Everything you wanted to ask an embryologist: part two

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Embryologists perform an essential role throughout the patient pathway at an IVF clinic. As well as their lab work, they also regularly interact with patients. In part two of ‘Ask an Embryologist’, Senior Clinical Embryologist Kim Hill answers your most frequently asked questions, including how often you will hear from your embryologist.

“We speak to patients in general every other day, typically after the fertilisation check, then on day three and day five. Obviously, some people prefer not to hear from us during that time and just want to know the final outcome, which is fine. Some people want to speak to us every day. It depends on how the patient feels and what support they need.”

What is the difference between a day three embryo and a blastocyst?

At day 3, it should have about six to eight cells. When it becomes a blastocyst, it makes different cell types and expands. You can usually start to see a small cavity forming by the end of day four, and by day five, you would hope to see a nicely expanded blastocyst with clear cells inside. It usually reaches that stage on day five or day six, but it can even be from day 7.

Why do so many embryos stop growing after day 3 and not make it to day 5?

Most fertilised embryos reach the day 3 stage, as the egg drives development until that point. The drop-off from day 3 to day 5 is when the egg and sperm fuse, creating a new genome. This process requires a lot of energy.

If it reaches the blastocyst stage, we know it’s overcome a major hurdle in the embryo’s growth.

Only about 40 to 50% of embryos make it from fertilisation to day 5 stage, so it is essential to prepare patients for this.

Is there anything that could address this in the future?

Unfortunately, IVF is a numbers game, which is why the patients go through the stimulation process because we want to start with as high a number as possible.

Techniques will hopefully be developed in the future to address that drop-off. Artificial Oocyte Activation (AOA) with Calcium Ionophore is currently being investigated, although more research is required to determine its benefits for patients.

When my embryologist talks about normal fertilisation the day after my retrieval, what does that mean?

A newly fertilised embryo will have one small circle for the egg and one small circle for the sperm. That is what we call a Pronuclear (2PN) embryo. Sometimes, you can get a 1 PN or 3 PN embryo, and this usually indicates that something isn’t right. For example, three circles could indicate that two sperm fertilised the egg at the same time during IVF, which means there is too much genetic material in there, and it’s likely that that embryo will be abnormal.

What is assisted hatching?

Assisted hatching is a technique that we use to help the embryo hatch out of its hard outer shell. When the embryo is small, it has a thick layer of protein around it and when it’s ready to implant, it normally hatches out of this shell.

A small incision is made using a laser. Sometimes, we may do this if the embryo can’t hatch naturally, but often, we do it if we need to do a biopsy. At that point, the embryo is hundreds of cells, and this helps us get a couple of cells from the outer layer with the least manipulation as possible.

What is PGT-A?

PGT-A is pre-implantation genetic testing for aneuploidy, and more and more patients are opting for it compared to three to five years ago. It checks the number of chromosomes inside the embryo.

The Aria consultant will discuss this with them initially but often they are receiving a lot of information at this stage, so we will also discuss this with them during the decision-making process.

Can my embryo be damaged during the PGT biopsy process?

Anything that requires embryo manipulation is risky, but I would say the risk here is very low, under 5%. The process requires us to remove three to five cells from the embryo, but at this point, it has hundreds of cells, and we know it can regenerate those cells quickly as long as the quality is sufficient.

It requires quite a bit of training on our part because you are taking cells from the outside, which are the placenta cells, rather than the inner cell mass.

How is sperm quality assessed?

Sperm quality is taking a front seat compared to ten or fifteen years ago. There has been a decrease in sperm count worldwide, and there has been much research into the role of lifestyle factors, such as our sedentary lifestyle, diet, stress, and pollution.

We assess the sperm under a microscope, looking at the number of cells we can see, how they move, and how they look. We use certain criteria to determine whether we can proceed with IVF confidently, knowing that there’s a good chance of fertilisation.

If it doesn’t quite meet those criteria, we recommend ICSI, which bypasses the swimming process.

How much does sperm DNA fragmentation affect the quality of embryos?

Sperm DNA fragmentation is linked with poor embryo development and quality and is being taken more seriously now. We can perform a test to determine the damage or ‘fragmentation’ of the strands of DNA held inside the sperm head. This can be genetic but can also be caused by several factors, including lifestyle choices, environmental factors, and health issues.

More questions? Call +44 (0) 203 263 6025 or email us at admin@ariafertility.co.uk to arrange a consultation at Aria Fertility.

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Everything you wanted to ask an embryologist: part one

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The role of an embryologist is central to the success of an IVF cycle, requiring an exceptionally high level of skill and focus to nurture life at its earliest stages. However, embryologists don’t only work in the laboratory; they also regularly communicate with patients, helping them understand the lab side of their treatment.

Kim Hill, Senior Clinical Embryologist at Aria Fertility, answers the questions they get asked most frequently: “We try to guide the patients through the decisions they will have to make, help them understand what to expect in terms of outcomes, and manage their expectations.

My embryo was abnormal; why did you freeze it?

Even embryos that look good in the lab and have good grading may have defects not visible to the naked eye.

If an embryo undergoes PGT-A testing, we must freeze it while we wait for the results. When the embryo is grown to the blastocyst stage, we do the biopsy procedure, where we remove a few cells, but then we must freeze the embryo while we wait for those test results, which can sometimes take about two weeks to come back.

Another reason would be that the patient wishes to test embryos further. So, if the embryo was frozen and they wish to do genetic testing at a later stage, then we would thaw the embryo, biopsy it, and then refreeze it. Unfortunately, it could then come back as abnormal.

How long do frozen embryos last?

From a biological standpoint, embryos preserved through modern vitrification techniques can be maintained indefinitely, provided they remain frozen. We know that quality doesn’t decrease, and survival rates are good.

Legally, the current rule is that gametes or embryos can be stored for up to 55 years, but you will need to renew your consent every ten years. Some patients choose not to consent for the full ten years, so we must go through the renewal process with them and discuss their options at an earlier stage.

What is the likelihood of embryos not surviving the thaw?

Unfortunately, it does happen, although not very often. Our in-house survival rates are about 98% and so we are confident in our freeze and thaw protocols. Thorough training is involved to reach competency and this is important to maintain that high rate.

The embryo grade is a description of how robust it is to survive the freeze and thaw processes.. If an embryo is only borderline quality, we must discuss it with the patient(s) so they understand it might only have lower survival rate. It’s about clear communication and an empathetic approach with the patient.

We have a cut-off criterion for embryos, and we are as transparent as possible. Our role is to ensure patients have all the information they need to make this decision. Every patient’s journey is different, so it is never a one-size-fits-all situation.

Are frozen transfers more successful than fresh ones?

Our rates are pretty similar between fresh and frozen transfers. A fresh transfer means they collect the eggs, quickly followed by the implantation, which is a lot for the body to go through. Whereas a frozen transfer means you can let your body recover after the stimulation cycle.

Is the size of the follicles linked to egg/embryo quality?

It’s difficult to predict which eggs will come from which follicles. In general, you are more likely to expect more mature eggs from bigger follicles, but sometimes they can be empty, and sometimes we get mature eggs from smaller follicles as well. Our doctors always aim to get as many eggs as possible.

How do you grade embryos?

We get a lot of questions about this because we give our patients a report which outlines the quality of the embryos. Aria employs the Gardner Grading Scale, the most common and universally used blastocyst grading system.

It has three parts: the expansion of the embryo, the Trophectoderm (TE) layer quality, and the inner cell mass (ICM) quality.

This means that at your blastocyst-stage, depending on how expanded the embryo is, you can usually see the two cell types. The trophectoderm is the outer cells, which become the placenta, and then you have the inner cells, or the baby-making cells.

The Gardner Blastocyst Grading System:

Number (1 to 6)- Blastocyst development stage – expansion and hatching status.
First letter (A to C)- Inner cell mass (ICM) quality.
Second number (A to C)- Trophectoderm (TE) quality.

Aside from grading, how do you choose which embryo to transfer?

If a patient has multiple embryos of similar quality and hasn’t been tested for genetic status, we use a few scoring systems.

AI algorithms are built into our embryoscope, our time-lapse incubator. We use the KIDScore™, which tells us the embryo’s potential for implantation based on a large amount of data from multiple clinics. We also have something called the iDAScore, which predicts the chance of achieving a clinical pregnancy based on the detection of a foetal heartbeat.

We also use the ERICA (Embryo Ranking Intelligent Classification Assistant), an AI system that ranks embryos based on their chance of being euploid or genetically normal.

Our success rates are based on the clinical data we’ve collected over the years, and these multiple systems are tools for applying this data quickly to help with embryo selection.

If we’re doing a fresh transfer, you have to make the decision relatively quickly (day 5 of embryo development). If it’s a frozen transfer, you have from the point they start taking their luteal support medication, so we have a couple of days to decide. We usually have a team discussion, and we also like to consider the patient’s choice.

More questions? Call +44 (0) 203 263 6025 or email us at admin@ariafertility.co.uk to arrange a consultation at Aria Fertility.

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“The moment I stepped into the IVF lab, I knew I had found my true calling”

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2025 marks the 10th anniversary of the International Day of Women and Girls in Science, which focuses on closing the gender gap in science. To celebrate this important day, we interviewed Aria Embryology Practitioner Ghazal Khalili about what drew her to a career in reproductive science and her journey so far.

Why were you drawn to a career in embryology?

I originally wanted to pursue a career in paediatrics because I am interested in caring for and helping children. However, after observing doctors in a hospital setting, I realised that the emotional demands of that role were not the right fit for me.

My desire to work in the medical field, particularly with children, remained strong, so I shifted my focus to embryology and IVF. During my undergraduate studies, I had the opportunity to shadow professionals in a fertility clinic for the first time. The moment I stepped into the IVF lab and explored its various facets, I knew I had found my true calling.

What education did you pursue to become an embryologist?

I earned a first-class Biomedical Science degree from the University of Warwick, during which I undertook a placement year as a trainee Andrologist at the University Hospitals Coventry.

Following this placement, between my second and third years of study, I completed an eight-week summer research project at the Sheffield University Hospitals under the guidance of Professor Allan Pacey. This project focused on investigating the advantages of microfluidic devices compared to traditional sperm preparation methods in IVF settings. This happened during the COVID pandemic, which made training even more difficult.

These experiences significantly enhanced my scientific knowledge and research skills in the field of reproductive science.

What stage are you at in your career?

I am in my second year of the Scientific Training Programme (STP) in embryology, where I am gaining academic knowledge and practical experience. I work as a trainee embryologist, and as part of the programme, I travel to Manchester University for exams and academic training.

Additionally, I receive hands-on practical experience at Aria under the supervision of Dr Xavier Gonzalez, where I apply what I’ve learned in a real-world setting. This combination of training and studying simultaneously provides me with a well-rounded experience as I continue developing my clinical embryology skills.

What training do you do at Aria to optimise the skills necessary for specific procedures?

I am supported by a comprehensive training plan and a dedicated training officer throughout my learning process. Some key areas of my training include:

  • Oocyte retrieval
  • Assessment of oocyte maturation
  • Sperm processing for fertility treatments (IUI, IVF, ICSI)
  • Sperm analysis and cryopreservation
  • Embryo grading and assisted hatching (using the embryoscope)
  • Preparation of culture dishes and tubes for treatment days
  • Communicating embryo development updates to patients
  • Handling of liquid nitrogen
  • And more…

Who do you work with in the lab?

In the lab, I work with senior embryologists and embryologists.

What is a typical workday for you?

A typical day for me could begin with oocyte retrieval in the morning, followed by assisting my colleagues with various tasks, such as calling patients and providing updates. I may focus on andrology in the afternoon or prepare for the next day’s procedures.

When I’m involved in set-up, my responsibilities include printing patient notes, verifying all HFEA mandatory consents and blood work to ensure accuracy, and reaching out to patients to explain the upcoming steps from the lab’s perspective. I also encourage them to ask any questions they may have. Finally, I prepare culture dishes and embryoscope slides before the next day’s treatment procedures.

How often do embryologists interact with fertility patients? Do you enjoy the balance of lab work and patient contact?

Embryologists interact with patients regularly, primarily over the phone, to provide updates on their embryos/gametes. However, some patients prefer minimal contact until the final stages of their treatment, which we respect and document accordingly.

For patients undergoing egg retrieval and IVF cycles, there are occasions when they wish to discuss questions regarding their eggs or sperm samples, at which point we engage in face-to-face conversations at the recovery area in our clinic.

Personally, I find in-person interactions more fulfilling than phone conversations, as they allow for better communication through body language and expressions. This is especially helpful when delivering difficult news, as it’s easier to gauge how the patient reacts and provide support accordingly.

Overall, I genuinely enjoy the balance between lab work and patient contact – it creates a stronger connection and allows me to be more involved in the patients’ fertility journeys.

Is there an area of fertility that you’d like to specialise in?

I hope to be a fully-trained clinical embryologist by the end of my STP programme.

What new or future developments in IVF are you most excited by?

I’m particularly excited about the advancements in stem cell-based embryo models. Studying embryo models could provide insights into the development of genetic diseases and potential therapeutic targets. Using stem cells to develop embryo models could offer groundbreaking opportunities for understanding and improving fertility treatments. It’s exciting to think about how these developments could shape the future of reproductive medicine.

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The Blend of Human Expertise and AI in IVF

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Have you ever wondered how technology is transforming the world of IVF? At Aria, we combine human expertise with the power of artificial intelligence (AI) to help create families.

Embryologists are the unsung heroes of the IVF process, but their human ‘AI’ does not develop overnight. Their keen eyes and skilled hands result from years of experience, which allow them to make judgments based on a multitude of knowledge points derived from their extensive training and practice.

The role of AI in IVF: enhancing decision-making

In our lab, AI is not just a tool but a trusted partner. AI is used to analyse imaging data – pictures and videos of the precious cells that we hope will become a success story one day. This data is processed to generate scores that help us assess quality.

When evaluating AI algorithms, and there are lots of them nowadays, we ask critical questions: How large and diverse was the dataset used? What type of microscopes or images were involved? Was the data static or dynamic, 2D or 3D? What is the accuracy of the predictions? Are they developed to predict pregnancy chances, live birth rates, or genetic makeup?

These questions ensure that the AI tools we integrate are reliable. Ultimately, the embryologist makes the final decision, guided by both the AI’s recommendations and their expertise.

Aria’s own studies

AI’s role in the fertility lab has been much in the media spotlight. UK researchers recently published a study in Nature Communications that explored which follicle sizes were associated with improved rates of retrieving mature eggs, resulting in babies being born.

The scientists at Imperial College London used ‘Explainable AI’ techniques – a type of AI that allows humans to understand how it works – to analyse retrospective data on more than 19,000 patients who had completed IVF treatment.

One of the challenges with AI is the ‘black box’ nature of many algorithms. This means that while AI can provide scores and recommendations, the reasoning behind these decisions is not always clear.

At Aria, as scientists, we are committed to understanding AI processes. For instance, we used an AI tool to assess single-sperm motility variables related to ICSI practices but went a step further and looked for biological reasons (in this case, sperm maturation properties) to support the ranking we were given.

We tested AI systems designed to predict the genetic makeup of embryos and their chances of implantation. How? Because we use time-lapse technology, we collect thousands of images, providing a comprehensive view of development. The AI can then analyse these images in a single second, identifying patterns and making predictions that would be impossible for a human to do in such a short time. But are these, on their own, better? The jury’s still out.

“Something key is to understand why an embryo is deemed good by AI,” says Aria’s Senior Clinical Embryologist and Laboratory Manager Dr Xavier. “This knowledge will help us refine our processes and make IVF more efficient.”

While AI offers tremendous benefits, it also raises ethical and practical considerations. We ensure that the AI tools we use are reliable, maintaining a balance between human expertise and technological support. This approach guarantees that our patients receive the best possible care.

Founding director of Aria Mr Stuart Lavery concurs. A well-respected member of the global human fertility community with over 20 years’ experience providing fertility care and support, he believes, “AI represents an amazing opportunity that could impact on improving laboratory results, optimising clinical decision making and enhancing our patient’s experience.

“There is no doubt that its potential will be best realised not by replacing doctors and scientists but by supporting their decision making.”

AI systems have run quietly in the background from the start, always ready to provide an immediate second opinion. They are our copilots, enhancing our decision-making process and ensuring that every choice we make is backed by the best possible data and insights.

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The January reset: how your resolutions can prepare you for IVF

How are your New Year’s resolutions going? January is a time for reflection, resolve and renewal, and for those considering fertility treatment, the commitments you make now can do more than improve your daily life – they can also boost your chances of IVF success. Here’s how focusing on exercise, stress management, nutrition, and eliminating harmful habits like smoking and drinking can help you get ready for your journey towards parenthood this year.

1. Embrace regular exercise

Research into the relationship between IVF and exercise has shown mixed results, with a 2006 study indicating a negative impact on assisted reproductive outcomes, but more recent studies have found regular exercise increased implantation rates, improved the chance of getting pregnant and reduced miscarriage risk.

Moderate, regular activity is recommended for your physical and mental wellbeing, and it could also have a positive impact on your fertility. Moderate exercise can help regulate your hormones, improve circulation to the reproductive organs, and maintain a healthy weight, which is crucial for IVF success.

Excess weight can negatively impact egg quality and make implantation more challenging while being underweight can disrupt your menstrual cycle. A 2023 review concluded that overweight and obese women with polycystic ovary syndrome should be encouraged to engage in aerobic exercise or resistance training to optimise their chances of conceiving.

2. Manage stress for a healthier mind and body

The IVF process can be emotionally and physically taxing, and stress can exacerbate these challenges. High-stress levels may impact hormonal balance and reduce your chances of successful implantation. Making stress management a resolution can help you stay calm and focused during your fertility journey.

Consider incorporating relaxation techniques like mindfulness meditation, deep breathing exercises, or acupuncture. If you’re feeling overwhelmed, don’t hesitate to seek support from a therapist or a fertility counsellor.

3. Prioritise nutrition

A balanced diet rich in fertility-boosting nutrients can make a big difference in preparing your body for IVF. Start by including whole foods such as fruits, vegetables, whole grains, lean proteins, and healthy fats. Key nutrients like folic acid, vitamin D, omega-3 fatty acids, and antioxidants are essential for egg and sperm health.

Limit your intake of processed foods, refined sugars, and trans fats, as they can cause inflammation and disrupt hormone balance. Consider consulting a fertility nutritionist to tailor your diet to your needs. By making mindful eating a resolution, you’ll nourish your body and optimise your chances of success.

4. Make essential lifestyle changes

Smoking and drinking can significantly reduce fertility for both men and women. Smoking damages eggs, sperm, and the uterine lining, while excessive alcohol consumption can disrupt hormone levels and impair reproductive function.

If you smoke, make quitting one of your top resolutions. Seek support from smoking cessation programs, therapy, or nicotine replacement options. When it comes to alcohol, aim to limit or eliminate it altogether. Consider replacing alcoholic drinks with mocktails or sparkling water during social occasions.

5: Learn about your fertility

Understanding your fertility is an empowering step. Whether you’ve faced challenges conceiving or simply want to explore your options, our assessment will provide insight into your fertility health through a range of tests that evaluate your lifestyle and other health issues. A fertility check is about getting information to support your decisions.

Call +44 (0) 203 263 6025 or email us at admin@ariafertility.co.uk to arrange your fertility assessment.

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The benefits of reproductive reflexology

Embarking on IVF and fertility treatment can be incredibly stressful, and this time of year can make it particularly challenging. In our latest post, we chat with reflexologist Charlotte Bentley about the benefits of reproductive reflexology.

“Reflexology not only stimulates the reproductive and endocrine systems but also helps put the body into a relaxed state, which is needed at this sensitive time,” she explains.

The holidays emphasise family and celebration, which can be lonely and isolating. At the same time, the demands of the party season can make it hard to focus on a healthy lifestyle. So, this could be the perfect time to find an approach that decreases stress and increases relaxation.

Reflexology, an ancient healing practice rooted in Egyptian and Chinese traditions, involves applying pressure to specific points on the hands and feet. This technique is often used to alleviate various health concerns.

“I have been specialising in women’s health, including menstrual cycles, fertility, pregnancy, postnatal, peri-menopause, and menopause since qualifying. I also see people suffering with any kind of ailments which may include insomnia, anxiety, pain management, migraines, sinus issues, and lots more.”

reproductive reflexologyPractitioners believe that the soles of the feet serve as a miniature map of the body, with specific areas corresponding to internal organs and systems, including the fallopian tubes and ovaries. By massaging these points, reflexologists aim to clear energy blockages, helping the body restore its natural balance and promote self-healing.

“Reflexology is the technique of applying gentle pressure to reflex areas on the feet or hands to bring about a state of deep relaxation and stimulate the body’s healing processes. Reflexology can help boost the immune system and create a stronger body and calmer mind.

“Reflexology is a safe, natural therapy that helps to give your body what it needs.”

Why did you decide to specialise in reproductive reflexology?

“During my year-long reflexology course, I had to do approximately 100 case studies. One woman had been trying to get pregnant for three years and was planning to start IVF. As a case study, I saw her once a week for four weeks, and that month she conceived.

“That had a huge impact on me, and I decided to specialise, doing additional courses in fertility, pregnancy and postnatal reflexology as well as everything relating to women’s health, such as the menopause.”

What are the benefits for those trying to conceive?

Irregular or missing periods can be regulated through reflexology by stimulating hormonal points such as the pituitary gland.

“I can make a big difference for patients with PCOS and endometriosis. Many girls are on the pill for so long, they don’t know where they are in their cycles.

Couples struggling to conceive will also experience significant levels of stress, which increases the release of adrenaline, cortisol, and nor-epinephrine in your body. Reflexology can help rebalance these hormones while stimulating the release of oxytocin.

“One of the most significant benefits of reflexology is that it puts your body into a relaxed state. This is particularly important for patients undergoing IVF.”

When should clients see you if they are trying to conceive naturally?

“This varies. Some women come to me a year before they plan to start trying, especially if they’ve got PCOS or endometriosis, to regulate their periods. Typically, they’ll see me once a month.

“When they want to start trying for a baby naturally, I like to see them twice before they ovulate. So, once they get their period, they let me know. Then, we will do two reflexology sessions. Obviously, everyone’s cycle is different.

“Then I don’t like to see them until they get their periods or not. If they get a period, we will try again the following month.

When do you prefer to see IVF patients?

“Ideally, as soon as possible, just to have a starting point. You can have reflexology as much as you want in the run-up although, depending on where they are in their fertility treatment, we do not stimulate the ovaries.

“I would see a patient until their egg collection, apart from the 24 hours after the trigger injection. After that, I can see them up until their transfer. Personally, I don’t like to see them post-transfer as nature should take its course.

Do you see patients after the embryo transfer?

“If it is a failed transfer, we can obviously start again. If the transfer is successful, I don’t usually see them during the first trimester unless there are special circumstances.

“One client was seven weeks pregnant but was celiac and didn’t want to take her medication during pregnancy, so reflexology helped her metabolism work properly.

“From the second trimester onwards, it’s all systems go, and they can have as much as they want. After childbirth, women often don’t have the time to prioritise themselves, but I recommend at least one treatment to rebalance hormones and to stimulate drainage of toxins.”

Click here to get in touch with Charlotte Bentley. Go to our Support Hub for access to some of the organisations offering fertility support, advice and information.

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Aria embryologist Dr Xavier Vinals Gonzalez publishes preimplantation genetic testing research

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At Aria Fertility, we believe in empowering our patients with knowledge and support to make informed reproductive decisions. Our commitment to patient education is at the heart of everything we do. Recently, our head of the laboratory, Dr Xavier Viñals Gonzalez, in collaboration with University College London, published a study on patient perspectives after preimplantation genetic testing for aneuploidy (PGT-A). This research sheds light on the complexities and challenges faced by patients when deciding whether to transfer a non-euploid embryo. Today, we sit down with him to discuss the findings and their implications for patient care.

Dr Gonzalez, can you explain what non-euploid embryos are and why they presents a challenge in reproductive medicine?

Dr X: When we perform preimplantation genetic testing for aneuploidies or PGT-A, we typically would expect to get embryos reported as euploid (genetically normal) or aneuploid (genetically abnormal). Mosaic or segmental aneuploid embryos are non-euploid embryos which have shown to have moderate to good reproductive potential based on published literature. When a non-euploid embryo is identified, the decision to transfer such embryos offers challenges to patients as the clinical outcomes and long-term effects are often uncertain.

Your study highlights several key factors influencing patient decision-making. Can you elaborate on these?

Dr X: Certainly. Our study involved an online survey of individuals worldwide who had undergone PGT-A during their fertility journey and had a non-euploid embryo as a result. For most respondents, the type of non-euploid found was a mosaic. From their responses, we learned that the opportunity to discuss implications, the number of topics covered during consultations, and the country where the treatment was received were significant factors influencing decision-making. Additionally, respondents highlighted mismatched expectations, inadequate information provision, and an unsupportive decision-making process as major challenges.

Can you share some of the respondents’ experiences regarding mismatched expectations of PGT-A?

Dr X: Many respondents noted a gap between how IVF professionals explain PGT-A to patients and the certainty with which it is offered. Quotes in the paper reflect a common sentiment that the limitations of PGT-A may not have adequately been communicated.

How common is mosaicism in human embryos?

Dr X: This is a very good question and the answer may vary depending on which clinic you will be undergoing treatment and the genetic laboratory that will process your samples. However, we would typically expect the mosaicism rate to fall under 10% across all age groups. Not all clinics report mosaicism, so if this information is important to you – this is something you will need to discuss with your team.

What about the clinical outcomes of mosaic embryos?

Dr X: In recent years, research in mosaic embryos has shown similar reproductive outcomes compared to embryos reported as euploid – and by outcomes, I  mean sustained pregnancy/live birth and miscarriage rates.  One of the main concerns I hear from patients is how likely is this mosaicism seen on embryos to be present at birth; and from what we know, this is very unlikely. It is important to also note that there are different types of mosaic and other non-euploid embryos (ie. non-mosaic segmental), with varying outcomes. We are very active in the area of human reproductive genetics and we hope to share the work we are doing soon.

Respondents also mentioned inadequate information provision from clinics. Can you discuss this issue?

Dr X: Yes, some respondents expressed that their clinics provided limited or no information about PGT-A ahead of the testing. Less than a quarter of the respondents were given information about the use of non-euploid embryos and only 17.5% were aware of the risk of miscarriage after PGT-A. One respondent said, “There was no discussion other than it was included into the IVF package.” This lack of detailed information led many patients to undertake their own self-directed research, often relying on medical literature, peers, private genetic counsellors, and social media groups.

How does Aria address these concerns?

Dr X: At Aria, we are committed to providing comprehensive and transparent information to our patients. We believe in clear, patient-centered communication to help patients understand their options. Our team is available to discuss the implications of PGT-A results and answer any questions. We strive to create a supportive environment where patients feel empowered and informed. We have an excellent Genetic Counselling support service that explores complex genetic information with patients so they can understand some of these terminologies in the context of current evidence in the field.

What are the global trends and insights from your study?

Dr X: It’s important to note that the data in our study comes from patients worldwide, with a higher proportion of respondents having received treatment in the US. This highlights global trends and could provide insights into how different populations navigate non-euploid embryo transfers.

What are the next steps for research in this area?

Dr X: The field of reproductive genetics (and embryology) is continuously evolving. Studies on non-euploid embryos, show that some previously not recommended for treatment could now be considered after careful consideration. The eldest baby born from a mosaic embryo in our dataset was 3 years old at the moment of response and met all developmental milestones. Research on live birth data and developmental milestones could bring further reassurance to patients and professionals.  Our research highlights the need for further studies to better understand the experiences and needs of specific patient groups. By expanding our understanding, we can continue to improve the support and information we provide to our patients. We are committed to advancing reproductive medicine and ensuring our patients have the best possible care and support.

Thank you for sharing these insights. Any final thoughts for our readers?

Dr X: At Aria, we are dedicated to helping our patients navigate the complexities of human reproduction with information based on internal evidence and experience, considering global trends. It is part of our human nature to want to quantify success in numbers, and with the broad information we have online nowadays it is difficult for patients to gather whether that is relevant to them or not. If you have any questions or need more information about genetic testing, please don’t hesitate to reach out to our team.

Click here to read the research in full >

For more advice on preimplantation genetic testing for aneuploidy (PGT-A), call +44 (0) 203 263 6025 or email admin@ariafertility.co.uk to arrange a consultation with one of our fertility experts.

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Is a vegetarian diet good for fertility?

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It’s National Vegetarian Week, and the latest figures show there are just over 3 million vegetarians and vegans, with 4.5% of the UK population having a vegetarian or vegan diet.

Traditionally, meat was the star of a meal, but more and more of us are cutting back or cutting it out together, whether you’re a ‘classic’ vegetarian, lacto or ovo vegetarian, pescetarian or flexitarian. The health benefits of a vegetarian diet can be myriad, from boosting heart health, lowering blood pressure and cholesterol, preventing diabetes and managing your weight to keeping your brain sharp and reducing the risk of cancer.

In our latest blog, we focus specifically on whether a vegetarian diet is good for fertility and explore how other popular diets, ranging from keto to vegan, affect fertility and IVF outcomes.

Does vegetarianism impact your fertility?

The first question should be, does diet affect your fertility? The reasons that couples are unable to conceive range from a woman’s ovaries not producing healthy eggs or blocked fallopian tubes that prevent the egg from moving to the womb to the egg’s inability to attach to the lining of the womb successfully. Male infertility can be the result of poor sperm quality, including motility, morphology and sperm count.

Even after tests, the cause of infertility may not always be clear, as about 15% of infertility cases remain unexplained.

No individual food or supplement can fix these potential issues, but there have been multiple studies into the positive and measurable influence of diet and other related lifestyle choices on fertility.

If done correctly, a vegetarian diet is at least as healthy as one that involves meat. It is important to clarify that any diet—whether plant-based or meat-focused—must be well-planned and varied in terms of nutrients and avoid ultra-process food (UPF). The popularity of plant-based meat alternatives has seen staggering growth in recent years.

In fact, it might be even better, as a 2015 study into IVF couples found that men’s meat consumption could affect the outcome of fertility treatments. Although poultry consumption had a positive impact, processed meats such as bacon and sausage, with men who ate the most processed meats, with an average of 4.3 servings a week, had just a 54% chance of achieving pregnancy with their partner.

What about other popular diets?

A recent study published in Nutrients journal examined the impact popular diets have on fertility. It analysed the Mediterranean diet, the DASH diet, the keto diet, and plant-based diets such as vegetarianism and veganism.

  • Mediterranean diet: Rich in fruit, vegetables, nuts, whole grains olive oil and other heart-healthy fats, this diet is routinely described as the gold standard for health and there is growing evidence it could also be beneficial for fertility.
  • Dash diet: This diet was devised to lower blood pressure. It heavily features fruit, vegetables, and nuts with low meat and salt consumption. It’s been found to be beneficial for PCOS patients.
  • Vegetarianism and veganism: Excluding meat and potentially all animal products, these diets can have many health benefits but could cause nutritional deficiencies if poorly planned.
  • Ketogenic diet: high fat and low-carb diets have proven very successful in diabetes management or reversing obesity and have also shown significant benefits for women suffering from PCOS.
  • Western diet: high in ultra-processed foods and chockfull of sugar and salt, this diet is linked with rising BMIs and associated health risks. Studies have also shown a negative impact on sperm quality and embryo development.

If you’re looking for more advice on nutrition and fertility, please visit our Support Hub, where we provide links to experienced and empathetic dieticians who treat couples and individuals undergoing fertility treatment. To arrange a consultation with one of our fertility experts, call +44 (0) 203 263 6025 or email admin@ariafertility.co.uk.

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A hostile environment: male infertility and pollutants

Breathing in air pollution in the form of fine particles produced by road traffic and construction and which hang in the air could increase the risk of male infertility by 25 per cent, a new study warns.

Published in the British Medical Journal (BMJ), the Danish study also found that women face a different threat with UK traffic noise levels, leading to a 14% increased risk of infertility.

Researchers analysed data on over 500,000 men and nearly 400,000 women in Denmark aged between 30 and 45 who had fewer than two children. They looked for patterns linking reproductive health and air and noise pollution prevalent in their location.

In terms of air pollution, the study’s authors specifically looked at PM2.5s. These are tiny particles, less than 2.5 micrometres in diameter, created by road traffic and the burning of fossil fuels.

Danish men exposed to an annual average of 2.9 micrograms of fine particles of pollution per cubic metre had a 24% increased risk of infertility. Yet, worryingly, levels in our UK cities are nearly double that figure.

Female fertility and pollutants

The study found that PM2.5 exposure did not have a similar effect on women’s fertility, but it did note that noise pollution had an impact. This is thought to be due to the link between noise pollution, increased stress and disturbed sleep patterns.

The research, published in the BMJ, is observational, meaning it cannot directly establish that pollution causes infertility. Lifestyle factors were not considered.

Professor Allan Pacey, an expert in andrology at the University of Manchester, commented on the study: “It is possible that the real cause of this association lies with something that it was not possible to measure.”

Lifestyle factors in male infertility

It is challenging to avoid exposure to environmental pollution, particularly if living and working in urban areas, but there are modifiable lifestyle factors that we know impact our overall health and, by extension, the health of our sperm.

Here are 7 lifestyle factors that could affect male fertility and sperm health:

  1. Smoking: smoking can impact sperm quality, by giving you a lower sperm count, poorer sperm movement and can affect your DNA fragmentation.
  2. Alcohol: we know that women are advised to abstain if they are trying to get pregnant, but is there a ‘safe’ amount for men?  A 2023 meta-analysis of 40 studies found alcohol intake reduced semen volume during each ejaculation.
  3. Steroid use: anabolic steroids are recognised as one of the causes of male infertility. Even things like testosterone supplements can act as a male contraceptive, and it may take some time to reverse their effects.
  4. Stress: chronic stress can cause hormonal imbalances within the body, affecting sperm production.
  5. Lack of sleep: research has found a lack of sleep may be a factor in male infertility. A study published in Fertility & Sterility, which followed almost 700 couples for a year, found that men who slept less than 6 hours a night were 31% less likely to get their partner pregnant.
  6. Being overweight: having a too high BMI is associated with many different health risks, and it is recognised as a common cause of male infertility. Studies show that it can affect hormone levels, causing reduced sperm production, and there may also be a link between obesity and reduced sperm motility and morphology.
  7. Poor diet: good nutrition supports all our bodily functions, including producing healthy sperm. Diets high in processed meat, caffeine, saturated fatty acids and trans fats are linked to low-quality semen. Conversely, antioxidant-rich diets are linked to better sperm quality.

Male infertility affects up to half of couples having problems starting a family. Our Male Fertility MOT test will check your sperm count, shape, movement, and other characteristics and help diagnose and treat male infertility causes.

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What’s the difference between IVF and IUI?

Different methods of assisted conception have come under the spotlight recently as Democrat vice-presidential candidate Tim Walz speaks out about his family’s struggle with fertility.

Walz and his wife have been open about their “journey with IVF” but were then forced to clarify that they had relied on a different process known as intrauterine insemination, or IUI.

It is common for patients to conflate the two under the umbrella of ‘IVF’, but what’s the difference?

What is IUI?

During intrauterine insemination, or IUI, sperm is placed directly into the uterus. This increases the chance of the sperm reaching the egg as it reduces the distance it must travel.

Furthermore, the semen is separated from the seminal fluid before it is injected, significantly increasing the number of sperm in the uterus compared to through intercourse.

If you have irregular ovulation, we can use fertility drugs in combination with IUI.

How is IUI performed?

The sperm sample is injected through a fine catheter into the uterus at the time you are ovulating. The patient may be prescribed fertility medication to stimulate egg production.

The procedure is relatively quick and painless. In preparing for the IUI procedure, you will visit the clinic to monitor the eggs’ development before ovulation.

Who is IUI suitable for?

IUI may be recommended for:

  • Couples with unexplained infertility, often as a first-line treatment
  • Mild male factor infertility, such as low sperm count, sperm motility, or other mild sperm abnormalities
  • Cervical factor infertility as IUI bypasses the cervix
  • Use of donor sperm
  • Male and female conditions that make full penetrative sex difficult, such as vaginismus or erectile

What is IVF?

IVF or in-vitro fertilisation involves fertilising the egg with a sperm outside the body. Embryos are developed in the laboratory before they are transferred to the uterus, where they will hopefully implant successfully and lead to a full-term pregnancy.

IVF maximises the chance of fertilisation, and we can use embryo selection techniques, including time-lapse monitoring and preimplantation genetic screening, to choose the embryo with the highest potential for pregnancy.

How is IVF performed?

IVF involves several steps. First, ovarian stimulation medication produces multiple eggs in one cycle. These are then retrieved through a minor surgical procedure performed in our Marylebone fertility clinic. Our embryologists then fertilise the eggs with sperm in our lab to create embryos.

The embryos are carefully monitored for a few days before the healthiest ones are selected. At this stage, they can either be frozen, or one or two are transferred to the uterus, with the rest frozen for possible use later.

The IVF process involves several visits to the clinic over four weeks for monitoring, egg collection and transfer.

Who is IVF suitable for?

IVF is suitable for the following fertility patients:

  • Couples with infertility issues
  • Same-sex couples wishing to use donor eggs, sperm or embryos
  • Single individuals using donor eggs or sperm to conceive
  • Patients with ovulation disorders such as PCOS (polycystic ovary syndrome)
  • Individuals with genetic disorders as embryos can be screened before implantation
  • For fertility preservation as IVF can be used to freeze embryos, eggs, or sperm for future use

Regarding success rates, there are many factors to consider, such as age and underlying fertility issues. Typically, IVF has higher success rates, but IUI can be a viable option for couples with minor fertility issues as a first-line treatment.

During your fertility consultation, our experts can thoroughly explain each procedure’s benefits and drawbacks and advise you on the most appropriate treatment option.

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