As you may have seen, we’ve just launched #fertilityexpertlives, where we’re bringing you multiple Instagram ‘Lives’ and ‘Takeovers’ every single week! We are doing these with world-renowned holistic fertility experts, to empower and guide you on your TTC journey. Follow us on Instagram and the new hashtag so you don’t miss any expert updates and advice. Last week we had the pleasure of welcoming Dr. Elias Tsakos from EmbryoClinic in Greece onto our Insta ‘Live’. We chatted for about 30 minutes, covering multiple topics related to the implications of the Covid-19 pandemic on your TTC journey, fertility clinics reopening and fertility treatments in general.
Read What You Missed ‘LIVE’ Here…
www.embryoclinic.eu I email@example.com
Please introduce yourself and tell us more about what EmbryoClinic does…
My name is Elias Tsakos. I am a fertility gynaecologist and Director at EmbryoClinic, Greece – UK trained and certified. Whilst I work as a Medical Director at EmbryoClinic , I also consult in the UK, Cyprus and all around the world.
Let’s talk a bit about the general implications of the Covid-19 epidemic on people’s fertility journeys – IVF and fertility treatments?
The main implication is the fact that most of the IVF units in the western world have been shut down for a period of six weeks or so. Europe has been the first to be shut down, agreed by the regulations of the European Society of Human Production. However, fertility clinics across the Atlantic, including American fertility clinics have also been closed. There has been an announcement in Denmark, that they will be the first one to reopen imminently.
I believe the UK will continue to be in lockdown for at least a further three weeks. It will be interesting to understand a bit more about the fertility clinics in other countries and what might be happening in terms of opening their doors again?
There has been a huge impact. We have been devastated for our patients who have had to discontinue their fertility treatments. We had to wrap up the treatments as soon as we could. All that happened in the continent of Europe in 28 days or so. The impact has been extraordinary and this is something totally unprecedented. In Greece the epidemic has been rather soft because the measures were taken quite swiftly. We have suffered a very small effect, about 2000 cases of Covid and just over 100 deaths so, hopefully , Greece will be the first country to reopen in the next 10 days or so and we hope that fertility clinics will be able to reopen in the next fortnight.
When you are able to open the doors again, how are you planning to manage the patients in terms of order?
We are expecting to hear from official bodies for confirmation very soon. That being said, we have of course been in talks with European, UK and American colleagues and it seems that there will be quite a few differences in terms of Covid-19, which is slowing down but is not disappearing. I think that an important issue here would be prioritising treatments. Of course, a lot of patients have had fertility treatments cancelled so these patients will have absolute priority and will be treated in the next few weeks. Secondly, we will prioritise the urgent cases, for example women approaching the age limits and women who have some sort of urgency for the treatment.
I mean cancer patients undergoing fertility reservation have always been on the top of our list; also of course, ladies with low AMH or ladies near the age limit of either egg IVF, which currently is age 45 in Europe, or egg donation which is currently at 50.
A lot of our readers are concerned about not knowing when treatments can continue or start, which panics people because they’re worrying about their AMH Levels lowering and the fact that they’re not getting any younger whilst this is going on. Thoughts?
Sure, it’s devastating. We feel very embarrassed having to cancel patients especially. My team and I have been working endlessly ever since they shut down, trying to support our patients. We have been on the phone for endless hours during the day, trying to come to terms ourselves first and then of course trying to consult our patients as how to prepare best for post-lockdown. There are a lot of things that could be done in the meantime of course, preparing for afterwards. We need a lot of support to be given to our patients – physical, emotional and spiritual. We try to reassure everyone.
Read an article here about ways a fertility counsellor could help you.
Regarding fertility and genetics, the brilliant news is that up to now the evidence is that the virus is not attacking reproductive organs, reproductive cells, eggs or sperm so we’re quite optimistic from that point of view.
Do you know yet whether you’ll be able to open all kinds of fertility treatments at the same time? For example, will people be able to start a new protocol with egg retrieval stimulation etc., as well as having frozen embryo transfers, as well as IUI?
Absolutely yes, all the fertility treatments should be available. Of course, there’s a question whether people will be able to travel. Especially international travel will not be allowed for another four or six weeks minimum. However, there’s a lot of discussion about the conditions that will allow international patients to visit us.
So, how does that work? For example, if your clinic opens next week and people in the UK are interested in coming to Greece to see you at EmbryoClinic, could they start the process now, virtually, without knowing when they might be able actually to start a cycle?
Absolutely. As you know, by the time we start talking about a possible cycle, we need at least four to six weeks before we initiate that cycle. We are taking inquiries and we’re prioritising our patients, booking cycles for 20th May and further down the line. So, if anyone is interested, they could start enquiring and of course we can put in process all the tests and all the evidence we need before we embark on the cycle. More good news is that, although traditionally most fertility clinics (including ours) are closed for most of August, because of this situation we should be able to remain open and care for our patients during that time.
If people are interested in starting a virtual conversation and booking in for a cycle during June or July without knowing whether travel bans will be lifted, is that flexible, can people transfer to a later date?
Yes, of course. The sooner people start discussing and preparing for the next cycle the better, and that would allow us to make appropriate plans and to ensure the safety and quality of the treatments.
Advice on supplements to improve egg quality?
It’s a long discussion, we could spend hours on. In general, nutrition is very important for egg quality and for general health. I would personally start with nutrition before I moved on to supplements because, no matter how natural they claimed to be, they’re not 100% natural. I would prefer working with a nutritionist perhaps, or fertility dietician, in order to improve habits, to improve diet, nutrition, get the weight sorted, stress levels and so on. I would move on to supplements when I had explored all the natural options.
Healthy well-being is something that people could put into practice now, isn’t it? This downtime is a great time to get prepared.
Absolutely, this is the perfect time to come to terms with the fact that the better prepared you are, the better success you will have. The way we define success at EmbryoClinic is not just getting pregnant but as a successful experience without risks – an experience where everything is as pleasant as possible.
In terms of people having treatments abroad, potentially in Greece, are there things that they can be doing from home, once things have normalised? Are there tests etc that they can do in the UK, before coming out to you?
Yes, there are a lot of tests, a lot of preparation work that has to be done before. We have streamlined the process, so we aim to do as much as we can locally for patients. We have associates and collaborators all over the country and all over the UK, so that we can have as much information as possible because it is quite important to explore the options together.
Read an article here about optimising your immunity
A reader has had a couple of unsuccessful IVF cycles but has one blastocyst remaining. Would you generally advise her to have that blastocyst transfer before starting a new cycle?
Yes, a blastocyst is a very precious embryo, so I think that it should be utilised from a biology, genetics and ethical point of view. If it’s a good quality blastocyst, go ahead and use it. There’s a lot of preparation you can do, choosing the right physical and emotional environment and choosing the right time to have this embryo transfer.
What are your thoughts on taking DHEA?
Generally, positive thoughts, as long as we define what is a successful outcome – we don’t expect miracles. There is quite a lot of evidence at the moment that, for a proportion of patients, DHEA may be helpful. It may have some small side effects due to its antigenic activity. However, priming with DHEA, especially poor responders or women of what we call an advanced reproductive age, may give us a little bit of an edge with regard to the possibility of having a more effective ovarian stimulation.
Have you ever had success with embryos developing on Day 7 at Grade 4 CBE? Tell us more about embryo grading.
I am afraid not. Grade is something subjective. We do have criteria. Biologists have this ability to grade embryos. Now there is even artificial intelligence involved in this. In general, there is an agreement as to what is Grade A or Grade B. I am not an embryologist. As a clinician, I would not rely on any blastocyst on Day 7. It is very unlikely to be a good quality blastocyst which would have a good chance of pregnancy. There are other methods to assess the quality and we are talking about the external appearance of the embryo so we can use the time lapse or the embryo scope. If we want to move on to something more sophisticated then of course we have the PGS or PGTS. We can do genetic screening on the embryo because after the age of 35 plus, a good proportion of the embryos are genetically abnormal and perhaps this is one of the reasons why IVF fails. However even this is a little controversial. It has been becoming a little bit clearer in the last few years, simply because we have the second generation PGS and because of the fact that we are now testing blastocysts as opposed to Day 3 embryos.
In my opinion we should be focusing on top quality embryos and we should be very strict on what top quality is at any stage of development. That equally applies to fresh embryo transfers as well, but even more so with a frozen embryo transfer. In my opinion, a Day 5 embryo would be ideal.
Do you think 50 is too old to have a baby via IVF?
Well, that depends on who is answering. I think ‘no’, but sadly the legal people have answered that in Europe and Greece it is a bit late. However, there’s a huge trend at the moment to increase the age boundary in Greece to 53 (with donor eggs). We were hoping to have this legal arrangement done in spring of this year, but this has been postponed. So, my advice is not to give up, prepare to get healthy and hopefully when the regulation in Greece changes, we should be able to treat those people.
Read another article here about Day 3 embryos VS blastocysts
If someone has not been having their periods for three months, what would be your initial advice?
Try a pregnancy test. If it is negative, I would strongly suggest a scan initially, with some essential hormonal tests which would include the standard FSH LH progesterone testing, maybe prolactin testing and thyroid testing.
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