December 9th 2016
Cihan Halicigil – Chief Embryologist CFI| Matt Biagiotti – Marketing Director CFI
By Stacey Hill, Kickstartbabies
Back in October, one of my blog pieces about our journey through IVF was published on the HuffPost website. Soon after, I was contacted by Matt Biagiotti, a fellow IVFer and father of twin boys, who told me how great it was to see me talking so frankly about my fertility and motherhood journey.
Matt is the Marketing Director at Carolinas Fertility Institute, and later went on to feature my story on their website, in the hope that my open diary through IVF would be of some help to their patients going through it, over 3.5k miles away. I was truly humbled.
Matt Biagiotti, Marketing Director CFI
After researching Carolinas Fertility Institute (CFI), I was curious to know what their secret was. They were hitting success rates of a whopping 78.6%, smashing their national average of 48.7% straight out of the water. These numbers were the most impressive my eyes had ever seen and I wanted to know how the experience of In Vitro Fertilisation runs at their clinic, in comparison to mine.
One things for sure, with our national average of 33.7%(HFEA), they were more than doubling our figures here in the UK.
Although very impressive, it wasn’t just numbers that stood out for me. It was so open and informative, and from CFI’s website alone I felt I had already been given so much insight into all areas of IVF, that we don’t usually get to see. I read all about the experience these doctors had and how hi-tech everything was. They had all of the latest lab technology, including the Embryoscope machine, which played a key role in our successful outcome. Not only that, but it was so refreshing to see them actively encourage therapeutic activities like acupuncture and yoga alongside the IVF process, and with the offer of a behind the scenes tour of this modern-day IVF lab worked, I jumped at the chance.
Who are Carolinas Fertility Institute?
Carolinas Fertility Institute brings decades of experience providing excellent care in the treatment of infertility.
CFI was founded by Dr. Tamer Yalcinkaya, a renowned fertility expert.
Dr. Tamer Yalcinkaya has been named one of the Best Doctors in America® for 2016, marking the 19th time he has made this prestigious list since 1996. Dr. Y, widely regarded as a top expert in his field, is the head of Carolinas Fertility Institute (CFI), and practice with offices in Winston-Salem, Greensboro, and Charlotte that specializes in the evaluation, diagnosis, and treatment of infertility.
CFI pride themselves on giving the highest standard of care with the latest technology and offer treatment at a lower cost than many other fertility centers. They have success rates that are consistently above the national average, helping numerous couples through the fertility process to establish happy families.
Dr. Tamar Yalcinkaya
State-of-the-Art IVF Lab – Where ‘extras’ are standard procedure
Soon after the interview was planned, Panorama released their findings to the world about how the extras we pay for here in the UK to boost our chances of success, held no scientific evidence. I have to admit, I felt a little awkward about how I was going to interview such a successful fertility clinic, that boasted about having the latest technology, resulting in incredible success rates.
I personally was angry at how the documentary was delivered, it was sneaky, one sided and completely failed to take into consideration that without clinics like CFI, there would still be couples out there stripped of their god given right to be a family, and for me, science behind it or not, these extras work for some of us. They work by giving people like me a light at the end of the tunnel, a glimmer of hope that this might just be your ticket, that you’re doing everything in your power to get a positive and now I was more determined than ever before to find out how these ‘extras’ were contributing to their ever-growing numbers.
This was my chance to give a different side to the story. A voice to those who do believe in the latest technology. Afterall, without it I am certain our outcome would have been very different.
The more I spoke with Matt in the run up to the big day, the clearer it became how passionate CFI are with their work, how close their relationships are with their patients and the belief and knowledge in their equipment, cemented my feeling that it wasn’t just all about the science. It was about the journey.
These were expensive, crucial investments that had been made by experts in this field, people who have been doing this for decades. They come as standard at CFI, all IVF treatments will have embryos stored in their Embryoscope machine, all embryos will be cultured in a safer environment using the air purification system, LifeAire, maximising the chances of success, and it was! Of the first 24 IVF rounds , 23 were pregnant and they ended 2016 on a huge high after releasing a whopping 148 babies were born with the help of CFI, a huge difference to the 2015 figure of 20. This lab was state of the art, and I just couldn’t wait to find out more.
“Do you want a donut?”
It started with the offer of a donut being stuffed into the hard drive, it doesn’t get better than this, right? Wrong. It just kept getting better. After a grand entrance into the foyer at Carolinas Fertility Institute, I was failing miserably at my attempt to not say “wow” too much. Wow. I got a glimpse of a window, It was like I was stood there in the foyer looking right through it, from the waiting area, straight into the lab. I couldn’t believe that patients actually get to see what was going on behind the scenes here. Again, I could see how personal the experience through IVF was here, it was an open book, patients could be involved, ask questions, see who was dealing with their precious cargo.
I was introduced to Cihan, Chief Embryologist at CFI. All my nervous butterflies flew away and I slipped straight into my comfort zone of fertility talk.
Again, I felt completely at ease from the get go, and he guided me into the lab on his tea break. He goes on to tell me his background, having worked at CFI for 2 years, worked in this field for 16, this being his 16th Laboratory built!
With a million questions running through my head, I was conscious of taking up his precious time in the lab, so with a list sent over on an email (below), I could just listen (and “wow”) to Cihan, as he guided me through the many aspects of life behind the scenes. I got to see where the embryos are stored and frozen, the Embryoscope machine, microscopes and for once i was lost for words, when he shown me a live biopsy of an embryo ready for PGS (Preimplantation genetic screening). Mind = blown!
Cihan Halicigil – Chief Embryologist, CFI
Anyway, I don’t want to ruin it… so please go take a look for yourself! Video Interview below…
(Don’t forget to check out the Q&A’s below)
>>>>Click above – Play video<<<<<
——– Questions & Answers ——-
I’m so excited to see that you have use of Embryoscope technology at CFI, something my partner and I paid extra to have for our IVF round. We believe that this played a key part in our successful outcome, having 12 embryos, we transferred 2 and the remaining 10 never made the grade to freeze. The 2 strongest embryos were selected based on the information the embryoscope was giving, and I feel that because of this, we were blessed with our twin boys, Ronnie and Arnie.
At the time of our IVF treatment, our clinic said the embryoscope technology boosted success rates by 10%.
What is an Embryoscope machine? I hear you ask…
Embryoscope® time lapse monitoring as an optional extra to either IVF or ICSI treatment here in the UK. The embryoscope provides digital images of embryos every 10 minutes for the whole time they are in the IVF laboratory, which can be up to 6 days.
This provides unprecedented detail of early embryonic development which helps clinical embryologists to choose the embryo(s) with the best chances of implantation to transfer to the patient. The recording process also means that embryos do not need to be removed from the incubator for daily monitoring, so maintaining a more stable temperature and ambient environment.
Q. How is this technology boosting your success rates at CFI?
The technology allows is to safely store AND monitor the development of embryos. We can then choose the best blastocysts for the highest chance for success.
Q. Is it standard procedure at CFI to use the Embryoscope machine, or is this an extra option for those that want it?
This is standard procedure for our IVF patients.
Q, How often is the information analysed during the incubation stage, and what exactly are you looking for?
Hourly. We monitor how the embryos are developing and gauge their viability. I can check on embryos in the machine remotely from my computer or phone.
Q. How many of your clients make use of this as an extra option, alongside standard IVF?
Again, this is standard.
Q. How many Embryos can be monitored by the Embryoscope at one time?
The EmbryoScope incubator can hold up to 72 embryos – that is six clients can store up to twelve embryos at a time.
Q. Other than Embryoscope technology, what other advances in technology are you seeing great results from, at CFI?
The practice also uses LifeAire, an air purification system that minimizes the potentially devastating variable of ambient air, and maximize the in vitro culture environment, laboratory potential and clinical outcomes. CFI is the only fertility practice in the southeast US using both the EmbryoScope and LifeAire technologies.
Behind the scenes…
We all know the ins and outs of our IVF journey, we had the scans, we knew what meds we took, how to inject them, even googled what our cervical mucus was trying to tell us. But once you’ve got our precious eggs and spermies…. we jump to Egg transfer day. Ever wondered what happens in between?
Q. Once the eggs have been retrieved, can you explain what the first process is for the eggs?
The eggs are identified, rinsed in culture media, and placed in small drops in plastic culture dishes. The dishes with the eggs are then kept in specialized IVF incubators under carefully controlled environmental conditions.
Q. Once the sperm sample has been given, how is this stored and prepared for fertilisation?
The sperm can be used fresh for fertilization or are carefully frozen for use at a later time.
ICSI – What is it? I hear you ask…
Intra Cytoplasmic Sperm Injection is where the embryologist selects a single sperm and injects it directly into the egg for fertilisation, instead of conventional IVF, where many sperm are placed next to the egg.
Q. If ICSI (Intra Cytoplasmic Sperm Injection) is unplanned, at what stage do you decide ICSI is necessary?
Typically, when the patient’s ability to produce healthy eggs is low.
Q. What are the different stages an embryo has to go through before transfer?
We transfer or freeze on day 5 – preferably when they become a blastocyst. During the 5 days, we monitor them as the cells divide and form within the egg.
Q. Can you explain how CFI grade embryos?
Embryos should be at 2 to 4 cells at 48 hours after egg retrieval and preferably about 7 to 10 cells by 72 hours. I also access the degree of fragmentation, the process where portions of the embryo’s cells have broken off and are now separate from the nucleated portion of the cell. It is preferable to have little or no fragmentation. Other aspects of the microscopic appearance of the embryos we note include the presence of vacuoles, granularity and thickness of the outer shell.
Q. At what stage do you decide on a day 3 or day 5 transfer?
We focus on day 5, the blastocyst stage.
Below are pictures of our embryos we had transferred on day 5 as blastocysts, resulting in twin boys, Ronnie and Arnie.
Can you tell me what appears to be happening at each stage?
Image 1: These are Zygotes, or fertilized eggs. It’s a diploid cell resulting from the fusion of two haploid gametes; a fertilized ovum.
Image 2: This is stage 2 of the a fertilized human eggs (also called oocytes) Male and female genetic material (DNA) are in the 2 pronuclei.
Image 3: These are 3 human embryos at the 8-cell stage.
Image 4: These are blastocyst embryos on day approximately day 5. Blastocyst transfer can result in high pregnancy rates with low multiple pregnancy rates.
Image 5: This shows further blastocyst development. Again, probably ay 5 which is when we transfer or store / freeze them.
The BIG freeze…
I personally had no embryos left to freeze. But many women have lots of embryos left from a fresh cycle, or experience OHSS, so have to freeze embryos rather than having a fresh transfer.
Q. What is the process for freezing embryos?
At CFI, our lab uses an advanced freezing technique known as vitrification. This is ultra-rapid IVF embryo freezing instead of the traditional slow freezing process. Scientifically speaking, vitrification is the process of converting something into a glass-like solid, free of any crystal formation. By adding a cryoprotectant, water can be cooled until it hardens like glass without any ice crystals forming. This is important in the embryology world because ice crystal formation can be very damaging to frozen embryos. Vitrification in IVF can allow freezing of spare embryos with better post-thaw survival rates and higher pregnancy and live birth rates from frozen embryo transfer cycles. This rapid freezing process is the most effective method of successfully freezing blastocysts. Blastocysts have a large space in the middle of the embryo that fills with fluid. Embryologists have found that making a tiny hole between two cells permits the fluid to leak out, collapsing the embryo and permitting more effective vitrification. Blastocyst stage embryos are often “collapsed” on purpose before freezing to allow the cryoprotectant agents to infiltrate the cells in the embryo more effectively. If there are any quality blastocysts (advanced day five or day six embryo) remaining at the end of a treatment cycle, CFI will save them through the vitrification freezing process for future use. When ready, we thaw out the frozen blastocysts for transfer. It’s a great way to maximize your chances for a positive result after the eggs are harvested.
Q. How long will you keep frozen embryos at CFI?
We are a relatively new practice, but 10 years is a current standard.
Q. What grade do the embryos need to be in order to freeze, and why?
We’ve found that day 5 blastocysts are preferable.
Q. What are the success rates for FET compared to a fresh cycle?
Fairly equal, with frozen being slightly higher.
Multiple transfers …
Here in the UK, the Human Fertilisation & Embryology Authority introduced a policy for clinics to minimise the risk of multiple pregnancies. In doing so, they hoped to reduce multiple births to 10%, with all clinics having their own strategy.
1) Do you have a similar policy in the US for Multiple transfers?
2) Can you explain what your strategy is at CFI?
3) What is the criteria for women wanting a multiple transfer at CFI?
Regarding the above, we are currently implanting MORE single embryos due to our high success rates. In previous years, more then one embryo was implanted to create a greater chance for success. This also increase the change for twins, etc.
Secret to success, what’s the recipe?
You are consistently achieving the highest success rates in the country.
Q. What would you say, sets CFI aside from other clinics?
Our professional talent, technology, and attentive patient care.
Q. Where do you see CFI in 10 years time?
Likely with practices in a few larger metro US areas – Atlanta, Nashville, Etc
PanoDrama – Is it all about the science?
You may have seen in the media that a recent investigation by Panorama here in the UK, revealed lack of scientific evidence to support the effectiveness of ‘add on’ treatments offered by UK fertility clinics, one of these being the embryoscope technology.
I personally feel this was a huge blow to clinics similar to yourself, who are getting continuous, undeniably fantastic results, regardless of the add on options. After publishing my response on my website, many women who have been through IVF have said they too, would still pay for the extra options if we were to go through it again, regardless of the findings. I believe, and have living proof that these treatments can be the key to a successful round.
Q. What would you say to those questioning the results of these add on treatments because of these findings?
Give yourself the best chance for success. The numbers prove that first-time pregnancies are rising and patients can avoid multiple IVF procedures.
IVF – Body & Mind…
It’s really refreshing to see that you encourage therapeutic activity such as yoga, acupuncture and massage for patients undergoing fertility treatment at CFI. This isn’t something I was actively encouraged to do by my clinic during my treatment, but chose to, in order to keep my mind active and stay positive throughout the process.
Q. Why do you think therapeutic activities are so important during treatment?
A positive mind has been proven to enhance the chance for success and will improve a patient’s overall attitude during your treatment. Overall physical conditioning and keeping weight at a reasonable measure enhance the chance for success.
Fertility awareness, do we need to be in the know, sooner?
Here in the UK, schools are expected to teach sex and relationship education as part of the national curriculum from the age of 11, talking about fertility, reproduction, relationships and contraception. There is however, no mention of infertility, and in a class of 30, It’s expected that around 5 of those will experience problems getting pregnant. I personally would like to see schools encouraging fertility awareness in teenagers to prepare them for their future in every way possible, and with infertility on the rise, I feel it a duty for them to have better education on this subject.
Q. Would you agree that we need to be more fertility aware, sooner?
I agree with you. With the rapid enhancements and improved success of fertility treatments, students should be educated on it. There’s a good chance some of the students in each class are the result of some type of fertility treatment.
Q. If you had 1 ‘Top Tip’ for someone preparing for IVF treatment, what would It be?
Be emotionally prepared and educate yourself. While success rates continue to improve, patients and their loved ones need to participate in the process.
From the bottom of my heart, Thank you…
I am so thankful to CFI for this incredible opportunity.
It’s a tick off of the bucket list and all of the questions in my head that I’ve often seen floating about in the TTC community on what happens to our precious embies behind the scenes, have finally been answered.
My pro ‘add ons’ feelings are stronger than ever and I feel relieved to see that CFI are just as passionate about the journey as those are going through it. The power of technology has blown my mind, yet again.
Without this latest technology, such as Embryoscope & LifeAire, CFI for one wouldn’t be getting the results they are seeing.
I’ve formed a great relationship with CFI and wish them well in their future of making babies the long way round.
I’d like to personally say a HUGE thank you to Matt, who is a credit to the clinic and has gone above and beyond to make this interview happen giving the TTC community a great insight into the journey of IVF. Another HUGE thank you to Cihan, for giving up his precious time to guide a nosy, little, Brit through what can only be described as pure magic.
This information will be such a great support to couples going through the IVF process and will curb the curiosity of many, as to what goes on behind the scenes.
I would love to be able to visit in person one day and meet the team.
But until then, keep up the amazing work you are doing,