Dr Uliana Dorofeyeva on IVF: IVF off the clock in Dublin

Dr Uliana Dorofeyeva, Founder and Director of Clinical Operation from Ovogene

Solving fertility issues is often compared to completing a complex puzzle – one where every piece, from genetics to embryology, must fit perfectly to reveal the path to parenthood. For patients traveling abroad, the journey is built on more than just medical protocols; it is founded on trust, transparency, and the assurance that they won’t be navigating the unknown alone.

In the next part of our IVF Off The Clock in Dublin series, we speak with fertility specialist Dr Uliana Dorofeyeva, from Ovogene. With nearly 20 years of experience and a deep background in gynaecology, Dr Uliana brings a refreshing blend of clinical expertise and honesty to the table. Known for her open-mindedness toward innovative science and her “constant contact” approach, she ensures her patients are never left in the dark, correlating direct communication with a significantly more empowered patient experience. In this conversation, she discusses the evolving landscape of third-party reproduction and why Slovakia has become such a trusted, favorable destination for oocyte donation that offers high-quality care with an advantageous regulatory environment for IVF patients from abroad.

Dr Uliana, you have been in the fertility field for a long time now and are very experienced. I wonder: are there still things that inspire you or excite you about this field?

Absolutely, yes. I know that fertility is a very complex journey starting from the testing or motivation for the patients—like why they want to become parents, if they are sure about their decision, what is their problem, if this is a single and a simple problem, or if it’s a complex issue.

And, very often, it’s really a complex issue and solving fertility issues: it’s like creating a puzzle. Until you know that all the pieces are there and you completed them, you cannot be sure that you will get all the answers. Sometimes, the longer we are with our patients, the more experienced we are in completing their puzzles. The puzzle may become bigger and bigger because we think we already completed it, but then there is another angle and we still need to go deeper to see what’s going on there.

Fertility as a field is still very young; the very first fertility baby was born less than 50 years ago, and since that time we are opening new horizons. There are a lot of innovative techniques and treatments which can still be considered experimental. But if you are open as a physician—if you are reading a lot, if you are not afraid of trying new things for which you have evidence—that’s something that helps to complete the puzzle and solve the issue of infertility. That’s what really motivates me.

It’s really interesting and I’m curious: how do you go about solving that puzzle with patients? How does it look like?

It’s a systemic way of thinking, of asking questions, and of analyzing the patient’s stories, their journey, and their anamnesis. Sometimes it’s coming from inherited problems, so we know that genetics sometimes has a very crucial role.

Then there is the experience of the clinical team. It should be a group of experts working together: a clinician who helps to understand the female as a complex mechanism; a urologist or andrologist taking care of the male, because we need to understand what is inside the cell; and then the embryologist. Embryology is the heart of this treatment. It should not be a closed door; it should be an open door to understanding the processes happening in the lab. If all these professionals are aligned and willing to find real reasons—this is how we can get the answers and really, effectively, help our patients.

Do you have any areas of specialty within fertility medicine?

I’m focused on the diagnosis of the patient and then creating the best stimulation approach or protocol to understand the function and potential of the ovaries. My interest is in ovarian rejuvenation. Many of my patients are of advanced maternal age, and although we are forced to say that patients should become parents while younger, we know this is often not the case. Many of our patients are over 40, some over 45, and they are very individual.

Ovarian rejuvenation was the subject of my PhD, which I completed in 2021 or 2022. At that time, I worked on PRP (Platelet-Rich Plasma) as the single available solution. Right now, we have more complex and deeper solutions including exosomes, adipose-derived stem cell treatment, and stem cells themselves.

Another field of interest is mitochondrial replacement treatment (MRT). Here, from the position of the gynecologist, our responsibility is to bring the eggs into the lab, and then the true science happens. This is how we can help patients of advanced maternal age to be successful using their own DNA.

That’s really interesting. Mitochondrial replacement is still a quite rare procedure and not available in many places. I wonder: who is this procedure usually recommended for?

Mitochondrial replacement treatment has been approved and is totally legal—for example, in the UK since 2016—for patients who are carriers of mitochondrial disorders. But that is a very rare category. There is a much bigger group of patients who have secondary mitochondrial disorders related to age.

Age brings a huge decline in the potential of the oocyte. The oocyte serves as the environment where fertilization and embryonic development happen; it must provide food and energy for the embryo to grow. If the cell does not have the proper environment or energy, development cannot be successful.

What MRT does is exchange the nuclear environment from the advanced maternal age cell into a healthier cell that is “20 years younger.” By using the most effective environment, the genetic material develops better. We see increased results in terms of blastulation and can even impact the levels of euploidy (chromosomally normal embryos).

So, it allows the patient to use their own genetic material but still use better quality eggs coming from a younger donor?

Yeah, correct. Exactly.

 

So, today we’re here in Dublin, Ireland and I’m curious to know: when you speak to patients coming from Ireland, what questions do they usually come to you with before starting treatment?

Our Irish patients—I should say we have a lot of them because of our roots and our connections with Ireland—usually find us through word of mouth. They know the experience of our clinics and physicians, and they trust them.

Back 20 years ago, it was egg donation that we were famous for here among Irish patients. Now there are more options available across our facilities in Slovakia, Ukraine, Georgia, and Albania, including ovarian rejuvenation, mitochondrial replacement treatment (MRT), and surrogacy.

In general, international travel for fertility care is very common. Here in Ireland, oocyte donation is legal, but the waiting times for donors are huge. It takes a long time for patients to make the decision to use donor eggs, and once they do, having to wait even longer is incredibly difficult because they are losing the most important thing: their time. Because time matters, they are very open to traveling to destinations that can solve this problem immediately.

Do you ever get questions from patients about, for example, the success rates of treatments?

Oh, absolutely. That’s a very important question because this is not a very transparent sphere; marketing is everywhere. On one hand, marketing helps us promote our services if we are good at something. On the other hand, patients should be aware of real statistics and real expectations, because these are their potential results. They should not be falsely guided.

Proper expectations can only be provided by a physician after evaluating a complex, individual case. Advanced maternal age patients cannot simply be ranked equally based on their age, AMH, FSH, or antral follicle count, because they may have completely different immune factors, male factors, or metabolic characteristics.

Furthermore, stimulation is an art. Based on the real clinical outcome, we may need to adjust our expectations, change the protocol, or recommend different next steps. If a patient has a long fertility history and has been unsuccessful before, they need an open-minded physician who treats them as an individual rather than a number—someone who doesn’t just start the exact same protocol every time without making adjustments.

Could you tell me more about why patients in Ireland choose to come to Slovakia for treatment?

Slovakia is a European country and a trusted destination for medical tourism with clear regulations. In Slovakia, we can perform IVF for couples (who do not need to be married but must be in a relationship).

We are allowed to perform oocyte donation, and we have absolutely no waiting list because we operate our own global egg bank, Ovogene. We have a wide variety of donor phenotypes and a high number of oocytes immediately available.

We also provide guaranteed blastocyst offers based on the partner’s sperm characteristics. For patients who have failed multiple cycles, a blastocyst guarantee provides the absolute proof they need to safely move to the next stage and prepare for an embryo transfer. Egg donation has been recognized for many years as a highly successful, reliable, and relatively easy treatment because patients do not have to undergo multiple rounds of ovarian stimulation and injections themselves.

For patients from Ireland seeking egg donation in Slovakia, how is the process organized while they are still living here? What are the stages?

Initially, patients can choose a donor directly from our database, or a coordinator can help them select one based on phenotypic characteristics. An important distinction involves anonymity: in Ireland, donor donation is completely open, whereas in Slovakia, oocyte donation is anonymous. This allows families to keep their decision as a private medical secret if they choose to do so.

Logistically, because we have vitrified oocytes immediately available in our egg bank, the male partner can either travel to our clinic to provide a sperm sample, or the sperm can be shipped directly from Ireland. We then thaw the eggs, fertilize them, and cultivate them to the blastocyst stage. If the patient requests it, we can also perform genetic testing (PGT-A) as an additional layer of security to ensure we transfer a healthy, euploid embryo.

The endometrial preparation for the recipient is fully coordinated and performed back home in Ireland. We have great connections with local clinics and individual physicians in Dublin. Communication is maintained through a dedicated team chat containing the doctor, a medical coordinator, and administrative staff. Patients are guided through every step and only need to travel to our facility for the actual embryo transfer, which typically requires a maximum stay of three to five days away from home.

In terms of egg donation, do you offer mostly fresh or mostly frozen cycles, or both? What does this depend on?

We do both, but I would say that the modern gold standard is vitrified (frozen) oocyte donation. While some patients still hold the traditional belief that fresh is better, fresh donor cycles are logistically far more complicated and carry inherent risks.

With a fresh cycle, the donor might change her mind about starting stimulation at that specific time, or her cycle might not synchronize perfectly with the recipient’s timeline. There are also clinical risks, such as an unexpected reaction to the trigger medication or retrieving fewer eggs than anticipated.

A vitrified cycle eliminates these variables. The clinical results and guarantees are exactly the same as a fresh cycle, but using frozen tissue brings the immense benefit of knowing the biological material is safely secured and immediately available.

Patients are sometimes concerned about the survival rate when freezing oocytes. With modern technology, is this still a concern?

This historical myth stems from the older method of “slow freezing.” When IVF first started, slow freezing acted like a standard refrigerator; ice crystals formed inside the cytoplasm, which frequently destroyed the delicate intracellular mechanisms and spindle of the fragile egg cell. Survival rates back then were quite low.

Today, we use vitrification, which is an entirely different technology. It is an ultra-rapid freezing process that instantly turns the fluid into a glass-like state without forming any damaging ice crystals. Intracellular components remain perfectly preserved, meaning there is no inherent difference in cellular survival between an egg or an embryo.

However, vitrification success does depend heavily on the experience of the embryological team. Because we run a global egg bank, our team freezes and thaws thousands of oocytes every single month, maintaining an exceptional survival rate of over 95%. In facilities where hands-on training for egg vitrification is less common, you might see some losses. But in a high-volume, professional laboratory setting, the technology is completely safe and reliable.

 

IVF with own eggs: how is the process organised for patients coming from abroad when it comes to treatment with their own eggs?

Very similar to oocyte donation. If patients are traveling from elsewhere, specifically from Ireland, and they are not doing IVF for the first time, they are usually well-aware of the whole process. We just need to coordinate them regarding dates, their visit, prescriptions, medications, and the monitoring scans and hormone checks, which they can do directly in Ireland.

Because we collaborate with many centers and physicians in Dublin and around Ireland, we can coordinate the patient’s stimulation from their home country. We prescribe the protocol, ask the patient to do the local scans and blood tests, and they send us the reports. We monitor everything inside a dedicated chat where they receive answers within a few hours, telling them exactly what their next steps are. This is a very common practice in our sphere. We are always in constant contact, going through the whole process together and keeping the patient thoroughly informed in detail.

So, how long should patients expect to stay in Slovakia, for example, before the egg retrieval procedure?

Depending on whether they have a local physician who can monitor them, they can come as late as the day before the egg retrieval. However, if they don’t have a proper place for monitoring, or if they simply want to be under our direct supervision during the entire stimulation process, they come on day two of their cycle and stay with us for the next 10 to 15 days. That being said, the majority of patients choose to come later, which is why we coordinate the start of their stimulation with their local Irish clinics.

In terms of treatment with own eggs, do you prefer doing fresh transfers or frozen? Or is this also based on the individual case?

For the majority of treatments, we recommend doing genetic testing for the embryos. There has been a proven shift in clinical evidence showing that frozen embryo transfers (FET) work better because of normalized endometrial and hormonal conditions, rather than the super-high physiological hormone levels we usually see right after the ovarian retrieval process.

Furthermore, when we are limited in time and cannot perform genetic testing, we don’t really know which embryo we are transferring. The majority of our patients are complex, complicated cases. For them, genetic testing is a reliable solution and often a total game changer, because many struggle to receive a euploid (chromosomally normal) embryo. Without testing, relying only on morphology and development, we cannot truly know what is inside. Transferring a non-tested embryo can create false positive expectations, alongside the risks associated with aneuploid embryos.

The first risk is that they simply won’t implant. The second is that they will cause a miscarriage. A miscarriage requires recovery of the uterus, carries potential surgery risks, and can cause chronic endometritis or other long-term issues that lead to more complications. The third risk is that an aneuploid embryo keeps developing, resulting in a baby with genetic disorders. This is something we want to avoid for our patients.

So, in those cases of genetic testing, you would do a frozen transfer and this is how you decide whether fresh or frozen would be recommended?

We do biopsies at the blastocyst stage. For genetic testing, it takes between 7 to 10 days to get the biopsy results back from the lab. By the time we cultivate the embryo to the blastocyst stage, it is already day 5 or 6 after the egg retrieval, and then we need another 10 days for the results.

At that point, the patient is no longer in her natural implantation window. Therefore, we freeze the blastocyst immediately after taking the biopsy, and the patient is prepared for a frozen embryo transfer in the subsequent months.

And how do you assess for which patients genetic testing would be advantageous to have?

That is based on their previous medical history, their past implantation results, and whether they have experienced miscarriages—as miscarriages are very often associated with an embryonic factor.

Once we can solve the embryonic issue, the remaining factors are uterine and extra-uterine. These are the three main streams we need all the answers for: embryonic, uterine, and extra-uterine. If we are completely clear about all three, then we are ready for the transfer, and that embryo transfer will most likely be highly successful.

I often also talk to patients who are over 50, coming from Ireland looking for places abroad to have treatment. Which places in Europe can they opt for?

In Slovakia, there is no formal legal age limitation, but there is a strict ethical consideration about treating such patients. In our practical clinical network, we utilize Albania as one of the potential destinations where patients over the age of 50 can legally and safely be treated.

And what are the considerations when treating patients closer to 50 or over 50? Are there any risks that they should be aware of?

They are advanced maternal age patients, and if we are talking about their potential to create embryos using their own eggs, we must understand that we are severely limited by their biological ovarian reserve. Consequently, the vast majority of these patients will look for an oocyte donation program.

The implantation potential of the uterus can still be completely fine. We know many patients in their 50s who have successfully carried pregnancies and had healthy live births. It becomes much more a question of ethical and medical health considerations: ensuring the patient is a healthy mom for a newborn and has the physical longevity to take care of the child’s development.

Could you tell me more about why patients from Ireland tend to choose your clinic when deciding where to go for treatment abroad?

We have several clinical locations, and those locations differ in terms of their regulatory perspectives and the specific treatments we are legally allowed to perform there.

For instance, regular IVF treatments and anonymous oocyte donation are performed at our facility in Slovakia. We perform specialized MRT procedures in Albania. Meanwhile, we do surrogacy treatments in Ukraine or Georgia. Depending on exactly which treatment a patient requires to solve their case, they can choose the destination that fits that option perfectly.

Do you have a case in mind of, maybe a patient from Ireland, that you have worked with recently that you could tell me a bit more about?

I can tell you about a wonderful case from Ireland. This is a patient we met very recently in our clinic who returned for a frozen embryo transfer of her second embryo. Her first embryo transfer with us was three years ago, after which she successfully conceived and delivered a healthy baby boy. They actually came into our facility recently with their small boy, who is now two years old.

This couple had accumulated two euploid embryos with us using MRT (Mitochondrial Replacement Therapy). Her medical background was incredibly difficult: she started IVF at age 39, went through six full IVF cycles, and had never achieved a single blastocyst in her life because her embryos consistently suffered from developmental arrest.

As an MRT patient, she received four oocytes in her first round of treatment. In her second round, because we accumulated her eggs, she retrieved another four. We ran the MRT procedure utilizing those eight eggs, and the result was two perfect, euploid blastocysts. Both of these embryos worked. She was just here for her second transfer, and we learned recently that she is clinically pregnant. The small boy is going to have another brother very, very soon.

One of your areas of interest is the MRT procedure and I would like to ask you some questions that patients may have about this. So, who is eligible for this?

In short, I would say that as long as the patient is capable of producing an oocyte, she is eligible. But, definitely, a more specific answer would be that this technology was originally approved for patients carrying specific mitochondrial disorders.

However, we have learned from clinical practice that advanced maternal age patients, or patients with metabolic and more complex disorders within the oocyte itself, can also be categorized into this treatment group, as they often suffer from secondary mitochondrial disorders. The tricky thing is that, currently, there is no universal method to directly measure mitochondrial activity inside a living cell. If we can develop this—and we are actively working on that—knowing the precise mitochondrial potential of the cell will allow us to perfectly categorize patients for this specific treatment.

Hmm, so how do you decide which patients to offer this procedure to?

We decide based on their clinical and fertility background. Many patients who are eligible for this treatment have gone through a lot of unsuccessful IVF rounds before. This includes everything starting from fertilization arrest to embryo development arrest.

In fact, many of our patients have never even seen a blastocyst in their entire fertility journey. These are disorders happening at the critical stages of embryonic development. By replacing the patient’s nucleus into a different, younger, and healthier donor egg environment, this technology helps them finally grow their embryos.

And what are the success rates of using this procedure? How does it impact the success rate of a patient?

We should carefully define what “success rate” means with this technology, because this treatment is specifically designed to solve the problem of embryo development. However, a completely successful fertility treatment also includes implantation itself, and implantation is far more complex than just the embryo. Even if you have a healthy embryo from a previous treatment 10 or 20 years ago, an embryo from an egg donation treatment, or an MRT embryo—the base implantation potential for that category of patient will be the same, depending heavily on uterine and extra-uterine factors.

With this treatment, we help patients solve the question of how to get a healthy, euploid, and strong embryo. After that, we work together to optimize the implantation potential, looking at uterine and extra-uterine factors. Complex success depends on all of these pieces. Overall, we can share that currently, we see a 52% clinical pregnancy rate and a 49% live birth rate across all age groups utilizing MRT.

Are the babies born from the MRT procedure healthy? Are there any concerns that patients should have?

That is a very sensitive and highly responsible question. Absolutely, that was the exact question we were looking for answers to ourselves.

Currently, we have 43 babies born as a result of this treatment through our programs, and our oldest baby is over seven years old right now. The oldest baby in the world born via this method is almost 14, so it is still a relatively new and innovative technology. The global evidence we have comes from controlled clinical trials and animal models. There is limited data globally, with less than 100 babies born worldwide as a result of this treatment.

However, if you look at the history of IVF babies, we still don’t have multi-generational evidence about aging disorders or complex conditions over an entire lifetime. That being said, the evidence we currently have about MRT is strong enough to show that this technology is absolutely safe. Right now, we do not have a single recorded disorder among the babies who have been born.