Time to celebrate in the East of England

Anyone who needs fertility treatment and lives in the East of England should be celebrating today with the announcement that the area is to be the first to fully implement the guidelines on fertility treatment and offer three full cycles of IVF.

This fantastic news will offer new hope to many couples living in Norfolk, Suffolk, Essex, Cambridgeshire, Hertfordshire and Bedfordshire. There are some criteria, but unlike those used by many other primary care trusts, these are perfectly reasonable - the female partner must be between the ages of 23 and 39, they should not smoke and there should be no existing children from the current relationship.

The funding will start next April - just five years after the initial guideline from the National Institute of Clinical Health and Excellence which recommended that all primary care trusts should be funding three full cycles of treatment. It may have taken time, but maybe now more trusts will realise that these guidelines are meant to be followed rather than ignored, and perhaps couples in other parts of the country will eventually be able to access the treatment they need.

You can read the full details of the proposals for the East of England at www.eoe.nhs.uk/news

To rest or not to rest

I've been thinking about the two week wait after IVF recently - not something I too often choose to remember, but I've been addressing the debate about bed rest after embryo transfer and whether it's a good thing in the new book I'm just completing.

Nowadays some holistic fertility centres recommend that you lie flat on your back for a few days after embryo transfer (once you've got home from the hospital, of course..), Back when I had treatment, I'd always been told that being fairly active was beneficial as it increased the oxygen levels in the blood. It seems that although doctors in the UK don't generally recommend bed rest, in other parts of the world they often do, which makes it all even more confusing for anyone having treatment.

I've been looking up the available research on the subject and it seems that most studies have found no increase in the pregnancy rate amongst women who have gone to bed for a few days after embryo transfer. In fact, one paper found that women who opted for bed rest had a LOWER pregnancy rate. However, many women do say that it helps them feel calmer and more relaxed. I think I've concluded that you just have to do what feels right for you, but whether that's lying on the sofa watching television for a few days or dashing about as normal, you should feel assured that whichever you choose is unlikely to have much influence on the outcome of your treatment.

A cause of endometriosis?

Scientists think they may have worked out why some women get endometriosis - a common condition where tissue similar to the womb lining starts growing elsewhere in the female body. Endometriosis occurs in about 15% of women, and it can affect their chances of getting pregnant.

Now scientists at Liverpool University have identified an enzyme called telomerase that they believe may be responsible. They hope that this will enable them to diagnose and treat endometriosis more effectively. You can read more details about the research, and the enzyme, at www.liv.ac.uk

The treatments that don't work for unexplained infertility

It seems that two commonly used fertility treatments are a waste of time when they're used to treat couples with unexplained infertility. A research project in Scotland looked at the use of Clomid (clomifene citrate) and IUI (intra-uterine insemination) and concluded that they neither of them really made much difference to the chances of conceiving.

The study followed 580 women with unexplained infertility. Some were prescribed Clomid, some were given IUI and some weren't given any treatment at all. Perhaps surprisingly, the lowest pregnancy rates were amongst the group who took Clomid. Although the IUI group did have a slightly higher pregnancy rate than those who had no treatment, the research team say the differences are small enough to be statistically meaningless, and have concluded that there may be no medical justification at all for prescribing Clomid or attempting IUI in women with unexplained infertility.

No one would want to be given a treatment that isn't going to work, and we must welcome any research that looks into the efficacy of fertility treatment. However, it does worry me that this may make it easier for local trusts to cut their spending on infertility yet further - at the moment many will pay for Clomid and IUI, but not for IVF. If they decide to stop spending on Clomid and IUI for unexplained infertility, I fear they are not going to increase their spending on IVF, and some couples may find that they can't access any kind of treatment at all. What's more, commissioners may start to assume that couples with unexplained infertility would all get pregnant eventually if they left it to Nature. I know from personal experience of more than 13 years of unexplained infertility, that this is not the case. So although it's helpful to know that these treatments may not be much use if you don't know why you aren't getting pregnant, it may not be so helpful if you end up not being able to access any other treatment instead.

You can read more about the research which is published in the BMJ at www.bmj.com