★ Reprofit International — 1st Consultation Notes

• Two items need follow-up by email: trigger shot identity, HSG status — see Action Items below

Doctor asked about two items from the intake questionnaire:

Surgeries

• Egg retrieval — March 2026 (IVF cycle in Canada)
• D&C — January 2021

Pregnancy history

• Molar pregnancy, conceived naturally late 2020 → D&C January 2021 → 6+ months blood work follow-up before cleared
• Natural conception ~2024 → healthy child, now 2 years old
• IVF cycle in Canada, March 2026 (negative outcome)

Protocol used in Canada

• Priming: letrozole (early cycle) + estradiol (late cycle)
• Stimulation: Orgalutran + Puregon, alternating 200/400 IU daily + clomid in mornings
• Doctor considered increasing dose at first ultrasound but decided against it
• Trigger: not discussed — Andrea mentioned Orgalutran in the call but this was part of stimulation, not the trigger. ACTION: clarify actual trigger shot with coordinator via email.
• One follicle was significantly larger than the rest from early scans — smaller ones never caught up

Path: IVF with own eggs

• Doctor stated both fallopian tubes are blocked based on HSG results → IVF is the only option
• Clarification needed: The HSG finding was never definitively resolved. Recanalization was not performed. The blockage could have been caused by muscle spasms during the test — potentially a fluke. ACTION: clarify HSG status with coordinator via email.
• Two options presented: (1) IVF with own eggs — first approach, (2) egg donation — backup
• At age 40: expect 70-80% of embryos to be genetically abnormal, 20-30% may be healthy

Strategy: Freeze-all with PGT-A

• No fresh transfers — mandatory genetic screening at this age
• Fresh transfer without PGT-A described as "betting in a casino — good luck, bad luck"
• Biopsy taken at day 5-6, DNA sent to centralized lab in Prague
• PGT-A results in ~3 weeks
• Report shows healthy vs. abnormal with specific abnormalities listed
• No sex disclosure — sex selection is illegal in Czech Republic
• Freeze-thaw survival rate: ~100% (only a few failures per year across ~3,000 annual cycles)
• Embryos stored for decades

When to consider egg donation

• If numbers were generally good (many eggs, most mature, good fertilization, good embryo quality) but PGT-A came back all abnormal → "a little bit about luck," worth trying again
• If numbers were poor across the board (few eggs, low maturity, poor fertilization, poor quality, borderline embryo, PGT-A abnormal) → doctor would advise thinking about egg donation

1. Consistent daily dose

Same dose every day (e.g., 300 IU), not alternating. Stable FSH level promotes even follicle growth. This is the doctor's primary explanation for the leading follicle problem in Canada.

2. Drug with LH activity

Women 35+ should have FSH + LH, not pure FSH alone. Puregon is pure FSH only. Reprofit will use Menopur, Meriofert, or Pergoveris — drugs that include LH activity, which "can cause better eggs."

3. No priming

No letrozole or estradiol pre-cycle. Doctor noted Andrea had priming in Canada but still had abnormal follicle sizes — "we don't have any good experiences" with it.

4. Dual trigger shot

Combination of HCG + another injection. Better impact on egg quality and maturity. Doctor has had good experiences with this in recent years. Note: Doctor may have believed Orgalutran was the trigger shot used in Canada — this was a miscommunication. Actual trigger not discussed. Clarify via email.

5. Microfluidic chip sperm selection (MFSS)

"Embryo consists 50% from the egg and 50% from the sperm." If they can choose better sperm, they can hopefully get better embryos. Doctor has "excellent experiences" with the microfluidic chip method.

6. ICSI standard

Always used, included in package price. Best method for fertilization.

7. Time-lapse incubators

Confirmed available.

8. Extended culture if needed

Standard culture to day 5-6. In rare cases (roughly once a month), if embryo quality is good but growth speed is slow, lab will extend culture to day 7.

Andrea asked whether the clinic has experience with East Asian patients. Doctor said they have some Asian patients — "not many, but we have" — and that he has not seen any differences. Not a strong reassurance; he didn't elaborate on whether they account for ethnicity-specific factors in protocol design.

Doctor offers DuoStim but does not recommend it here for three reasons:

1. Conflicts with dual trigger — the dual trigger shot affects egg quality in the second stimulation round of a DuoStim
2. They have time — staying in Hungary for months, 5-6 hour drive to Brno
3. Minimal time savings — DuoStim second round starts day 5 post-retrieval; natural period comes 7-10 days after dual trigger anyway. Negligible difference.

Recommendation: wait for regular period after each retrieval and start a new cycle from day 1.

• Doctor's strong advice: "Start as soon as possible. You will not be younger. High-dose stimulation. Choose the strongest strategy."
• 2 consecutive cycles: OK
• 3 in 3 months: Not recommended — body needs at least 1 month of rest after 2 back-to-back cycles
• Pattern: cycle → cycle → break → cycle (if needed)
• Total estimated time in Europe: ~4-5 months
• No multi-cycle discount — same price for each cycle

Stimulation (at home)

• Starts day 1 of menstrual bleeding
• 1-2 injections daily for ~12-14 days
• All drugs purchasable at local pharmacy using Reprofit prescription (original form with stamp/signatures — print the copy they send)

Monitoring scans

• 2 scans needed: day 7 and day 10
• Scan report must include: uterus size, endometrium thickness, follicle count + sizes per ovary, photos of largest follicles
• Three options: (1) both scans local in Hungary (coordinator can recommend someone in Budapest), (2) both at Reprofit (free), (3) first local, second at clinic
• Warning: after second scan, egg collection may be called for 2 days later — need to be prepared for quick travel

Egg collection

• Both partners must be present (sperm collection same day)
• Short general anesthesia, 4-7 minutes
• Stay at least 1 night after retrieval
• Suggested logistics from Hungary: arrive day before → retrieval → stay 1 night → travel back

After collection

• Client portal: track embryo development online (checked day 1, 3, 5, 6)
• Can be back in Hungary during this period
• PGT-A results ~3 weeks later

Frozen embryo transfer

• Can be done in the next cycle after receiving PGT-A results (~4 weeks)
• For future children: fly back to Brno anytime — embryos stored for decades

• No waitlist — can start anytime
• Once they decide: "anytime, anytime, anytime"
• No additional records needed from Canadian clinic

1. Doctor — prepare protocol in system (has all needed info: AMH, hormones, semen analysis)
2. Adam — get sperm DNA fragmentation test, send results to coordinator
3. Coordinator — will send protocol + prescriptions + documents once DNA frag results are in
4. Coordinator — send cost estimation based on the protocol
5. Coordinator — recommend monitoring doctor in Budapest
6. Andrea — buy stimulation drugs at local pharmacy with printed prescription
7. Both — decide on timing and book flights