Baby 2 · IVF · Consult Notes

Repromeda — Dr. Filková Consultation

Doctor video consult, second of two Repromeda touchpoints (after Adéla Apr 22).
Date: May 7, 2026 · 11:30 CET (2:30 AM PT)
Doctor: Dr. Filková
Format: Zoom · 60 min
Fee: €125 (paid May 5 via OTP transfer)
Participants: Andrea Antal + Adam Antal
Transcript: European IVF/2026-05-07 Repromeda Doctor Filkova.md
Strongest doctor of all 7 consults. Andrea's read: "very thorough, very good explanations, especially probabilities and what to expect, more so than any other doctor we've chatted with so far." Adam's hypothesis: correlated with the €125 consult fee — most consults were free, only one other was €50. Probabilities-first communication style aligns with how Andrea wants to evaluate decisions.
First in-person visit booked: Mon May 25 in Brno. 1 PM spermiogram, 2:30 PM consultation. Lucky availability — Tue/Wed were full. Andrea + Adam arrive HU May 24, drive ~4 hours to Brno. This is a soft commit to Repromeda for cycle 1 unless pivoted before May 25.
📊 PROBABILITIES & EXPECTATIONS

The part Andrea found exceptional. Dr. Filková gave concrete numbers at each stage of the funnel.

AMH read9.3 pmol/L ≈ 1.3 ng/mL → expected 10–13 antral follicles. Andrea got 7 oocytes — lower than expected. Dr. flagged mildly; will re-test AMH at first visit (drift across cycle + lab variance is normal).
Cultivation attrition~70% of oocytes die during 5-day culture — normal across all clinics, not lab-quality dependent. Dr.: "doesn't matter if you have perfect environment for them — we cannot stop this natural procedure."
Oocytes → embryos10 oocytes typically yield ~1–3 embryos at blastocyst stage.
Egg → baby (age 40)~5% per egg. "Egg in your age is having about 5% chance to be born to be a baby."
Aneuploid rateOf 5 embryos, ~3 will typically be aneuploid (wrong chromosome number). "Out of five embryos it's pretty normal that three embryos are aneuploid."
Euploid embryo → baby50–60% per euploid embryo.
Embryos per baby planned3 euploid embryos recommended per baby. For 2–3 children, banking up to 8 embryos pre-PGT is reasonable.
Multi-cycle variability"Apple tree" analogy — one cycle catastrophe, next surprisingly successful. Sum-over-cycles fits the statistics. With 7-oocyte starting point, expect 2–3 embryos per cycle, occasionally 1 or 4.
💊 PROTOCOL RECOMMENDATIONS

Several recommendations diverge from what coordinator Adéla pitched on Apr 22 — doctor's call wins.

Stim protocolLong protocol — Andrea had short protocol in Canada with poor synchronicity (one large follicle dominated, others small). Long protocol gives more time to synchronize follicle sizes. Estradiol priming also possible. Final choice depends on ultrasound + AMH at first visit.
MedicationsPergoveris + Gonal-F (FSH + LH). Branded/original meds — "highest of highest quality on the market," not cheap but stable level. Picked up at first visit, carried to HU (fridge, OK for one month).
DuoStimNOT recommended — Dr. Filková: "We don't have so good experience with that. Usually there is not a good number of follicles raised up from the reserve. Really better to wait till the next period." This contradicts coordinator Adéla, who said the doctor would likely recommend DuoStim.
Cycle cadenceCumulative cycles: month 1 retrieval → month 2 retrieval → month 3 retrieval, accumulate embryos, batch PGT-A all at once when 8 embryos collected (PGT-A package covers 8 embryos at one price).
TriggerNot discussed in detail — open question for Adelka follow-up (single vs. dual).
Transfer policySingle embryo always (consistent with coord notes).
🧬 LAB AND TESTING

No changes from coordinator notes. Dr. Filková confirmed the testing approach.

  • PGT-A in-house — 4th floor of same building, samples don't travel.
  • Karyotype mandatory — can bring HU/CA results or test at clinic.
  • PANDA test — clinic's name for carrier panel. Three groups:
    • Fertility genes (~50–60 genes) — investigates causes of infertility, low ovarian reserve, fertilization/cultivation issues.
    • Thrombophilia mutations — clotting risk during pregnancy. High coagulation can cause miscarriage via placental clots.
    • Recessive disease genes (~110 conditions) — matched against partner. If both carry the same gene, embryo can be tested too.
  • PANDA Complete — wider fertility gene panel, optional upgrade. PANDA result takes ~1 month — but first stim can start without it (use AMH/AFC/weight to set dose).
  • Time-lapse incubators standard. Single embryo transfer always.
🇭🇺 HU MONITORING — NUANCE VS. COORDINATOR
Doctor is more conservative than coordinator implied. Plan ~2 Brno trips per stim cycle, not 1.
  • Coord (Apr 22): HU monitoring fully supported. Two visits total (in-person consult + retrieval).
  • Doctor (May 7): Repromeda has a partner clinic in HU but Dr. Filková: "sometimes we are not very happy with the findings... I personally am not very happy when results are from some other doctor just according to the eye of that doctor. Because the stimulation is very individual and it's also the best when one doctor can see it... the same scales eyes... or ways how to measure the follicles."
  • Compromise pattern: day 7 ultrasound in Brno (most important for stimulation success) → can travel back to HU → day 10 ultrasound in Brno → stay overnight in Brno before retrieval. So at least 2 trips to Brno during each stim cycle.
  • 4-hour drive each way from HU; manageable per Adam ("we don't have time pressure other Canadians have").
📅 LOGISTICS & TIMELINE
  • First in-person visit: Mon May 25 in Brno. 1 PM spermiogram, 2:30 PM consult with Dr. Filková. Visit ~1 hour. Andrea/Adam arrive HU May 24, drive ~4 hours to Brno May 25.
  • First stim cycle: starts with end-of-May period (May 28–29 expected; last period started May 2). Don't need PANDA results to start — basic results (spermogram + hormonal profile) come back in 1 day. PANDA gives sensitivity info for dose tuning, but not strictly required.
  • No deposit required. €125 consult fee was a one-time charge, paid May 5 via OTP transfer.
  • Adelka (coordinator) is the communication channel for organizational + medical follow-up post-consult. Andrea asked her in-call for a written summary covering protocol + medication + logistics — awaiting reply.
❓ OPEN QUESTIONS FOR ADELKA

Topics not addressed by Dr. Filková that need follow-up before May 25:

  1. MOON method (€375 add-on) — coordinator pitched, doctor didn't bring up. Still recommended for Andrea's profile?
  2. Sperm packet for fertilization (MAX + Zymot + PIXI) — included? Recommended for Adam's profile?
  3. Diagnostic sperm packet (DNA fragmentation, maturity, oxidative stress) — separate add-on, recommended?
  4. PANDA Carrier vs. PANDA Complete — which does the doctor recommend?
  5. Multi-cycle discount — Adéla said she'd ask financial director. Still outstanding.
  6. Sex selection — coordinator said flexible (preference can be flagged to embryologist). Doctor's stance not directly confirmed. Worth verifying for the second-child-girl preference.
  7. Trigger — dual trigger (Reprofit's plan) vs. single trigger? Not discussed.
🎯 DECISION POSTURE
  • Doctor experience: tier 1. Most thorough of all 7 consults. Probabilities-first style aligned with Andrea's evaluation approach.
  • First visit booked May 25 = soft commit to Repromeda for cycle 1 unless Andrea pivots before then or Adelka's written summary surfaces a dealbreaker.
  • All decision gates passed. Repromeda doctor done. Unica done Apr 29. Decision is now ready when Andrea wants to make it.
  • Doctor-vs-coordinator discrepancies to weigh:
    • DuoStim — coord said yes, doctor said no. Doctor's call wins.
    • HU monitoring tone — coord said fully supported, doctor said only between-ultrasounds (not as substitute for in-clinic monitoring). Doctor's bar is higher.
  • Frame for the decision: pick a primary clinic for cycle 1 + identify a backup for cycles 2–3 in case cycle 1 disappoints. Frontrunners are Repromeda (booked May 25) and IVF Cube (Prague, strongest external signals); ReproGenesis is the cheapest finalist.
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