the thing - my work was suddenly not some mad scientist in a lab doing weird stuff, it was a real, live baby that they were holding. They could see the reality, not just the science, of how we were creating families and if that isn’t doing something that God would be proud of, I don’t know what is.
That was the turning point, from then on, they would discuss my work with me. Dad and I would
read and share when new advances came out, discussing the good and the bad and do you know, from his theological standpoint and my scientific one, we more often than not came to the same conclusion on what treatments felt right and what didn’t.
I am thankful that I have had their support for so many years now and that for the most part the
church doesn’t stigmatise those undergoing fertility treatments, but I know there is still some way to go. If you are wanting to consider fertility treatment but feel that you don’t have that support to help you through the process, know that we are here, and we will support you. Just contact us and have a chat.

"Where to even begin?  When I explain to others that Brian and I went abroad from America to
Greece to do IVF, their first question is “why?”  My immediate response is because Ruth is
phenomenal.  There really is no other word to describe her and the process that we went
through.  A year ago we were just beginning IVF and now we have an awesome baby boy!  Let’s
start from the beginning.
We first heard about IVF Treatment Abroad from an infertility conference.  To say we were a bit
apprehensive is an understatement.  We obviously didn’t want to get scammed, but we really
didn’t have the money to do IVF in the states.  Our thought process was that we could do the IVF here and hope for the best, or we could go abroad and do IVF and even if it didn’t work, at least we would get a vacation out of it.  But it was not an easy road to get there.  We had so many bumps along the way to even start the process such as getting shingles, financial crisis in
Greece, meds being held up in customs, starting the cycle four days early, flight delays, etc… it
seemed like pretty much everything was going wrong but the great thing was that Ruth was there as a support.  She walked us through every step, every mishap, and encouraged us to keep going.  Ruth is not just a nurse that facilitates the whole process, but she is the foundation of your journey and rock to lean on.
Once we got to Greece, it was beautiful, smooth sailing!  Kosta was a great doctor and explained what he was doing the whole time. The clinic was very clean and all of the doctors were very professional.  The egg retrieval went well and I liked that we got an update on how the embryos were doing each day.  The transfer was great as well.  We used our own eggs/sperm.  It was great to have Ruth there as a resource through the whole thing because I had borderline OHSS and so having her there to help explain the symptoms I was feeling was a huge help. She was very reassuring. But the awesome thing about this process is that she continues to be a support system even when you are back home.  She kept up with us via social media and email to make sure all was well.  I had complications early on as a result from the OHSS and she would check in and make sure I was doing okay.  Now she gets to see pictures of my little one and watch him grow!
We are so beyond grateful for Ruth and IVF Treatment Abroad.  It is impossible to say in words
how amazing our experience was.  With all of the complications we had, our IVF experience
could have been a disaster, but because of Ruth’s dedication to making her patient’s experience
nothing but the best, it was one of the best times of our life.  We highly recommend IVF
Treatment Abroad!"