How to start a fertility clinic from scratch?

I am writing this article because it has been one of the common questions patients, colleagues and friends ask me frequently. How did I start a fertility business from scratch? Especially in a country where the political and financial situation is getting worse every day.

The idea came to me one day sitting with my mum on a bench just opposite my apartment in London. Everyday my mum used to wait for me to come home, with a piece of cake to share and her knitting kit to keep her entertained while waiting for me. I was working on a prestigious fertility clinic in London and needed to work long hours because of the high workload. When I arrived home it was pleasant to find mum waiting for me, looking at her was the best part of my day, she is also of the biggest loves of my life. I was usually tired and with very low energies from the amount of work and things to do every day. The lake was great, located just besides the river Thames and with lovely birds and ducks that enjoyed the casual visitor with cakes to share with them. It was relaxing just to sit there for a while, looking at the blue sky (which is not very usual in a city like London) and overlooking at the river. However, I was not very happy with my life.

image001

I started having this crazy idea of me having my own fertility clinic, which by the time seemed almost impossible. I did not have that much money to start and I did not wanted to continue living in the UK. I wanted a change. As much as I love UK a part of me still in Venezuela, which was my home country. I lived in the UK for many years and was used to stare on the Internet looking at videos and photos to keep me updated about Venezuela.

It is a beautiful, with lots of potential. I then had the opportunity to collaborate with a group of doctors who needed my advice regarding them starting a new fertility clinic. It was exciting helping them. A nice project with lots of potential. After a few years, they decided that could not continue with the project because they were in need of someone with the knowledge in human reproduction to manage the clinic. They were busy and working in another areas.

I thought that was the opportunity for me. I asked them to give me a price and they negotiated it. I sold almost everything I owned. Got loans and even friends helped me to complete the money needed. It was crazy. Then moved to Venezuela.

One of the key elements in starting a company it is to find the right partner. I was very lucky to find it.

We started the company from scratch, with nothing more than our knowledge in the fertility field. In a country with a huge inflation rate, with lots of poverty, with a constant instability with the political situation, with increasing crime rates, and crazy prices. To fill an oil tank cost 0.5 dollars, and water cost 2 dollars. Oil is cheaper than water!

The directive of the clinic is composed of serious and capable people who really know what they are doing. The company is running on a day-to-day basis in a very smooth way. We work hard everyday to guarantee a higher chance of success to patients and we really love what we do. It is a great, familiar, friendly environment. I am very happy there.

image003

We decided to create different areas in the clinic for research, gamete vitrification, consultations, endoscopy, and we keep growing every year. Our patients have been the biggest testimony of our success. The success of hard working people with lots of potential for improving the human reproduction’s system.

I do still work in another places around the world and do lots of travelling, but when I go to Caracas it is a pleasant experience to treat with lovely and great patients.

My dream came true, and I am thankful for that. I am also very thankful for the knowledge and experience I gained during these last years with all the fertility patients I have encountered. I am not sure if will continue doing the same work for a long time, but I am sure I am enjoying it very much. It is great to bring life and to make things possible in a country that gave me so much when I was born.

The key elements of running a fertility business are:

1. Be truthful to your customers (in this case your patients)
2. Love what you do. That way you will enjoy solving the day-to-day situations encountered in a business.
3. You need to know all the details of the company from scratch. I mean, you need to know everything, from changing the water of the incubators to fixing the most difficult parts of a microscope. That way you will know exactly what is happening in the organization.
4. Find successful, intelligent people with lots of potential to give to the company. Driven people will always impulse the business.
5. Create warmth, familiar, comfortable environment for your patients. They like to feel relaxed.
6. Don’t be greedy. You don’t need to lie to patients to get more income into your business.
7. Keep everything in order. Coordinate and manage the administration, human resources, and accounts, in a way that allows you to know how well the company is doing.
8. Pay your taxes! Avoiding them will cause you trouble in the future.
9. Be up to date with new techniques and equipment.
10. If you are lucky, find the right partners to work with. A good relationship with your partners will allow you to accomplish more things, teamwork is essential.
11. Have a good support system from family and friends. Surround yourself by positive and great people it is a good and healthy way to run a business.
12. One of the key points for a great business is to get professional people who really love what they do, instead of going to work just because they need the money.

I thank everybody who was and still being part of my many accomplishments.

To visit our baby gallery you can go to www.fertiaguerrevere.com/videos

image005

How to meditate

image001

My patients ask me every day: “Dr. you are advising me to meditate and relax, but I have not idea how to meditate”. These are the tips I give them to learn how to meditate:

 

  1. Find a comfortable and relaxing place to meditate. It does not matter where it is as long as it is comfortable for you and quiet
  2. Silence is a very important component to meditate. It heals the thoughts and the crowded mind
  3. Try to let go of any negative emotion before you start meditating. Focus your attention in the hard work that is involved on calming yourself down
  4. Sit on a comfortable position, better is your body is upright with the head up
  5. Close your eyes and try to focus your thoughts on the blackness of the space inside
  6. Breathe easily and focus your attention on the breath. Feel the way your lungs absorb the air as you inhale, and feel the air coming out as you exhale
  7. Start counting your breath. You can even set a goal to count to 100 every time you meditate. This is a great way to get focused and to concentrate on your own body. Eventually the thoughts will go away
  8. Visualize yourself making possible whatever seems difficult at the time. Imagine yourself being there, doing what you wish, accomplishing the task
  9. Enjoy the experience of meditation, and feel the relaxation through all of your muscles and nerves as you continue breathing
  10. Set a time to meditate. 5 minutes everyday is a great starting time. This time can be increased whenever you feel the need to do it longer

image003

How to know how many is too many?

im1

When it comes to fertility treatments it is really hard to make choices or to know when it is time to step back and reconsider what we are doing.

Most patients are so focused in having a successful treatment that they spend most of their time planning how to make it possible. I understand this and can relate to the story myself. Patients become too obsessed with positive results, and when they do not get them, there is too much disappointment because their expectations were set too high. Also considering the amount of money that cost having these type of treatments.
I do my best to explain the implications of fertility treatments, the advantages and disadvantages than come with it, the emotional burden that causes, and the cost of trying too many times. Even when sometimes feel I have been too strong or harsh explaining the case and probabilities of success, I do so because it is better to know the true than live in a dream. And that is exactly what I like my patients to know, the true. Many times the true it is not pleasant, but helps to prepare for any circumstance and event that might arise prior, during and after the fertility treatment.

How to know when do you need to stop? When you have had 3 un-successful attempts for intrauterine insemination or in vitro fertilization (IVF/ICSI). Take a step back for a while, reconsider the probabilities and possibilities of a future successful attempt, and talk to your doctor about your feelings and doubts.

I have found many patients coming to our clinic looking for answers. Some of them have had several prior attempts, sometimes more than 6 in a row. And if we try to discuss the alternatives, the possible causes and what they had done, 80% of them have no idea of what procedure they had, how many embryos they got and even if they still have frozen embryos. What I concluded is that 1 in 4 couples coming to our practice and coming from other clinics, do not remember what was discussed with their doctors and the type of treatment they had or will have.

To undergo a fertility treatment it is necessary some preparation. It is not for everyone to understand and digest all the information that will be provided in the clinic. Everything happens too quickly. Communication with your specialist is vital. Counselling and guidance is strongly advisable.

adm2

It is important to receive proper counseling and guidance prior to the fertility procedure.

When the fertility treatment starts becoming more a problem than a solution, it might be time to step back and find guidance. There is a list of guides and counselors who offer this kind of help.

I myself offer this service if you wish to talk about it.

How to do research about infertility issues? (For patients)

image001

You are sitting there in front of the computer, trying to understand all the gibberish written there regarding possible causes of infertility, male causes, female causes, so many medical terms, it is so difficult to read. Although getting online is easier than trying to read it in a book, because books seemed to be dedicated to fertility experts no patients.

 

For some time you have been trying to get information about the reasons you and your partner are having problems to conceive, and nobody knows exactly what is happening. Some of your friends and family recommend you to see a doctor, but you prefer to wait and make your own research about the subject. For sure is something fixable, perhaps you are not doing something right. There are so many theories going inside your head now, and this infertility name sounds too complicated.

 

You either talk to your partner or not, but the doubt still inside of your head, and at night is very hard to sleep with so many questions going around.

 

The best thing to do in this case is to calm down first. Look for literature dedicated to patients, go online and do your research in blogs that are written from doctors dedicated to patients. Please avoid questionable sources of information like websites that are not endorsed by fertility specialists, magazines written by speculative people, or blogs with stories about other’s patients stories because those will definitely be confusing. Remember every patient is different, every fertility case is completely unique.

 

If you get too overwhelmed with information, and the fertility issue remains please make an appointment with a fertility specialist. There you will get all the needed information.

 

It is advisable to do your research together with your partner, both need to be integrated into the situation to find the best solution.

image003

How to be truly happy with your life?

image003

A challenge you think? Well no. It is not a challenge. It is actually easier than what you’ve been thinking. It is a matter of attitude towards life.

I usually encounter patients and friends who complaint too much about their lives. Because they do not like their jobs, because they do not like the partner they are with, because the political situation in the country is crazy, because everything is too expensive, because they wish to do something and it seems unimaginable for them to do it, and keeps going on and on. It is their day-to-day way of living. And I usually ask them: and how are you expecting to change that? – Their answer: “we can’t”.

You won’t be able to change anything if you are not doing anything to change it!

Look around you right now, what do you see? Life. Everywhere you are looking represents life. And that life is there for a reason, it has a meaning. Most people take that life for granted and come to appreciate it once they are involved in situations where life it is the unique most important thing in the world, like illness. When we loose our health it is one of the most frequent situation we come to appreciate life for what it is, an opportunity to do something new and different everyday. It does not matter what. It is up to our attitude and not our former believes of what life is. Even look around you people with certain disabilities can be even happier than healthy people.

 

The living situation on earth is becoming more difficult every time. Our past and current generations have been doing lots of harm to our nature, and that is deeply impacting the way future generations will live. If we make a change inside ourselves first, then to our outside and surroundings, we will definitely contribute to that future, to make it better.

Today you need to start appreciating life as it is. Imagine yourself not having anything else but health, would you still being happy? Now imagine yourself with lots of money and just a few days to live because you have terminal Cancer, does it seems like happiness to you? Well, that is what life is about. Remember situations can change in matter of seconds, people die every day, people come to this earth every day, and if you are still here it is because there must be something you still have to accomplish. Do you know what it is? Think about it. Do not take life for granted, because it is not.image001

You can make your body ill, and you can heal it at the same time. We do have several mechanisms our bodies use to protect us and to destroy us at the same time. It is all up to us.

I have seen amazing cases of patients healing themselves and accomplishing their dreams. I have seen it and I admire them very much, because they made a huge transformation to their own lives.

To all my patients out there, please find happiness and look inside of you first. Once you accept the transformation and allow happiness to come into you, we will work together in synchrony and the results will substantially be improved.

How to approach you partner and talk about fertility issues?

cc1

As I have mentioned before in previous articles, it is not an easy task to realize the fact of being challenged in the fertility area, and to acknowledge it. Once we know there is something going on, measures should be taken. If you are in a stable relationship then communication is important. It is crucial to speak the truth and find solutions together.

If you are faced with infertility issues, talk to your partner in an open, honest and direct way. Communication is one of the main ingredients of a relationship. Communication in fertility treatments is key. If you address this at the beginning is better. There are signs and symptoms that tell us something is wrong when we decide to conceive. If you have had previous long-term relationships and had sex without protection this might be a sign that something is happening. If you are having sex with your actual partner for over a year without protection and no pregnancy is achieved that is another sign. If you are under 35 years and have sexual relationships without pregnancy, if your partner has children from previous relationships but fails to have them with you, etc. There are several signs that help us realize something is not working properly. When you spot one or more of these signs then is important to speak to your partner and address the concerns properly in order to find the best alternatives, then visit a fertility specialist.

I have seen patients during the fertility consultation that clearly have a lack of communication with their partners, and everything turns to be more difficult. During the whole procedure, fertility specialists need the collaboration of the couple. If one member of the couple is collaborating but the other still in negation, and denies to be treated then the procedure might fail. The same as when the procedure starts and information is given to the couple to be discussed together and they do not communicate and make decisions without consulting the other party, it creates problems.

cc

If you face difficulties in communication with your partner it might be a good idea to get counseling and guidance. It might be a good way to address doubts, fears and anxieties created by the infertility challenge.

Couples meditation has proven to be successful. When both members of the couple agree to participate in guided meditation/relaxation therapies. It has shown a huge improvement in the procedure, especially in patients with previous attempt failures.

When both member of the couple are coordinated, communicated and organized regarding what needs to be done, the steps to take and the procedures then everything is easier. Also remember the positive energies the new coming life needs to stay and grow. These energies need balance in order to prevail.

We are working alongside mother nature. If mother nature gave us the challenge of infertility, this is a clear sign we must overcome something else in order to succeed to the challenge programmed to be that way. What this mean is, if mother nature made us face the infertility challenge this must mean we have to find the way to overcome that challenge. Changing our destiny (which is possible) makes mother nature to allow certain changes.

 

I advice patients to realize, understand, acknowledge, accept and decide, when it comes to infertility challenges. Everything needs to be said. The frustration created, the fears, anxieties, stress and depression can be treated first with the person they trusted the most, which is mostly their partner, then with the infertility counselor. Without keeping anything inside.cc2

Once the communication channel is created, the rest will take care of itself.

How to make the decision about undergoing a fertility treatment or not?

fastorslow

It is not easy. Undergo a fertility treatment it means a lot for most couples.

Some of them feel scared about the treatment. They think it is anti-natural or counterproductive for their health. Some fear they might not get the expected results. Some simply do not have the money required. It is a tough decision. It is one of those situations when you do not until you live it.

What to do? If you and your partner are completely convinced parenthood it is something very important and will make your relationship stronger, and if you have been trying to conceive for 6 months (if you are under 35) or one year (if you are over 35 years) without contraception, then you will need advice and guidance of a fertility specialist. Make some inquiries and go with the one you feel better with, listen all the explanations and choices they will give you. It is crucial to feel comfortable and supported by your medical team. They will guide you through the process and explain the pros and cons of having fertility treatments. You might even get surprised if the problem was easy to correct. In some cases the alteration is minimal and a mild treatment can do, without having to go through in vitro fertilization. I make emphasis on this, you need to feel comfortable with your medical team! If the feeling is not there, even if they are the top fertility specialists, that will impact the results at the end.

Fertility treatments are of course anti-naturals. Because it is not the conventional way of conceiving in vivo where the embryo can fertilize and implant without having to be manipulated outside the body. However, today techniques are so great that the embryos won’t realize they are outside their environment. They will feel comfortable in the embryology laboratory and the manipulation and direct observation will increase the chance of getting the best quality embryo. It is an advantage.

Expected results? Ok let’s define the expectations. Mother nature makes human beings to feel the need to reproduce. It is in our genes. Most of all feel the necessity to leave something or someone when we leave. It is a way of preserving our own specie. When we face the challenge of being infertile at any degree, it makes a big impact in our lives. We then consider the possible options because our goal it is to defeat the adversity. And we put ourselves in a lot of pressure. Once we take the first step to have a fertility treatment we are determined to be successful. Unintentionally we are making a big mistake.

Nothing is guaranteed in human reproduction, not even human reproduction itself. To have too high expectations it is the first cause of frustration when the procedure becomes more complex, and when results are not favorable. This makes patients sad and unsure of what they would like to do. So, set your expectations right. Be positive, confident of your doctors and embryologists, collaborate with the whole process and become part of it. Understand every step and work towards making it better. That is the attitude.

Regarding to money, well this is a difficult one. These procedures tend to be quite expensive and time consuming. So it makes it even more difficult to make money if you need to spend time with doctors and tests. Make a plan and coordinate what are the steps that need to be taken to do this procedure. Talk to your insurance company and find out about the coverage they offer with these procedures, or make a plan yourself and save some spare money if you know it has been a challenge for you to have babies. Couples today are aware of these facts, and it is a trend now to have fertility check ups to know “in advance” if they face or will face fertility challenges. Once they meet, already know in advance if any one of them can o cannot conceive easily. Because the increase number of fertility cases is staggering now, people are adapting to this trend and are taking measures planning their future. I think it is a good back-up plan, don’t you think?

How can I tell my family and friends I have been challenged in the fertility area?

image001It is a big pressure to see that your friends and family are having babies, starting their families without problems, and you are still fighting to conceive. It can be caused for many factors, maybe you or your partner are the ones with the problem. However, it does not matter who is the one to blame, the problem here is social pressure.

Social pressure can be difficult to overcome depending on your beliefs and values. For some, not having children at the age of 20 is a huge problem, for others at the age of 30 or 40. It can be a real challenge to face the reality of having that “situation”. The pressure might come from many places, from family, friends, media, etc. How many of you sit in front of your computer watching Facebook, Twitter, Instagram… and see the old friends with a lovely picture of their children, and writing proudly: “they are the love of my life”, “you do not know what love is until you have your own children”, “I am the happier mom on earth”, and goes on. I tell you, it is hard.

 

First, you need to face the fact that your condition is different, and the “situation” (as many like to call it) is the fertility challenge you are facing today.

Second, acceptation of your “situation”. Accept we are all different humans. Everyone faces different challenges in their lives.

Third, take the right measurements to correct the “situation”. Look yourself in the mirror and say: “OK, let’s deal with this”.

Fourth, understand that whatever the results may be, you will be alright and take it as a valiant, strong person.

Easy to say, not easy to do. However, those are the steps you will take.

Remember, social pressure can be overwhelming. But it does not have to be. It can be easier and you can make the best of it. After all, if you are not successful then there might be others things you can do. I am sure you have talents in several areas.image003

Try to avoid stress and frustration, those are negative feelings that will not contribute in anything, they will do bad instead. Fulfill yourself with positive thoughts, visualize the success and change your lifestyle. If you are preparing to welcome another person into your life, then a radical lifestyle is necessary. Be as brave as you can, and avoid feeling anxious when others have what you dream of having. Send them love and light, and focus yourself on your body, take care of it properly, look after your food and habits.

image005

I am sure if you let those negative feelings go, then positive and good things will come to your life. To feel good envy for what others have still not a positive feeling. Make your own wishes and design your own life, that way you will end up having what you designed, and not what society decided for you.

This is the time for changes, big changes in your life. Start now.

How do embryologists select the best embryos?

The procedure of in vitro fertilization is complex and involves several important and necessary steps in order to increase the chances of success. The scientific personnel needs to be prepared for any last minute event that might arise as consequence of dealing with live cells. These gametes can show different behaviors at any moment during each hour they spend in the laboratory.

 

It has been said that the embryology laboratory is a surrogate environment resembling the same environment (in vitro) provided to the cells by the uterus inside the body (in vivo).

 

Once we obtain the eggs and make possible the fertilization with the sperm, in a few hours we will start having consecutive divisions that are crucial to the process of selecting the best embryos. First we need to take into account the fact that 16 to 18 hours after fertilization we need to pay attention to the formation of the pronuclei. Normal fertilization of the egg will show the presence of two pronuclei, not one, three, four, five, and so on. If we observe anything different than two together, symmetrical and centered then we need to suspect something is not right. This is what we should have:

 image001

 

And this is an example of an abnormal fertilization:

 image003

 

 

After this time we will observe subsequent divisions each day, starting from the early cleavage stage during the first 24 hours post-fertilisation, and day 2 and 3 embryos (morula) with 2, 4, 6, 8 and 16 cells).

 

image006

 

Now the selection of the embryos is a key factor even for a well-trained embryologist. Involves the selection of the embryo/s that are considered stronger, with high quality and bigger chances of implantation, and the discarding or freezing of the ones that look less likely to succeed.

 

How to select the embryos if we have seen in our practice success with poor/low quality embryos developing into a healthy baby? And we have also seen not successful procedures using very good/high quality embryos? Not an easy task for us.

 

Some might be guided by their pure scientific knowledge than a good quality embryo it is likely to succeed rather than a slow, poor quality one. Some might use their embryologic instinct of using the embryo they consider to be stronger based on some of their qualities like good timing during fertilization and divisions, low fragmentation (rupture of the cells), cell symmetry, good zona pellucida, etc. There may be several factors to consider scientifically speaking. Also clinically it is important to judge the quality of the endometrium and the response of the embryo receptor to the treatment given to prepare for the embryo transfer. There are several factors to consider before selecting the best embryo for “the embryo transfer”. There is just one chance to make “the embryo transfer”, and even if the patient has remaining embryos to be used in future attempts, “the embryo transfer using those embryos” it will always be a one time chance. You will not have the same embryos or the same conditions to use them again. So, the embryologist criteria is really important to select the right “embryos to be transferred”. I call it “the point of no return”. Because there will just be one time to do it, and one time the same set of embryo/s to be used, not eh same again.

 

After being compelled to mention the scientific and clinical key points to be considered for the embryo transfer, among many others we will encounter during real life practice, it is important to mention another aspect to consider when selecting the right embryo/s, and is the behavior they showed during their short time stay on the embryology laboratory.

 

image007 

 

 

They will show an specific behavior, each one of them is a unique being with the capacity to communicate in their own way, and embryologists are the tool to translate their language.

 

During our training as embryologists we learn a lot about embryos, all the scientific and clinical based studies and facts, but we do not learn how to translate their language or read their behavior. I realized working with thousand of embryos that each one of them is unique and shows an specific way of communicating with us, and to help us choose among all of them which one/s is the most suitable for “the transfer” which will occur one time only. We do learn to master that knowledge and understanding on our day to day practice in the field.

 

When I choose the suitable embryo I share the responsibility with them, because they are in charge of showing me their behavior and signs of capacity to implant or not. There are also others factors to consider, however it seems they know them all, even the ones that don’t relate to the treatment like the psychological and spiritual condition of their parents. Some of my patients already know in advance when their procedure will be successful because somehow they have been communicating with their embryos through meditation and prays, and they let them know it is time. Some other patients undergo the difficult in vitro procedure in order to feel relieved because at least they tried it, even when they know the result is not going to be positive. Some other patients do the procedure knowing they need to be resilient because they will get the positive result in the second or third attempt. There are so many stories of patients feeling different things before, during and after their treatment, and some of those stories literally change the patient’s lives. When the embryologist works alongside the clinical and scientific team, and with the patients, the results can be astonishing.

 

image009

 

I believe these tiny, microscopic beings, capable of behaving and sending messages to us through their short stay life on the laboratories, are changing the way medicine was before. They have been showing us life is possible in any form, in any way, at any moment and with any person. It is possible to get messages that we do not yet know where they are coming from and the reason they have been sending them in the first place. They have also been offered themselves for research to understand some of the mysteries of life and its many forms of changes throughout the centuries. Just decades ago it was nearly impossible to observe an image like this one, because life was considered to be sacred and just possible through the eyes of God. Today we have been allowed to admire these beautiful cells, which are accompanied by the being inhabiting it. They do deserve respect, consideration and understanding, because when I am able to create a baby after I saw him formed as an embryo before, and he is capable of recognizing my voice and respond to my touch, in a way like he knew me from before, it makes me believe there is certainly something else we have been missing out in our study of this science for decades, it might be time to check it out.