Nurses call on government to end IVF lottery

Members of the Royal College of Nursing have voted to call on the government to fund three cycles of IVF for those who need it, and to put an end to the current postcode lottery for treatment.

Delegates at the RCN's annual Congress voted nine to one in favour of the proposal to lobby the government to ensure that local primary care trusts put the guidance they were given four years ago into action.

In 2004, the National Institute for Clinical Excellence (NICE) recommended that the primary care trusts should fund three cycles of IVF for those who needed it. At the time it was welcomed by all those in the field, but things have not improved for patients since.

in some areas there is still no funding for IVF at all. In others there is funding for one cycle, but many primary care trusts have invented their own eligibility criteria which means that many couples don't qualify.

It is wonderful news that the Royal College of Nursing have recognised the heartache caused by the current system, which has been branded a 'disgrace'.

The story has been taken up by the Daily Mail, and you can read more about it at www.dailymail.co.uk

The best test to predict menopause

I was particularly interested to come across some new research from the Netherlands after my last post about ovarian reserve tests. A team from the University Medical Centre in Utrecht have concluded that anti-Mullerian hormone, or AMH, is the best way to test a woman's reproductive age.

AMH is a hormone produced by the follicles in the ovary when they are still at their tiniest stage, and the levels of the hormone seem to be the surest way to predict the ovarian reserve (the number of eggs left in the ovaries) and to see how close an individual may be to the menopause. The research team studied 144 healthy, fertile volunteers, and used their AMH levels to predict their reproductive age. They concluded that AMH levels are able to predict this better than your chronological age, as women will not all reach the menopause at the same point in their lives.

The research is due to be published in the Journal of Clinical Endocrinology and Metabolism, and you can read more about it at http://jcem.endojournals.org

Ovarian reserve testing

I've just been reading about the launch of a new "biological clock" test for women, but on closer investigation it turned out to be the American launch of a product we've had here in the UK for a few years now.

PlanAhead is a test of your ovarian reserve, a term used to describe the quality and quantity of eggs left in your ovaries, which can give an indication of your fertility. PlanAhead involves a blood test for three separate hormones, FSH (or follicle-stimulating hormone), AMH(or Anti-Mullerian Hormone) and Inhibin B. Anyone can buy the test, but you then book yourself in for a blood test either privately or with your family doctor, and send off the resulting blood sample to the lab for a result which comes back within a few weeks.

PlanAhead is a good test because it looks at the levels of all three hormones. Traditionally, doctors have used FSH testing to get an indication of a woman's ovarian reserve, but experts in the field now believe AMH may be a better test. However, it is an expensive test, and if you have any reason to believe you may be approaching an early menopause, you'd be better off asking your doctor to do the test without shelling out for it yourself. It's also really important to understand that this isn't a test of your fertility, just of the store of eggs left in your ovaries, and you shouldn't assume that a good result means you'll be able to get pregnant when you want to, as there could be all kinds of other fertility problems that this test wouldn't highlight.

If you are interested you can buy the test online at www.planaheadtest.com

Bananas for boys

You've probably heard about the new research suggesting that women who eat bananas, and breakfast cereal, are more likely to give birth to boys.

The research group from Exeter and Oxford Universities looked at what women had eaten in the months before they got pregnant. They found that those who had high-calorie diets were more likely to have boys. Breakfast cereal appeared to play a major role, and women who ate it had a significantly higher chance of giving birth to a son. Intake of potassium - found in plenty in bananas - and salt also seemed to be relevant.

I wonder whether these findings would still be relevant for embryos fertilised in vitro...

You can see details of the research on the Exeter University website at www.exeter.ac.uk

Easy IVF

According to The Times , IVF could be about to become so much easier that you could do it in your lunch hour.

Apparently a new device called Invocell would enable most of the treatment to be carried out in a GPs surgery. Instead of mixing eggs and sperm in dishes in the laboratory, the eggs would be put into the device along with washed sperm, and then put back into the vagina. The device would be removed a few days later and fertilised eggs could then be transferred into the womb.

It all sounds quite straightforward, but even with this device, you'd still have to have eggs collected from the ovaries, which isn't something you are ever going to be able to do in your lunch hour, and from a patient perspective I'm not entirely sure the advantages of saving on laboratory bills would make it worthwhile. You can read more at www.timesonline.co.uk

Hope for cancer patients from new research

For some time, fertility clinics have been storing ovarian tissue from women who have cancer and have to undergo chemotherapy, as this can destroy the ovaries and lead to infertility.

Until now, storing the tissue has been a measure doctors have undertaken in the hope that at some point in the future, it may be possible to use it to develop eggs in the laboratory.

Now a team from Edinburgh University have managed to do just that. They added artificial growth hormones to ovarian tissue taken from volunteers who were having caesarean sections, and managed to observe a number of follicles, or egg sacs, developing in the tissue.

It has been suggested that this research means the eggs that develop inside follicles could be used for IVF for cancer patients, and even that it could offer an opportunity for all women to preserve their fertility by freezing ovarian tissue. However, it is important to note that the research team admit they are a long way from this at present, and that they cannot be certain that the eggs they are growing in the laboratory are normal. Despite this, it is still a significant scientific development and a large step forwards. There's a balanced analysis of the research here

A new look

I hope you like this new green look - I think it's more fun than the old one, but if no one else likes it and it hurts your eyes / gives you a headache / is just too green, then let me know, and I'll think about changing back to the old one!

New IVF technique

I've just been reading about a "new technique" for IVF, which researchers claim could double IVF success rates if recent trials using mice can be replicated in humans.

The trials have been carried out at the University of Adelaide, and the researchers have been given a grant to carry out further investigations. The new method involves putting just one embryo back in the womb, and it is hoped that the increased success rates would lead to more patients opting for single embryo transfer which would cut out the risks associated with multiple births for both mothers and babies.

Despite reading a number of reports on the subject, I'm still no clearer as to what this "new technique" might involve, or how it could double the IVF birth rate, but if you want to read more, you can see an Australian news report here

Questions over vitamin supplements

Many of those experiencing fertility problems, or going through treatment, will be taking vitamin supplements in an attempt to boost their general health and increase their chances of conception, and the recent debate over the efficacy of some of these supplements is bound to be of interest.

Complementary fertility therapists often believe that vitamin deficiencies can play a role in fertility problems, and many prescribe their patients with a cocktail of supplements to try to help.

The latest study on the subject was a review of 67 existing studies into the use of vitamins A, C and E, beta-carotene and selenium, which have been considered to help increase life expectancy due to their antioxidant qualities. In fact, the researchers found no evidence that the supplements could help you live longer, and in the case of vitamins A and E and beta-carotene, there was actually some suggestion that they may have completely the opposite effect, with vitamin A in particular increasing the risk of death by 16%.

Many doctors believe that most of us should be able to get all the vitamins we need by eating a healthy diet, and there are concerns about people taking combinations of many different vitamins in large doses. There is no evidence in this study about fertility, but it does perhaps show that you shouldn't assume that all vitamin supplements are always good for you.

The study was a Cochrane review, one of a series of studies which looks at all the existing research on a particular subject in order to draw a balanced conclusion, and you can read more on the website at www.cochrane.org

Research identifies problems for lab-matured eggs

Researchers from Yale University have been looking at egg development in the laboratory, and may have found some clues as to why in-vitro maturationn (IVM), hailed of late as a great new advance in assisted reproduction, doesn't have higher success rates.

In standard IVF, eggs grow in their natural environment in the ovary and are given their last hormonal boost to mature them inside the female body. However, IVM, or in-vitro maturation, involves taking immature eggs from the ovaries and maturing them in the laboratory. It uses less drugs and is cheaper than IVF, so was heralded by many as a significant way ahead, but it is not suitable for everyone as you need to have lots of immature eggs in the ovaries to make it worthwhile.

The research team looked at eggs matured in the laboratory and compared them with eggs that were matured in the woman's body, and found that there were significant differences in their genetic development. The eggs matured in the lab had differences in their gene activity as they developed, and in their genetic profile.

This new research suggests that we don't yet have the ideal laboratory conditions for maturing eggs, and this may be why IVM success rates are not higher. The research team were aiming to find better ways to culture these immature eggs, and to identify the eggs most likely to lead to a pregnancy. The details of the research are on the Yale website " www.yale.edu

Workshops for donor parents

Bookings are now open for the first dates in a series of workshops aimed at parents who have used donor eggs, sperm or embryos. The one-day courses are also open to anyone expecting a baby conceived using donor gametes.

The "Talking and Telling" workshops are organised by the Donor Conception Network, a self-help organisation for families created with the help of donor eggs, sperm or embryos and for those who are hoping to start a family this way. The network also supports adults who were conceived using donor gametes.

The workshops will look at how and when parents can tell children about their conception, and will also provide a valuable opportunity to get to know others in the same situation; whether other parents, or others who are expecting a child.

The first workshop is on May 10 in Oxford, followed by May 17 in Twickenham, June 7 in Amesbury, June 21 in Bristol and July 5 in Bloomsbury.

The Donor Conception Network is also planning some workshops to help those who are considering parenthood using donor eggs, sperm or embryos but the dates and locations have yet to be set for these.

You can find out more on their website www.dcnetwork.org

Fraudulent online donor services

Anyone considering using an online sperm donor service should be warned by the conviction of the founder of one such company for fraud and financial misconduct.

The company was offering fresh sperm, delivered to your door, and claimed to have had around 5,000 customers. However, the very fact that they were offering fresh rather than frozen sperm rang alarm bells for experts, as it suggested they couldn't be carrying out proper screening and checks on the samples they were offering.

Now it has emerged that behind the scenes money was being siphoned off, whilst the company was claiming to be pursuing a mission to help women get pregnant. According to reports, customers had reported problems such as samples being delivered by minicab, or in one case in a dirty coffee flask, and employees claimed people were not always sent sperm samples from donors with the physical characteristics they'd requested.

Finding a sperm donor through a reputable clinic may take more time, but the safeguards that are in place will ensure you know your donor has been properly screened and that the sample they have provided is safe.

You can read more about the case here

New approaches to IVF

You may not be aware of the existence of the International Society for Mild Approaches in Assisted Reproduction, or that it held a World Congress on the subject in London a few days ago, but if you've had any personal experience of IVF, you would probably welcome moves to make it an easier treatment.

When you go through an IVF cycle, you can end up feeling like a battery hen as your ovaries are stimulated to churn out more eggs at one go than Nature would deem possible. The doctors and scientists in the International SocIety for Mild Approaches in Assisted Reproduction are advocates of a more gentle approach, which they hope will prove to be just as successful.

Some consultants do offer a form of IVF where you don't take any drugs to stimulate the ovaries, known as natural cycle IVF. Although it has many advantages, it doesn't have particularly high success rates, which often puts people off. Now, more doctors are considering mild, or "soft", IVF where patients are given far lower doses of drugs. There will not be as many eggs, but research presented at the World Congress suggests that the resulting embryos may be better quality, with fewer genetic abnormalities.

This milder approach can cost less as it cuts down on the hefty IVF drugs bill, and it can also be less risky for patients, as it reduces the chances of over-stimulating the ovaries which can be dangerous. IIVF may seem a bit of a sledgehammer treatment for what are often subtle fertility problems, and a milder form of treatment could be the way ahead.

Nurses to debate fertility funding

Members of the Royal College of Nursing (RCN) will discuss funding for infertility treatment in a debate at their annual conference in Bournemouth at the end of the month.

The RCN's Congress will consider a motion calling on the union to lobby for proper funding for fertility treatment, recognising the inadequacies of the current system. Most people still pay for their IVF in the UK, despite the recommendation by the National Institute for Clinical Excellence (NICE) that women under 40 who needed IVF should get three cycles of NHS treatment. That guideline was issued in 2004 and at the time the government responded by saying that, as a first step, all those under 40 who needed IVF should get one NHS cycle by 2005.

In fact, this still hasn't happened. Instead, there are a wide variety of different criteria applied in many areas to make sure fewer women will qualify for their single cycle of treatment. In other parts of the country, there is simply no funded treatment available at all. Whatever you think about funding for fertility treatment, the current system is unfair and causes heartache for thousands of couples who find they can't get the help they need.

You can read more about the RCN motion on the issue at the union's website www.rcn.org.uk

Thirty years of IVF

This year's National Infertility Day in July will mark thirty years of IVF with a speech from Professor Robert Edwards, the pioneer whose research led to the birth of Louise Brown, the first IVF baby, in 1978.

National Infertility Day is open to anyone who'd like to attend, and a whole host of speakers will cover a wide range of fertility-related topic from specific medical treatments and conditions to complementary therapies and ethical issues. There will also be a good selection of exhibitors, all giving their own advice and information on infertility and treatment. The event is being held at the New Connaught Rooms, close to the heart of London's Covent Garden, on July 19th.

The organisers have also just announced an evening social event with a champagne reception and barbecue at the Grange Whitehall Hotel, where delegates will have a chance to mingle with speakers and exhibitors.

You can book a place now online at www.nationalinfertilityday.com

Metformin and polycystic ovary syndrome

It's a drug that was developed for the treatment of age-related diabetes, but in recent years metformin has been fairly commonly prescribed to women with polycystic ovary syndrome. However, recent studies have suggested that it may not be particularly useful in helping them ovulate or increasing pregnancy rates.

Now researchers in the States have discovered that the way women with polycystic ovary syndrome (PCOS) respond to metformin may all depend on a variation in a particular gene which is involved in controlling levels of blood sugar, and that the women were more likely to ovulate after taking the drug if they had this variation. It may help to explain some of the conflicting data on the subject.

Polycystic ovary syndrome is one of the most common causes of fertility problems, as most women who have it ovulate irregularly or infrequently. It is often associated with weight problems, and may also lead to unwanted body or facial hair and skin problems. Women who have PCOS usually have imbalances in their hormones.

You can read more about the research here . Anyone who is affected by polycystic ovary syndrome, or wants to learn about it, may like to look at the website for that national charity supporting those with PCOS, Verity www.verity-pcos.org.uk

Synthetic oestrogens and fertility

We are often told that environmental toxins can damage fertility, but it is not something fertility doctors usually rush to suggest as a cause of an individual's fertility problem as it is often impossible to tell exactly what might be to blame.

Researchers at Yale School of Medicine have been investigating the way synthetic oestrogens, which are sometimes found in plastics, can impact on our future fertility. They exposed mice to a particular type of synthetic oestrogen, DES, which is actually no longer widely used but which they believe has a similar effect to other products we may often encounter. They found that the synthetic oestrogen alters the gene which is necessary for uterine development. The future fertility of the female offspring of the mice exposed to DES was found to be affected.

There seems to be growing evidence that some of the fertility problems we are experiencing today date back to our mother's wombs, but what is possibly more alarming is the worry that we could still be unintentionally putting the fertility of future generations at risk. You can see more about the Yale research on their website www.yale.edu