★ ReproGenesis — Consultation Notes

Andrea

• Age 39 (turning 40 in May 2026)
• Height 157 cm, weight 50 kg
• AMH: 9.3 pmol/L (1.3 ng/mL in his units) — lower ovarian reserve
• AFC: ~4 (late 2024)
• Regular 28-day cycle, period 3-5 days
• Molar pregnancy late 2020, D&C Jan 2021, cleared after 6-8 months monitoring
• Son born Apr 2024, naturally conceived/delivered, healthy
• No current medications, no allergies, no prior blood transfusions
• Family: parents have hypertension (medicated), grandmother had breast cancer (survived, lived to ~100), sister had IVF (successful)
• Currently taking prenatal multivitamin (Materna), vitamin D, CoQ10

Adam

• Age 42 (turning 43 in May 2026)
• Healthy, no medications, no surgeries, no blood transfusions
• Penicillin sensitivity
• Normal spermogram (doctor reviewed)
• Family: grandmother died of breast cancer at 54 (BRCA status unknown)

• Protocol: short antagonist, clomid 50mg + Puregon alternating 200/400 then 200 consistent, Orgalutran from day 9, Ovidrel trigger, Imedis post-trigger
• Priming cycle prior: letrozole + estradiol
• Result: 7 eggs retrieved, 6 fertilized (conventional IVF, not ICSI), 3 embryos transferred day 3 (fresh), none reached blastocyst, no frozen embryos
• One lead follicle noted at 13mm on day 9; others 7-8mm

Core recommendation: Embryo banking with PGT-A

• At age ~40, roughly 70-80% of embryos are expected to be aneuploid
• PGT-A is essential to avoid transferring non-viable embryos
• Need to accumulate embryos across cycles — no fresh transfer if doing PGT-A (must freeze all and wait for results)

• Recommended to do the test (since there's been an IVF failure)
• Results take a few days at their clinic
• Not urgent — results needed before egg retrieval day, not before starting
• If fragmentation is high → ZyMot chip method (preferred) or MACS technique for sperm selection

• Dr. Maderka is not a huge fan personally but acknowledges it can work
• Practical benefit: two retrievals in one menstrual cycle (saves travel time)
• Suggestion: consider doing it as the last cycle since it can be physically taxing
• Back-to-back DuoStim + another standard cycle would be very rough — not recommended

Karyotype

Recommended for both Andrea and Adam before PGT-A testing. Can be done in Canada, Hungary, or at their clinic. No delay concern since they'll be banking embryos anyway.

PGT-A

• Biopsy done at ReproGenesis clinic
• Genetic analysis sent to external lab (Gennet Clinic, Repromeda Lab, or similar — not in-house)
• Results classify embryos as: euploid (transfer), mosaic (possible transfer with lower success/higher miscarriage risk), or aneuploid (do not transfer)
• Embryo quality also graded by trophectoderm/ICM (A/B/C scale) + morphokinetics from time-lapse

• Dr. Maderka's app/calculator suggests ~10 PGT-A tested embryos would be ideal
• Reality: with ~20-30% euploid rate and ~50% implantation rate per transfer, 10 euploid embryos could yield 3-4 children (best case)
• May require up to 5 stimulation cycles to reach that number
• Andrea and Adam are thinking 3-5 cycles over the summer

• No waiting list — can start whenever ready
• Monitoring in Hungary: Possible and routine — they have many Hungarian patients. Any experienced gynecologist can do follicle count/size ultrasounds. Clinic coordinator can recommend a collaborating doctor in Budapest.
• Pre-treatment tests needed: Karyotype (both), DNA fragmentation (Adam). Everything else already provided.

Proposed first cycle

• Andrea's next day 1: ~May 28
• Arrive in Brno ~May 26 to pick up medications
• Start stimulation, return to Hungary for monitoring
• Return to Brno for egg retrieval
• Drive is ~5 hours each way

• Back-to-back cycles OK: Can do June, July, August consecutively without mandatory breaks
• Embryo storage: At their clinic, indefinitely (embryos have been stored 20+ years elsewhere)

• Dr. Maderka does not know of official multi-cycle discounts
• Suggested asking the coordinator — chief of clinic may be able to arrange something
• No official package but seems open to negotiation

Dr. Maderka suggests: vitamin D, myo-inositol, vitamin B, melatonin, omega-3 — "can help a bit, no miracles." Andrea already taking prenatal + vitamin D + CoQ10.

1. ICSI instead of conventional IVF
2. Consistent 300 units FSH (no alternating, no clomid/letrozole at high dose)
3. Day 5-6 culture instead of day 3 transfer
4. PGT-A on all embryos
5. Freeze-all strategy (no fresh transfer)
6. Double trigger option
7. Assisted hatching standard
8. DNA fragmentation testing for Adam

1. Contact ReproGenesis coordinator re: Budapest monitoring doctor recommendation
2. Contact coordinator re: multi-cycle pricing/discount
3. Arrange karyotype testing (both) — can do in Hungary or at clinic
4. Arrange DNA fragmentation test (Adam) — can do at clinic on arrival
5. Plan arrival in Brno ~May 26 for first cycle start ~May 28
6. Decide on supplements (myo-inositol, melatonin, omega-3 to add?)