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FAQ (MEDICAL & ORGANIZATIONAL)

MEDICAL QUESTIONS SECTION

1. HOW LONG DO OUR IVF PATIENTS HAVE TO STAY IN SAINT-PETERSBURG?

The part of NGC patients come from abroad. Many of the required screening tests and procedures, including initial fertility stimulation treatment, can be coordinated with a patient’s local gynecologist or reproductive endocrinologist. Those who have started stimulation treatment at home will travel to our clinic about 5-7 days after the beginning of stimulation or even can arrive by the day of OPU. Those who have no support locally arrive for the whole process of stimulation which usually takes about 15 days. In 99% we segmentate the cycle, so that to prepare your endometrium carefully before the transfer or for PGScompleting. So we freeze embryos on day 5 of cultivation, and welcome you in the next after egg retrieval cycle for frozen ET. For patients applying for egg donation program only one day visit for sperm collection and for embryo transfer is required. Our staff is always available to help and counsel our patients throughout treatment via e-mail, Skype or by phone.

2. WHAT ARE THE CHANCES OF PREGNANCY WITH FROZEN EMBRYOS?

In general, the success of frozen-thawed embryo transfer is about the same with fresh embryo transfer and reaches 50%. In case of transferring euploid embryo after PGS we declare 65% of clinical pregnancy rate. In general, we only freeze good quality embryos so the current rate of survival is greater than 95%.

3. ONE OR TWO EMBRYOS FOR TRANSFER

NGC mission is one IVF - one baby. We are struggling for selective embryo transfers, as soon as multiple pregnancy is a pathologic one, associated with numerous complications as for mother so as for babies. Besides, PGS gives us a great opportunity to select the most viable embryo for the transfer, according to the statistics - transferring one euploid blastocyst after PGS gives us the identical clinical pregnancy rate comparing to double embryo transfer. However, transferring one embryo we mostly exclude twin pregnancy, as soon as transferring two - we are risking to get 30-35% of multiple pregnancy. Our usual advice is for transfer of one embryo. Over recent years changes in the laboratory and culture medium have resulted in a higher percentage of embryos available for transfer and freezing.

4. IS DENTAL TREATMENT RECOMMENDED IN PREGNANCY?

Routine dental treatment is safe during pregnancy. Some procedures and medications should be avoided in the first 3 months of pregnancy so always inform your dentist you are pregnant. Visiting a dentist early in pregnancy is highly recommended as some women may be at increased risk of gum disease during pregnancy and women experiencing a lot of vomiting in pregnancy may be at increased risk of tooth erosion.

5. CAN I FLY AFTER ET AND DURING THE PREGNANCY?

Flying in pregnancy (and following an ET) is generally considered to be safe. There is no evidence that the change in air pressure or decrease in humidity will have any harmful effect on you or your baby.

6. CAN I GET PREGNANT IF I NO LONGER HAVE MENSES (MENOPAUSE)?

The answer depends on the etiology of the lack of menses. If in fact you are menopausal then you will need egg donation. However, if the problem is hormonal, you may be treated with fertility medications.

7. ARE URINE PREGNANCY TESTS AS RELIABLE AS BLOOD TESTS?

No. The urine test depends on your hydration level. Furthermore, they are predictable to about 25 mIU per mL of bHCG. On the other hand, blood tests are sensitive to approximately 2 mIU per mL. Therefore, a very early pregnancy could be missed with a urine pregnancy test that may still be detected with blood levels.

8. IS IT NECESSARY TO HAVE THE HCG TEST DONE IF I HAVE STARTED BLEEDING?

Yes. Even if you have started bleeding, you can still be pregnant and continue with a normal pregnancy. In case the HCG test is positive and the woman has her menstruation, she might have an ectopic pregnancy. Therefore we recommend she always makes the HCG test.

9. IS BED REST RECOMMENDED AFTER THE EMBRYO TRANSFER?

We recommend that you take it easy following transfer for the rest of the day, but routine activities can be resumed the next day. If there is an increased risk of ovarian hyperstimulation, we will recommend reducing activity for a few days until the hyperstimulation resolves.

10. WHEN CAN WE HAVE INTERCOURSE AFTER EMBRYO TRANSFER AND IF I AM PREGNANT?

After your embryo transfer, we ask that you refrain from intercourse until your pregnancy test, which is 10 days later. If you are pregnant, as long as you are not experiencing bleeding or discomfort, intercourse is okay after we are able to detect the baby’s heartbeat. This will be approximately two weeks after your positive pregnancy test.

11. WILL ASSISTED HATCHING IMPROVE MY PREGNANCY CHANCES?

Assisted hatching means that the embryologist applies a small hole in the zona pellucida to allow the embryo to escape from the eggshell. It is not recommendable to perform assisted hatching for all women. The following groups may have advantage from this procedure: 1. Women over 40 years 2. Women who received very high FSH doses for stimulation 3. When the zona pellucida is thickened 4. When frozen embryos are transferred.

12. WHO NEEDS EGG DONORS?

There can be many reasons why a woman might need the help of an egg donor to become pregnant and carry a healthy baby to full term. Most commonly, egg donation is a successful treatment option for infertile women who do not produce enough normal eggs, have malfunctioning ovaries, have entered menopause prematurely or have had several unsuccessful IVF treatments using their own eggs. Some women will also elect to receive donated eggs because they are aware of an increased risk for inherited disease in their biological offspring. Egg donation is unlike adoption in that the intended mother has the special opportunity to conceive, sustain a pregnancy, give birth and breastfeed her child. This unique experience allows for special bonding as a couple, as parents and as a family.

13. DOES THE PATIENT'S AGE IMPACT THE SUCCESS RATE IN ED PROGRAM?

Actually, not. As soon as you are transferred embryos made from donor's eggs the pregnancy itself should be as healthy so as in a young lady under 30 years old. The uterus itself has no significant changes throughout ages, so there is no sufficient difference if the recipient aged 35-45 or even 50. Definitely the overall somatic health and chronic diseases which are more likely for advanced age can bring some difficulties and recipients should be carefully prepared, screened and assessed before the embryo transfer. NGC provides ART programs until you become 50 y.o (mostly regarding egg donation), own eggs programs are discussed individually. As the outcome depends on numerous parameters we should carefully assess the effectiveness of such program before proposing you one.

14. IS THE BLEEBLEEDING AFTER EMBRYO TRANSFER NORMAL?

Sure, not. Any bleeding during the pregnancy is abnormal. It can be caused by numerous factors. Even if the bleeding is small and looks like spottings the only right way is to inform your doctor about bleeding who should suggest you how to behave. Patients after egg donation may experience bleeding much often as soon as by the beginning of the pregnancy there is no functioning natural corpus lutheum, which supports pregnancy releasing progesterone. Medical support in this case may be insufficient, waives of hormonal fluctuations in blood may provoke bleeding and scares patients. However it’s usually easily stopped just by the drugs dose adjustment.

15. DOES PGS INCREASE MY IVF SUCCESS?

We suggest doing PGS to patients after 37 y.o, with numerous unsuccessful IVF attempts in the past, in case of recurrent pregnancy loss, known genetic abnormalities and some other problems. PGS is not making the embryo better or worser, it just shortens timing before getting pregnancy by excluding from transfers aneuploid embryos (with failed chromosomal set), minimizing chances of implantation failure or miscarriages.

16. SHOULD I USE PGS IN CASE OF EGG DONATION?

According to the statistics young women under 35 y.o have around 30-35% of embryo aneuploidity after PGS. We recruit egg donors from young and healthy women with proved fertility,however this statistics is spreading among them as well. So if recepient wants to exclude potential risks of chromosomal abnormalities within egg donation cycle sge is suggested PGS procedure before the transfer.

17. DOES THE BIOPSY OF EMBRYO HURT IT?

Nowadays we perform the biopsy on day 5 or 6 of embryo developing when it turns into a blastocyst stage. Biopsy is a process when few cells from the outer wall of the embryo (so called trophectoderm) is rapidly taken out by laser cut. We do not touch the inner mass which turns into fetal structures later on. So there is no dramatic leasion caused by the biopsy. Embryo survival rate after biopsy, freezing and defreezing is more than 95%.

18. WHETHER USING FROZEN EGGS AS BENEFICIAL AS FRESH ONES?

Yes, we declare that frozen eggs give more or less the same chances of implantation, pregnancy rate and life birth rate per transfer. There is no increased aneuploidity in embryos made of frozen eggs compared to fresh ones. However we admit that blastulation (% of blastocysts formation by day 5) is a little bit lower in case of using frozen eggs.

19. HOW LONG CAN WE STORE EGGS OR EMBRYOS IN FREEZING?

There is no declared time out for biologic material storage. There’re published data about successfully used embryos frozen 10-15 years ago. As well as to eggs. Neither the quality of the material no the success rate are suffering after longer storage in freezing. Therefore one of the most popular programs among young ladies so called "postponed maternity" was based on a long term cryopreserved oocyte storage.

20. EMBRYO GUARANTEE?

Every IVF program is unique.We meet different people every day, with different cases and fertility problems. So even if the are intending to use the same donor's eggs in the same time, same quantity, got from the same stimulation - it's quite hard to predict how many embryos are going to be at the end of cultivation in each case. Mostly it depends on sperm characteristics, egg and sperm gene's combination etc. So based on preliminary data as your anamnesis, previous IVF outcomes, and some other points we may give a very presumable prognosis,however it shouldn't be clarified as a guarantee.

21. HOW CAN I GET MEDICINES FOR MY ENDOMETRIAL PREPARING?

We do not send medicines by post. There are two ways to manage it: 1. You may come to our clinic (for example, while your partner is here for sperm freezing), we will provide you with all necessary prescriptions for the whole set of medicines, which are available at NGC pharma. Please note that these prescriptions are not usable in other European countries. 2. As most of our programmes are so called "shared care" after receiving the treatment plan from us you should contact to your local gynecologist and get all medicines accordingly. Most of our patients get a proper support locally and fully supplied with all required drugs.

NON-MEDICAL QUESTIONS SECTION

1. HOW TO START?

The first step is filling out an Application Form, which allows our staff to receive important information about your medical history and determine a suitable program. This application form is available on the website and will be sent to you by your coordinator. The second step is discussion of non-medical questions with coordinator and medical issues with your treating doctor and medical assistant. We prefer, when Patients know about all costs and services before starting the treatment, when Patients feel safe and confident, have a possibility to plan the budget and avoid unpleasant surprises as hidden costs. Fertility specialist is ready to answer on all medical questions and provide you with the necessary information by email, it is also possible to arrange a call or Skype-consultation. Step three is to start preparation by your individual Treatment Plan and visit Next Generation Clinic accordingly at convenient for you time!

2. IS THERE A WAITING LIST?

No, there is no waiting list neither for egg donation programs nor for IVF treatment with own eggs. Planning the treatment depends on program type, medical situation, convenient for you time for traveling and visa/tickets issues.

3. DO I NEED ENTRY VISA?

Citizens of most foreign countries need to obtain entry visa to Russia before traveling. However, there is a free visa regime for passport holders of several countries and a possibility to stay not more than 72 hours if you travel by a ferry. We recommend to contact the Russian consulate in your country to check the details. There are 2 main visa types – tourist or medical. You may apply for a tourist visa with an invitation letter from a hotel or tourist agency, it is usually the easiest and quickest way to get visa for 1 entry. If you apply for a medical visa, please contact your patient coordinator.

4. WHERE TO STAY?

Our patients usually prefer to book hotels near the clinic such as Solo Sokos Vasilievsky, Marco Polo, Castle Hotel, Park Inn Primorskaya, Osobnyak Brullova, etc. For those, who prefer to stay in an apartment, we recommend to use Airbnb.

5. ARE MEDICATIONS INCLUDED IN THE COST OF TREATMENT?

Medications are not included in the cost of an IVF cycle. The amount of medication you need will depend on many factors. One more point is that our programs are mostly shared-care programs, as our goal is not only successful treatment, but also optimization of the time, which you spend abroad. Required medications can be purchased in a home-country or by your arrival in NGC Pharmacy.

6. WHAT ARE THE PAYMENT TERMS IN EGG DONATION PROGRAMS?

Payment for Egg Donation Programs must be done in full prior to fertilization of donor eggs. It is possible to pay to the Clinic’s bank account, specified in an invoice, in Euros or upon arrival in Rubles in cash or by credit/debit card. Please notice that bank money transfer in Euros requires 3% fee. For reservation of available donor eggs or to start stimulation of chosen egg donor must be paid 30% of a program’s cost, the rest can be paid by invoice in advance or in the clinic as mentioned above.

7. CAN I SEE ADULT PHOTOS OF DONORS?

We have 2 types of matching a suitable egg donor: by child photos from cryobank or by adult photos in personified program. The adulthood photos of egg donors, which you are interested in or which will be matched for you by Coordinator according to your photo and blood type, will be sent to you by email while planning the treatment in NGC. Child photos are available on the website in the opened and free database. Regarding sperm donors, only childhood photos are available.

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