Polycystic ovary syndrome support

If you have PCOS, you may be interested in attending a one-day conference organised by the polycystic ovary syndrome support network, Verity. The agenda for the day has now been set, and includes discussions on nutrition, acupuncture and complementary therapies as well as fertility.

The event will take place in Manchester on 25 October, and you can see the agenda and book online at www.verity-pcos.org.uk

IVF rationing in Yorkshire

In one of the most ludicrous attempts at rationing IVF I've come across, women who need IVF in one area of Yorkshire will only qualify for funded treatment once they are approaching their fortieth birthday. North Yorkshire and York Primary Care Trust now only offers IVF to those who happen to be in the six months between the ages of 39 and a half and 40.

What possible logic can there be to limiting treatment to women who've reached an age at which it is far less likely to succeed? How can anyone consider this to be a sensible use of limited funds? It would perhaps be more honest to admit they are not really funding any treatment at all. The way treatment is being restricted by eligibility criteria in some parts of the country just goes to show how little understanding those who make decisions have of the things they are making decisions about...

I can only imagine that perhaps this is a deliberate attempt to make it impossible for anyone to qualify for NHS-funded treatment in the area, and to have so very few successful NHS-funded cycles that they can then claim IVF is simply not cost effective and stop paying for it altogether. The government keeps making noises about the unfairness of the postcode lottery, but surely a decision like this illustrates that it is time to give primary care trusts very strict guidance as many are clearly incapable of making sensible funding decisions themselves. You can read more about the situation in North Yorkshire and York here

Lifestyle issues

You've probably heard a lot in the last week about the survey of fertility experts that showed they thought people's lifestyles should be taken into consideration when deciding whether they should have IVF. The survey, for the British Fertility Society, questioned about 200 experts in the field, and just 29% of them thought that treatment should be offered to all, regardless of their lifestyle. So anyone who couldn't get pregnant and was overweight, who drank or who smoked should beware...

It is true that all of these things can affect your chances of conceiving, but it is also true that many people who smoke, who are overweight and who drink get pregnant naturally without any trouble. No one in their right mind would smoke or drink to excess when they were pregnant, but it does seem that those of us who don't get pregnant easily are expected to turn into paragons of virtue in order for others to feel we should be allowed to try to have children. We shouldn't forget the immense stress of living through year after year of trying to conceive unsuccessfully, and perhaps should forgive rather than chastise those who end up succumbing to bad habits every now and again. And when it comes to weight, one of the most common causes of female infertility, polycystic ovary syndrome, makes it harder for women to lose weight.

When I wrote The Complete Guide to Female Fertility , I gave lots of advice on lifestyle changes you can make to try to maximise your chances of getting pregnant because I know that people want to do whatever they can. However, it is also important to recognise that making your life utterly miserable in order to have the best possible lifestyle for conception may be counterproductive.
Professor Bill Ledger , one of the country's leading fertility experts, gave an absolutely fascinating presentation on this at National Infertility Day, in which he explained how guilty fertility patients are made to feel about their lifestyles, and how this can cause stress, which is known to damage fertility. It was a refreshing look at the subject, as all too often we end up feeling we are to blame for our fertility problems. Of course you should try to give up smoking, of course you shouldn't drink too much, and if you are overweight you should try to lose some excess pounds, but if you don't reach your ideal weight, or get drunk at a party, or find yourself having the occasional sneaky cigarette, you shouldn't feel you've ruined your chances of ever being allowed to try to have a baby. Guilt, Professor Ledger told us, is the new black!

But getting back to the
British Fertility Society survey ... Apart from the stuff on lifestyle issues, one of the main findings was that most experts in the field wanted to see more research into new techniques used in IVF, such as immume therapy and PGS, and felt they were offered to patients too quickly before scientific trials had shown them to be effective. This is something patients would welcome, as it is impossible to know who to believe or what to trust when the evidence on these treatments is so scanty. From the patient perspective, perhaps the most reassuring finding of the survey was that the majority of the experts believed fertility treatment should be funded by the NHS - maybe one day we'll see the implementation of the government's own advisory body's recommendation of three funded cycles for those who need them...

Your chance to hear the experts in reproductive medicine

You may not know that the Human Fertilisation and Embryology Authority holds an annual conference that is open to the public, and gives you the opportunity to hear from many leading experts in reproductive medicine about the latest news and developments in the field.

This year the meeting is to be held in central London on October 13, and speakers will include the Health Minister Dawn Primarolo and the new Chair of the HFEA, Professor Lisa Jardine. I've been to a few of the conferences, and although some of the subjects up for discussion can be quite complex and scientific, it's still possible to learn a lot about fertility treatment and the latest hot topics.

If you think you may like to attend, the details are on the HFEA website at www.hfea.gov.uk

Planning to use donor eggs or sperm?

Anyone who is faced with the prospect of using donor eggs or sperm may be particularly interested in the Donor Conception Network's annual conference which is to be held in Nottingham on October 11th.

This year, speakers at the conference will include donor-conceived teenagers and young adults who will talk about their experiences and what donor conception has meant to them. If you know you may need to use donor eggs or sperm, if you're about to start donor treatment, or if you already have younger donor-conceived children, this may prove to be an invaluable insight into how families deal with it and what young people think about the issue.

You can find out more on the Donor Conception Network website

The Fertility Forest

If you'd like to do something positive about your experiences of infertility or miscarriage, dedicating a tree in the Fertility Forest may be just the right thing. You will be donating money to charity, helping the environment and preserving precious woodland, whilst also leaving a tangible memory of what you've been through.

The Woodland Trust has just signed an exciting new contract with Infertility Network UK to join forces to plant the first ever Fertility Forest. The Woodland Trust has set aside land on the Hucking Estate in Kent for the project, and anyone who has had a brush with infertility can dedicate a tree at the site.

You may wish to dedicate a tree to commemorate a loss, or as a wish for the future. It may be marking the decision to embrace a life without children, or to celebrate a long-awaited arrival. Relatives or friends may also choose to dedicate a tree in the forest.

The scheme is open for dedications now, and will be officially launched at a planting event in November. If you'd like to find out more, take a look at the webpages here.

Treatment abroad - why so many are considering it

The results of the Infertility Network UK survey into fertility treatment abroad are now out, and they show that 3/4 of those who replied to the questionnaire would consider going overseas. The main reasons for this are the cost of treatment abroad, and the quick access, along with higher success rates and the availability of donor eggs and sperm.

It's often assumed that only those who need donor eggs and sperm are travelling for their treatment, because we know waiting lists in the UK tend to be long, but the results show that there are now many others considering going abroad for IVF, ICSI or other treatments using their own eggs and sperm.

There has also been an assumption that people going overseas for treatment using donor eggs or sperm are partly choosing to do this because they want anonymous donors. In fact it seems that many people don't want this, and that they are accepting donor anonymity as the downside of going overseas, and the price they and their future children must pay for quick access to treatment.

Of those who've been abroad, the vast majority have been happy with the treatment they've received, and the atmosphere, facilities and staff at overseas clinics were all singled out for praise. Just 12% of those who'd been to clinics abroad hadn't been happy, and in most cases this was down to language and communications problems. There had also been some issues with clinics charging more than patients had originally anticipated.

The survey shows that most people who go abroad for fertility treatment make all the arrangements themselves, and don't have recommendations from a clinic at home. This does highlight the importance of doing your research before you opt to go ahead with something like this. The UK fertility sector is tightly regulated and you shouldn't assume that clinics in other countries have to follow similar rules or guidelines. It is important to try to talk to others who've been to any clinic you are looking at, to make sure you understand the regulations the clinic must follow and to be sure you are as confident as you possibly can be that you are not going to encounter problems communicating with the clinic, or getting there when you need to.

Not too late for National Infertility Day

It's not too late to book for National Infertility Day this Saturday if you haven't done so already. It promises to be a fascinating occasion, and the presence of the IVF pioneer, Professor Robert Edwards, will be interesting as it marks thirty years since the birth of the first IVF baby.

There are a huge range of speakers covering virtually every topic you can imagine. You can learn more about the latest developments in fertility treatment, about male and female fertility problems, about donor issues and complementary therapies. There are sessions on surrogacy, adoption and involuntary childlessness as well as assisted reproduction. I am going to be speaking about treatment overseas, and sharing the results of a survey on the subject that will be released tomorrow.

The day-long event is held in Covent Garden in central London, and costs just fifteen pounds. There will also be the opportunity to visit the exhibition stands run by organisations and clinics involved in the field, and to buy books from the bookstand.

If you want to find out more, go to the National Infertility Day website at www.nationalinfertilityday.com

Too much ICSI?

When researchers first discovered that they could inject sperm straight into an egg in order to fertilise it (Intra-cytoplasmic sperm injection or ICSI), the prospects for men with fertility problems were transformed. Thousands of men were able to father their own genetic children thanks to ICSI when once they would have had to use donor sperm.

ICSI was soon being used in clinics across the world, and seemed to promise higher success rates than normal IVF. Some doctors no longer use it just for male fertility problems, but are also suggesting it for older couples or in cases of unexplained infertility. The European Society of Human Reproduction and Embryology meeting in Barcelona was told that ICSI is being used twice as often as IVF, despite the fact that it is far more expensive. What's more worrying, it doesn't actually improve the chances of success unless there is a male factor problem, so many people are paying more unnecessarily.

Some countries use ICSI far more than others. In the UK we have a relatively low ICSI rate, along with the Nordic countries, but in Greece, Italy and Spain it has become incredibly popular. You can read more on the subject on the ESHRE website

The male biological clock

Although we're often told about new evidence that suggests perhaps there is a male biological clock after all, the evidence doesn't seem to back this up. We've all come across men who have fathered children in their fifties and even sixties - at an age when women will have stopped producing any eggs at all

The latest research on the subject presented to the European Society of Human Reproduction and Embryology (ESHRE) in Barcelona earlier this week is interesting, as it suggests that women who have partners who are over 40 don't just take longer to get pregnant, but that they are also more likely to miscarry. The researchers studies couples who were having intra-uterine insemination, or IUI, and found clear patterns emerging where the male partner was over 40. It's thought age-related DNA damage may be the cause of the problem. You can read more about the research at the ESHRE website

Good news for frosties

I was fascinated to read that new research from Denmark has shown that babies born after frozen embryo transfers tend to weigh more, and to be less likely to be admitted to neo-natal units than their fresh counterparts. Freezing embryos is an everyday part of IVF, and yet the idea of a life being frozen in time is still quite extraordinary when you think about it.

When I started having fertility treatment about 13 years ago, some fertility experts were still suggesting that freezing embryos was potentially risky as we didn't know whether it would have any long-term side effects. Some patients chose to discard frozen embryos rather than "risk" freezing them. When I found I was pregnant after a frozen embryo transfer, I had to keep reassuring myself that the thousands of babies who'd already been born that way hadn't shown any adverse outcomes.

Now, this Danish study suggests that in fact frozen embryos may be stronger because they have to survive the freezing and thawing process, and that only the toughest will do this. You can read more here

Acupuncture and IVF

it's the one complementary therapy that we really thought could make a difference to IVF outcomes, and it wasn't just patients who were convinced - some clinics have allowed acupuncturists in to work with patients going through fertility treatment. Now, researchers are claiming acupuncture makes absolutely no difference. A team from Guy's and St Thomas' analysed all the published research on the subject, and concluded that there was no evidence that acupuncture had any effect at all on the chances of getting pregnant after IVF.

It had been thought that acupuncture could increase the likelihood of an embryo implanting in the womb if it was carried out around the time of embryo transfer, and that's one reason why it has proved so popular with fertility patients. In fact it seems the only clear effect of acupuncture is to reduce the need for pain relief at the time of egg collection.

When I wrote The Complete Guide to Female Fertility , I interviewed dozens of women who'd been through IVF, and many of them had tried acupuncture. Not one of them felt it had been a waste of time or money, and in fact most claimed they were sure it had made a real difference. Perhaps this is all psychological, but when we know that stress has a role in causing infertility, anything that helps reduce that must surely be of some benefit.

You can read more on this on the BBC website

The truth about IVF twin risks

You're probably aware of the controversy over moves to reduce the number of multiple births after IVF, but now the deep disagreements on the subject have been highlighted at a European fertility conference in Barcelona.

An American fertility specialist, Norbert Gleicher, claimed that doctors have been exaggerating the risks of twin pregnancies to try to mislead patients who will end up having more treatment if they put back one embryo at a time. His speech at the conference was immediately condemned by many leading fertility specialists, including the chair of the European conference, who are adamant that the claims are at odds with all the evidence.

Here, the Human Fertilisation and Embryology Authority has called on clinics to cut the twin rate in order to ensure babies, and mothers, do not face unnecessary risks. One of the problems with trying to do this successfully is that not all fertility doctors are behind the move and some, like Norbert Gleicher, believe the dangers are not so great.

For most patients, it is difficult to assess what any of this means in relation to your individual situation and how many embryos you should be choosing to put back in an IVF cycle. The reality is that single embryo transfer is never going to be the right thing for everyone, but for women who have a high chance of having a twin pregnancy, it can cut out the risks without having a great impact on the chances of success. How we view the risks as patients may be largely governed by how our doctors see them and if you're treated by Norbert Gleicher you're unlikely to be insisting on a single embryo transfer. If your doctor spends time explaining what the risks might mean for you, you may be happy to give it a go. If you want to find out more about single embryo transfer, there's lots of information on the oneatatime.org,uk website.

Predicting IVF success

One of the most difficult things about fertility treatment is that no one can really give you any idea of how likely it is to work. They may tell you that based on your age, or medical condition, your chances are slightly higher or lower than average, but predictions are always vague at the best of times.

Now, researchers in the United States have managed to predict with 70% accuracy whether IVF is likely to be successful or not. The team from Stanford University in California didn't use any amazing new techniques for the study, which was published this week. Instead, looking at 665 treatment cycles, they managed to work out how to predict success from existing evidence, using four basic measures.

They found the relevant factors were
1. The number of embryos
2. The number of embryos that had 8-cells
3. The percentage of embryos that had stopped dividing and would perish
4. The woman's FSH levels

By combining these factors, they found they could obtain a surprisingly accurate analysis of the chances of success. You can read more about the research at www.plosone.org