Surrey funding cuts

So Surrey is the latest to jump on the bandwagon - hping to make up a deficit of £125 million pounds by axing spending on tattoo removal, treatments for baldness and guess what... yes IVF. However they managed to end up with a deficit of £125 million pounds, one can safely say that it wasn't by spending money on fertility treatment, which is estimated to be less than half a percent of total NHS spending. And it's interesting that they have managed to cut £7 million from their spending on "management" (which is still going to cost around £10 million a year).

It's easy to cut IVF spending. No one gets terribly upset, apart from the people waiting for treatment who are often so devastated by their experience of not being able to conceive that they find it hard to talk to their friends about it, let alone to start waving placards outside their local PCT offices. The long-term impact for these couples is usually neglected in talk about "priorities". We know that more than 90% of couples with fertility problems suffer depression, and this can often lead to other health problems. In the future, the opportunity to try to have a child if you can't do it easily will only be available for those who have the cash to pay.

What's really worrying about all this is the precedent that is being set. Surrey have cheerfully announced that "If you don't need it, the NHS won't pay for it." Who decides what constitutes "need"? Do you really "need" a hip replacement? Or a cataract operation? Do children "need" free prescriptions? Do pregnant women "need" scans? If the NHS is only there to deal with life-threatening conditions, then we don't "need" an awful lot of what it does, but is that really a future that anyone wants?

Is fertility-related stress a good thing?

If you've ever worried about your stress levels when you're going through fertility treatment, you can stop worrying now. A new study has found that women who were most stressed during treatment had a higher pregnancy rate than those who rated themselves lower down the stress scale.

The researchers in the States weren't expecting this outcome when they studied more than 200 women going through treatment as it is generally believed that stress has a negative impact on fertility. They found that women who put themselves high on the stress score appeared to have a 20-30% higher pregnancy rate than those who were less stressed

There is nothing less helpful when you are going through fertility treatment than being told that it won't work if you are stressed - infertility causes a huge amount of stress, and telling women that they are making things worse by feeling stressed ends up being a vicious circle - you feel guilty about being stressed which then makes you more stressed, so you have to feel even more guilty about being more stressed etc. For that reason alone we should welcome this new research.

You can read more here

Donor eggs for black women

As more and more people who need donor eggs consider travelling abroad to avoid long waiting lists at many clinics at home, there is good news for black women from Barbados Fertility Centre. They've been actively recruiting donors locally for some time, and are now in the position of having more donor eggs from black women than they have potential recipients. This may be of great interest to black British women who often face incredibly long waits for treatment with donor eggs in the UK. You can find out more about the clinic and the treatment they offer at www.barbadosivf.org

an interview later...

I've just done an interview for LBC radio about IVF funding, which they'd linked to Robert Edwards getting the Nobel prize. It's such a shame that on the day one of our country's greatest scientists gets awarded for his ground-breaking work, we end up discussing how to cut all funding for an amazing treatment that was invented here. We carry out less fertility treatment in the UK, and considerably less funded treatment, than most of the rest of Europe - and yet this was a field in which we once led the world.

It always fascinates me when I do these interviews that there is a general assumption that the NHS is funding huge amounts of treatment at the moment, when in fact that isn't the case at all. It's a tiny percentage of the NHS budget and cutting it would cause such distress. Today the person interviewing me equated IVF with breast-enlargement operations for teenagers - it seems to get worse by the day...

IVF pioneer honoured at last!

What fabulous news that Robert Edwards, the scientist behind the birth of world's first IVF baby, has finally received a Nobel prize!

It has always rather mystified me that Robert Edwards hasn't received a Nobel prize for medicine in the past. His work has led to the birth of millions of IVF babies around the world, and has allowed many couples who would never otherwise have been able to conceive to have families of their own. Working with Patrick Steptoe, he'd been widely criticised for his work, with much scepticism about IVF from the medical profession as well as the church and the general public.

It's just a shame that they waited so long to honour him, as he is now 85 and not at all well. I went to interview him a few years ago, and I know how much he would appreciate finally receiving this prize. He explained to me that his conviction had allowed him to continue his work despite all the opposition, and that had led him to develop what has now been recognised as "a milestone of modern medicine".

It's not often that you meet someone whose life is really inspiring, and who you feel quite humbled to have the opportunity to speak to. Robert Edwards is a wonderful man, passionate about helping those with fertility problems and this is a truly well-deserved, if somewhat tardy, recognition of all that he has done. And on a personal note, it has cheered up my day no end!

Read more here

Reduced cost IVF for charity members

I wrote a while ago about the Benenden Healthcare Society, a mutual not for profit organisation which provides healthcare to public sector employees - and is offering IVF at reduced cost. The Society has now voted to open up to all those who are members of charities too, which means that anyone who has joined Infertility Network UK for support can benefit from this.

Benenden Hospital in Kent is a subsidiary of the society and has charitable trust status. It provides healthcare for members of the trust, and has its own fertility centre. Although IVF treatment cannot be offered free, it is subsidised - members who have been with the society for six months or more qualify for IVF at reduced cost.

You can find out more at www.benenden.org.uk

Another trust cuts fertility funding

So, now NHS Bury has decided to stop funding IVF too - apparently as part of a plan to save "millions of pounds". Well, I just hope the plan includes an awful lot of other things, as they're not going to save a single million by stopping fertility treatment.

In 2008, they funded a total of 31 treatment cycles - which means they'd probably struggle to save much more than £100,000 by cutting treatment altogether. That may seem quite a lot of money but in terms of their multi-million pound annual budget, it is peanuts. I suspect the board at NHS Bury could do with a few lessons in health economics - causing so much misery and depression for such a small saving is not good policy, it's a lazy way to make it look as if you are doing something by snipping away at small budgets,

IVF is not always successful, but the pain of involuntary childlessness is far easier to bear if you know that you had the opportunity to try to overcome your fertility problem. And let's be clear, a fertility problem is a health problem not a "lifestyle issue". I am never entirely sure why blocked Fallopian tubes or polycystic ovary syndrome are conveniently no longer classified as medical problems when it comes to funding fertility.

NHS Bury is also cutting "other discretionary procedures" such as cosmetic surgery, apart from in exceptional cases (which suggests a lot of unexceptional ones have been funded in the past) and homeopathy treatments. Says it all really...

Positive new research on DHEA

It's a subject that has come up at lot recently at the fertility support groups I visit - the use of DHEA to improve the chances of IVF success for women who have a low ovarian reserve.

DHEA is an anti-ageing vitamin supplement and women in the UK have been buying it online - and reporting that their response during IVF treatment has been much improved. It's quite a hot topic amongst the couples at the groups, and more and more have been using it recently.

Now, scientists in Israel have looked more closely at the effects of the supplement - and they found that women who took it were three times more likely to get pregnant than those who didn't. Apparently, the women who'd taken DHEA were also more likely to have a healthy pregnancy and delivery.

It isn't clear exactly what DHEA does to women to make them more fertile, and many consultants in the UK are reluctant to recommend it without larger scale trials - however, if you've got a low ovarian reserve and are having IVF, it's definitely worth looking into.

There's more detail on the research, which has been published in Human Reproduction, here

IVF cuts - make your feelings known...

It was depressing to get back from my holiday and discover that one Primary Care Trust had decided to stop funding fertility treatment due to the recession.

It's an easy way to look as if you are being thrifty - but the ridiculous thing is that it actually saves a very small amount of money whilst causing a huge amount of heartache. I heard an estimate the other day that in total fertility funding was less than 0.1% of the NHS budget. I suspect far more could be saved by a more careful monitoring of exactly what can be covered by executive expenses - and that wouldn't cause any heartache to anyone.

Clare Lewis-Jones MBE, chair of the National Infertility Awareness Campaign and Chief Executive of Infertility Network UK has made her feelings clear, urging Warrington PCT to rethink the decision; “We are very angry indeed at the decision taken by Warrington PCT to suspend funding for IVF treatment. The PCT has suggested that infertility does not affect general physical health but we deal with patients every day who contact us and whose health has been adversely affected by this illness. NICE Guidance issued in 2004 recommended eligible couples should receive up to three full cycles of treatment. It is high time that PCTs realised the impact infertility has on patients."

I think sometimes Primary Care Trusts are too quick to listen to the small but vociferous minority who oppose fertility treatment and to take their views as being representative. People who are living without the children they'd love are often so adversely affected by their situation that they feel unable to make a fuss when PCTs make decisions like this. Maybe you could help them. Tell Warrington PCT Chair, Mr John Gartside, what you think about the decision.

Mr John Gartside
Warrington Primary Care Trust
Headquarters
930-932 Birchwood Boulevard
Millennium Park
Birchwood
Warrington WA3 7QN

Does ovulation affect your choice of clothing?

I'm fascinated by some new research which shows that women buy more daring clothes when they are ovulating and imagined it must be to make themselves look and feel more attractive to men. Apparently, the researchers found that outdoing other women was the key factor rather than a simple desire to impress the opposite sex.

The women who chose the more daring clothes were not only ovulating, but had also been shown photos of attractive local women. Apparently the effect wasn't the same when they were shown pictures of less attractive women, or those who lived thousands of miles away, and in these cases they didn't opt for the daring outfits.

The research was carried out by a team at the Carlson School of Management in Minnesota and published in the Journal of Consumer Research - you can read more at www.csom.umn.edu

Pregnancy after miscarriage

How soon can you try to get pregnant again after a miscarriage? The conventional wisdom has been that women should wait for at least six months, and some recommend waiting as long as eighteen months. However, others have always believed that trying to get pregnant again as soon as possible could in fact enhance a woman’s chances of recovery.

This new study in Scotland looked at the outcome of pregnancy in women who’d had a previous miscarriage. The women were divided into groups depending on how long they had waited to try to get pregnant again. The researchers at Aberdeen University found that those who had conceived within six months of an earlier miscarriage were less likely to lose another baby or to have an ectopic pregnancy, and they were also less likely to give birth prematurely or have a baby with a low birth weight.

The researchers concluded that it was probably unncessary for women to try to delay conception after miscarriage unless there are specific issues that may indicate it is necessary. You can read more about the research at www.bmj.com

Superdrug deal on IVF drugs

Anyone who has had fertility treatment will know that the cost of the drugs can send the total bill soaring, and patients are often advised to shop around to get a reasonable deal on the drugs they will need.

Now Superdrug has announced plans to dispense fertility drugs with no mark-up on the cost - and this will also apply to other privately prescribed prescriptions. This is due to come into effect right away so if you're about to start a treatment cycle, it is worth checking the price at Superdrug as well as any other outlet you may be considering. However, do keep in mind that when Asda announced a similar scheme for fertility drugs a while back, some NHS hospital pharmacies were cheaper - so do make sure you check!

You can read more about the Superdrug plans here

Reduced cost IVF for public sector workers

If you or someone you know (a friend or member of your family) work for or previously worked in the public sector then you may want to consider joining The Benenden Healthcare Society, a mutual society which has charitable status and provides healthcare to public sector employees. Unlike private health schemes, the Society is only open to those who work in certain fields, and costs just £1.50 membership a week. Those eligible include people who work for the civil service, armed forces, post office, registered charities, BT, local authorities, in state education, for the emergency services and the NHS.

Benenden Hospital in Kent is a subsidiary of the society and has charitable trust status. It provides healthcare for members of the trust. Originally founded in 1907 to treat postal workers with TB, today it provides care for a most medical and surgical specialities including infertility. Although IVF treatment cannot be offered free, it is subsidised and members who have been with the society for six months or more qualify for IVF at reduced cost.

More to Life Day - March 2011

For anyone who has imagined that they will have a family, contemplating a future without children can seem a bleak and lonely prospect. More to Life is a charity offering help and support to anyone who is involuntarily childless, whatever their path to that point may have been. Next year will see the first ever More to Life day, with speakers, information, advice and support on hand for an afternoon in Central London. The date has been set for March 19 2011 and we are now putting together a programme of speakers. You can find out about More to Life at www.moretolife.co.uk

Callling London ACeBabes!

Did you know that there is a special group for families who had to have help to have children? ACeBabes is for anyone who has experienced fertility problems and went on to get pregnant. It provides help and support during pregnancy and for parents- and also offers a great opportunity to meet others who have had a long path to becoming parents.

I'm organising an ACeBabes picnic in Greenwich Park in August for anyone who is pregnant after fertility problems or those who have been successful and their families. Do come along and join me and my own ACeBabes - details can be found here.

Endometriosis

It's a condition that is not often discussed despite the fact that it is thought to affect 176 million women around the world. Endometriosis occurs when cells which are like the spongy womb lining grow elsewhere, usually in the pelvic cavity. It can be very painful, can lead to heavy or irregular periods and may affect fertility.

Now, the first ever global study of the impact of endometriosis on society has been carried out, and has discovered that women who have endometriosis often have such severe symptoms that it affects their work productivity. The study looked at more than a thousand women from five continents and found that the impact of endometriosis was greater than expected. It impaired life quality in many areas ranging from housework to studying and exercising.

Another alarming fact thrown up by the research was the amount of time it took to get a diagnosis - often a wait of seven years from first seeing a doctor about symptoms to being diagnosed!

It is hoped that this study will help raise awareness of endometriosis and highlight the need for research into finding better treatments - you can read more about the study at www.eshre.eu

Why freeze eggs

Why do some women choose to freeze their eggs for the future rather than get pregnant sooner? Two new studies have looked into the reasons behind this, and although one which questioned younger women found that they'd rather focus on their careers, the other discovered that it's the lack of a partner that drives women to make the decision when they are older.

We tend to assume that women who have children later do so because they are too busy furthering their careers when they are younger, but in fact most of the women I've spoken to who were trying to get pregnant in their late thirties and early forties are adamant that this isn't the case. For them, it was a matter of waiting for the right partner - so it's not surprising that the idea of egg freezing seems attractive.

In fact, freezing eggs is not a guaranteed insurance policy. The technology is still quite new, and it's an invasive and expensive business. Women have to go through most of an IVF cycle in order to harvest a crop of eggs, and it can take two or three goes to ensure there are sufficient eggs to freeze. If women leave it until their late thirties to decide to freeze their eggs, the chances of success will have diminished as egg quality will have begun to decline.

The studies on egg freezing were presented to the European Society of Human Reproduction and Embryology conference in Rome and you can read more about them at www.eshre.eu

Fertility support

I've been facilitating a number of support groups in the last few months, and have also attended some too, and at the end of every meeting I go to, I am more convinced that meeting other people in the flesh is hugely helpful to anyone experiencing fertility problems.

Online support has grown so much in recent years that most clinics have completely given up on the idea of providing a support group for patients - with one or two notable exceptions! It's a great shame, as although patients want good success rates, they also want to feel supported. Too often, patients come to the group with stories of insensitivity and lack of understanding from clinic staff. It's a great shame, as these same staff are often working flat out to improve the clinic and the treatment in every way that they can, but the little things can easily get forgotten.

Chatting to someone else online can be helpful, but actually meeting someone and talking to them is a far richer experience, and can be far more rewarding. I've yet to meet anyone who went to a support group and left concluding it wasn't for them. Once you take the plunge, you may be surprised at how much you get out of it.

Details of support groups meeting in England can be found at www.infertilitynetworkuk.com

Advance testing for menopause

Researchers have found that they can accurately predict the age at which women will reach the menopause - giving women a clearer idea about their reproductive future.

The team from Tehran tested the levels of Anti-Mullerian Hormone (AMH) which controls the development of the follicles in the ovaries. AMH has been used as a test of ovarian reserve, or the number of eggs likely to remain in the ovaries, for some time. In this new test, blood samples were taken every three years and looked at in conjunction with information about a woman's reproductive history. The women were also given a three-yearly physical examination. 266 women were involved in the study, and the researchers predicted their menopause very accurately - on average they were just a third of a year out. More research is now needed to see if the findings can be replicated in a larger group.

The research is particularly useful for women who want to plan when to start a family, but it is vital to remember that having a later menopause does not guarantee your fertility until that point. Women are less and less fertile for years before they reach the menopause, and there are many other problems that can cause infertility. However, any new research in this field is very welcome and will undoubtedly help many women.

A press release about the research can be found at www.eshre.eu

Official warning on online sperm agencies

The UK's fertility regulator has just issued a warning about online donor services, after a number of media stories about agencies offering to put people in touch with potential donors.

It all sounds quite simple, but in fact there are very real risks to using this kind of service. The agencies often claim to operate in a grey legal area where they only provide an introduction, rather than eggs or sperm. Even so, many online donor services are still working on the wrong side of the law. The reason for our stringent legislation when it comes to sperm and egg donation is to keep people safe. Using an agency, you can't guarantee you get the donor you think you are paying for, you don't know if sperm samples are screened or are safe and none of the safeguards that the law provides will apply.

I think it's particularly frightening that many of these sites offer fresh sperm. In licensed clinics, sperm samples have to be frozen before use to ensure that the donor hasn't contracted any kind of infection, such as HIV, since he was last screened. With an online service providing fresh sperm, it simply isn't possible that a sample can be guaranteed to be safe.

Not only are there safety issues, using an online agency can cause huge issues in the future over legal parenthood. If a man donates through a licensed clinic, he is not the legal father of the child born through the donation. This is not the case with an unlicensed donation where, in fact, the donor would be the legal father and could be legally and financially responsible for any offspring.

It may seem an attractive idea, it may be quick, but it certainly isn't safe or sensible to use an online agency and you could be creating problems for both yourself and your future child.

The HFEA have issued at statement which you can read at www.hfea.gov.uk

Chlamydia

I was talking to a journalist earlier this week about what young women can do to preserve their fertility, and came to the probably unhelpful conclusion that most of it was little more than common sense and a healthy lifestyle. However, the one thing that many young women don't think about is chlamydia, and yet it can have such devastating effects on your future fertility.

Apparently one in ten sexually active young people has chlamydia - and that's an estimate which some believe could be conservative. For up to 80% of women who have chlamydia, there are no symptoms which means people don't worry and don't get tested. It may only be years later that they discover their fertility has been compromised.

When I was writing The Complete Guide to Female Fertility I interviewed a young woman who was in her early twenties, but knew she would have to have IVF in order to conceive. She had sensibly been tested for chlamydia at an early age, but it was already too late. The infection had completely blocked her fallopian tubes (which connect the ovary to the womb, allowing eggs to get from one to the other). She was longing for a family, but was too young to qualify for IVF in her local area.

It's easy to forget about something that has no symptoms, that you may not know you have - but if you could be at risk through unprotected intercourse, it's worth having a test. It's simple and quick - and really could help preserve your fertility.

Indian triplets for 66-year old mother

I've just been reading about the triplets born to a woman of 66 in Northern India. Her doctor seems rather proud to announce that she is the oldest woman in the world to give birth to triplets. This was apparently her third attempt at IVF and she had three embryos transferred as the two embryos put back in the earlier cycles had failed to implant. The three babies are now in intensive care as they are very underweight.

The treatment was carried out at the same clinic in Haryana where a woman of 70 who became the world's oldest mother was treated. The clinic seems to specialise in treating pensioners and the website is quite bizarre, featuring pictures of elderly couples next to tiny babies. In India, the average age expectancy for a woman is 66 and it's even younger for a man, so the clinic are helping to create babies whose parents are highly unlikely to live past their first few years. And surely carrying three babies and then having a Caesarean at 66 is hardly going to increase your life expectancy...

It's stories like these that have to make you glad that we have such a highly regulated system in the UK, and that our fertility doctors consider what is right for potential parents and children when they are making decisions about treatment, rather than the desire to break new ground in totally unethical territory.

The French Study...

You may have heard about "The French Study" over the last few days... It has been quite widely reported in the media as it shows that there is a small risk of malformation for children born after IVF. The study looked at more than 15,000 IVF children's health records and found that 4.24% had some kind of congenital malformation. It sounds incredibly alarming, and is enough to worry anyone considering IVF.

As usual with these stories, there is a however... First, this needs to be put into perspective, as in the general population who have not had IVF, there is a risk of up to 3% of congenital malformation so the increased risk is very small. Second, although you may not have been aware of this, previous studies had put the figure of congenital malformation after IVF as high as 11%, so this is actually a lot better than many scientists had expected. The French researchers believe their figure is more likely to be correct because this was such a large study.

This is certainly an issue that needs further investigation, and makes the case for more long-term follow-up studies of children born after assisted conception. At the same time, it is important to understand that this increased risk is very small. If you do have worries about it, you should talk to the team at your clinic. See more here

Maybe being calm doesn't make you more fertile...

It seems to go against everything we've heard in the past, but new research apparently shows that neurotic women are more fertile and have more babies than their calmer laid-back sisters!

The research, which was carried out in Senegal, seems to contradict previous studies in Western countries which had suggested women who were had neurotic personality traits were likely to have fewer children. It is certainly interesting, especially as we tend to assume here nowadays that being chilled and relaxed is key to improving your fertility.

You can read an article on the subject at www.dailymail.co.uk

Is it too easy to buy eggs and sperm in the US?

I've just been reading an interesting piece in the New York Times which compares the complicated process people face when adopting a child with the ease with which donor sperm and eggs can be purchased in the States. During adoption, the interests of the child are always paramount, as they should be, but with donor conception, the interests of the prospective parents may seem to lead the way.

Columnist Ross Douthat discusses a study of donor conceived adults which showed that many of them felt some unease about their conception, often because money had changed hands. Unlike the UK, donation in the States is not only paid but can also be anonymous. Although getting rid of anonymity in the UK was initially seen to have reduced the donor pool and created longer waits for donor treatment, it is likely that in the long run it will reduce the potential problems of donor conception making it possible to trace a donor parent.

You can read the article at www.nytimes.com

Considering fertility treatment?

If you're considering fertility treatment, you may be interested in a new publication from the HFEA, called Getting started: Your guide to fertility treatment. It's for those who are at the beginning of their fertility treatment journey and explains what the different treatments are, what to think about before you start, what to expect at a clinic, funding options, potential risks and where to get support.

You can order your free copy at www.hfea.gov.uk/order or pick up a leaflet with a pre-paid order form at a GP surgery.
Each section of the new guide directs people to the HFEA website for more detailed information and the latest data on licensed clinics.

You may also be interested in my books The Complete Guide to IVF of The Complete Guide to Female Fertility , which is also ideal for anyone at the start of their journey and for any woman who is wondering how late she can leave it to have a baby.

Reduced fees for single embryo transfer patients

Did you know that the Human Fertilisation and Embryology Authority (HFEA) will no longer charge clinics for patients who have frozen embryo transfers after putting back just one embryo in a fresh cycle?

At the moment, fertility clinics pay the HFEA a fee for each cycle they carry out, and the clinics pass this charge directly on to their patients. From October onwards, the fee will be dropped if a patient who had an unsuccessful single embryo transfer goes on to have additional frozen embryo transfers. The idea is that this will help reduce any additional financial burden from the decision to have just one embryo put back at a time.

Single embryo transfer does make sense for younger women who have good quality embryos as it means you are more likely to have a single, healthy baby. However, in the current economic climate many people do worry that it may end up costing them more to get pregnant this way. The HFEA hopes the decision will show the authority's commitment to helping patients who choose the safe and sensible option.

You can see more here

Abortion after IVF

So, "dozens" of young women are apparently having abortions after getting pregnant by IVF because they have "changed their minds". The report that eighty women who'd had IVF went on to have abortions was said to show that infertile couples were treating babies as "commodities" and it brought out the anti-IVF brigade in force. It's such a terrible shame that something affecting a tiny number of the couples who have IVF every year has been allowed to taint the arguments about whether fertility treatment should be funded by the NHS.

The reality is that the number of women who went on to have abortions after IVF is less than one per cent of the total number of IVF pregnancies. The fact that one woman had told a newspaper reporter that she had been pushed into IVF by her partner, and changed her mind once she got pregnant has been assumed to apply to the other 79 women who didn't continue with their pregnancies. We have no idea what motivated them, but there is no evidence that it wasn't problems with the baby's or their own health, a relationship breakdown or even the death of a partner.

IVF is not something that anyone undertakes lightly - it involves huge emotional and usually financial commitment and is often a pretty traumatic process. The vast majority of those going through treatment would do anything they could to have a child, and using the example of one woman in order to make assumptions and draw conclusions about the three and a half million people having difficulty conceiving is both wrong and unfair.

Secondary infertility

I've just read a great piece on The Guardian on secondary infertility by the author Maggie O'Farrell.

People who have no personal experience of infertility don't understand how it feels, but there is a generally sympathetic attitude towards those who are involuntarily childless. Not being able to have a second, or third, child doesn't get the same reaction. People tend to assume you should be grateful for what you have - and even GPs are sometimes surprisingly ignorant about secondary infertility, not taking it sufficiently seriously soon enough.

Maggie O'Farrell's moving article points out that secondary infertility can be just as hard to cope with - and I loved her ending - read it and see...

The Complete Guide to IVF

I'm about to start revisions for a new edition of The Complete Guide to IVF as a new edition is due to be published later this year. It's fun to get a chance to go through your work with a red pencil, but I am going to have to be disciplined and only change what really needs changing - otherwise I won't ever stop...

Website up and running

Just to say that my website - www.katebrian.co.uk is now up and running again - hooray! Losing it for a while has made me realise my biography is hopelessly out of date. I suppose at least that means I'm busy...

Sextuplets

The birth of sextuplets to a couple in Oxfordshire has been trumpeted in the media, and many people will inevitably assume that the babies must be the product of IVF. In fact, multiple pregnancies of this order after IVF do not happen in the UK, as our system is carefully regulated to ensure that babies born after assisted conception have the best possible chance of a healthy life.

These six tiny babies were born prematurely, each weighing less than two pounds, and their chances of survival now hang in the balance despite round the clock medical care.

The mother in this case had taken a fertility drug - quite possibly Clomid - and it is here that many multiple birth problems lie. The use of fertility drugs by themselves is unregulated in the UK. People can get them from a GP or they can even be purchased online, and in these cases the ovaries are not always scanned and monitored to ensure that there is no chance of a risky pregnancy with triplets or more. Although our fertility services are sometimes criticised for being too closely regulated, this is one area where we could do with a little more regulation in order to ensure that dangerous high-order multiple pregnancies become a thing of the past.

Newspaper claims sex may become redundant

So, sex to make babies may become redundant in the future, according to the Daily Mail. I do love these stories. I remember a similar one some years back which claimed that career couples were turning to IVF because they were too busy to have sex!

This story is based on claims that IVF will become so successful in the future, that sex will appear "inefficient" in comparison so over 30s will all be choosing assisted conception if they want babies. It paints a picture of a scarily sci-fi Brave New World.

Of course, it's wonderful that scientists are predicting that IVF will have a near 100 per cent success rate in the not too distant future, but I still can't see anyone choosing it if they don't have to - however much more efficient it may be at baby making than sex. Anyone who had any personal experience of the daily injections, the scans, the blood tests, the visits to the clinic, of egg collection under sedation and embryo transfer, of the traumatic highs and lows and the lack of dignity of it all would know that it efficiency may not be everything. Have a look at the Daily Mail article yourself and see what you think!

The mystery of the disappearing website...

Actually it's not that mysterious - my website has disappeared from cyberspace, and it's all my fault. I have been getting those "you must pay xx now if you want to maintain your website" for about the last year, and I kept thinking I must do something about it, but was also, in retrospect rather stupidly, worried that they might be some kind of phishing thing from someone other than the website host. Instead of doing the sensible thing and checking it out to make sure I was paying the right person, I put it off, and put it off and put it off... As the website was still there, I forgot about it after a while. Now it has suddenly gone, and I have a terrible feeling I am going to have to start from scratch with a new one.

Maybe it's time to see it as a fresh opportunity for a bright new website... Watch this space!

Make a date for August

I went to the fertility information evening at Homerton Hospital in Hackney last night and would thoroughly recommend it to anyone who wants to understand more about their fertility - whether you're at the early stages of wondering whether it should be taking so long to get pregnant or further down the line of having tests and treatment.

Consultant Anil Gudi's presentation used video clips to illustrate every condition and treatment he discussed. So often medical explanations can end up leaving you more confused - but having a visual presentation of each subject, from what happens inside the female body during normal conception to how an ovary becomes polycystic was absolutely fascinating - and really gives you a much clearer idea of what is involved.

The fertility information evenings are set to run every three months - so the next one will be on the first Wednesday in August. If you're in London and you want to know more about your fertility, I'd put it in your diary right away!

Human eggs for sale online

An interesting story in the papers today about a woman who put her eggs up for sale on the internet, apparently not realising that it is illegal to do so in the UK.

The woman - a 28-year-old businesswoman - claimed she needed to sell her eggs to pay off her student loans and was hoping to make more than £4,000 for her trouble. She had apparently read about how much egg donors could earn in a magazine which suggested many women in the UK were already selling their eggs. She posted her ad on a website where she said she'd seen another woman advertising her eggs for sale. The ad was accepted without any problems, and she had no idea that what she had done was illegal.

The woman admitted that her family had been horrified by her plans, fearing that she might regret her decision in the future. However, she remained confident that this would be a good way to pay off her debts whilst helping a childless couple.

Should we be shocked by this? Is it wrong? At the moment in the UK, although it is illegal to advertise human eggs for sale and you can't get paid for donating eggs, you can receive "reasonable expenses" but what constitutes "reasonable" is a grey area. The HFEA is currently reconsidering the rules on payment for egg and sperm donors, and this may clarify matters in the future.

You can read more here

Fertility awareness information evening - London

There's a free fertility information evening open to all at Homerton Hospital in Hackney on Wednesday 5 May at 7 pm. A consultant from the hospital's fertility centre will give a presentation on fertility, looking at lifestyle issues that can affect your fertility and funding for treatment, as well as answering any questions. I will be there, representing Infertility Network UK.

The evening will be held in the main lecture theatre, Education Centre, Homerton University Hospital, Homerton Row, London E9 6SR. If you'd like to come along you can email fertility@homerton.nhs.uk or call 020 8510 7660 - or just turn up on the night!

Why the use of cheap fertility drugs should be monitored

There's an interesting comment piece on the BBC website from Professor Bill Ledger of Sheffield University about the risk of cheap fertility drugs leading to multiple births.

There is more now awareness about the dangers multiple births can cause both mothers and babies, and this has led fertility experts to try to put back just one embryo during IVF treatment when there is a good prognosis. However, many women with less serious fertility problems are initially treated with much simpler and cheaper fertility drugs. These drugs are sometimes prescribed by GPs or at general hospitals, and their use is not regulated by the HFEA. Drugs such as Clomid can still lead to multiple pregnancies if women are not properly monitored when they take them, and the comment calls for simple ultrasound scans for all women taking fertility drugs to ensure that they are not putting their own, and their future children's, health at risk.

You can read the piece on the BBC website

Is air pollution affecting your fertility?

New research from the US suggests that being exposed to air pollutants can decrease the chances of successful IVF - maybe a good excuse to take a long holiday if you're going through fertility treatment...

Women going through IVF had the air quality in their home monitored at specific stages during their first treatment cycle- more than 7,000 women were involved in the study which took place over a seven-year period. The findings showed lower likelihoods of a successful pregnancy in the women who had been exposed to higher levels of pollutants, in particular nitrogen oxide. Conversely, higher ozone levels seemed to show more chance of successful pregnancy.

It is thought that these effects could be mirrored more widely, and that exposure to pollutants may have an impact on all fertility, not just that of women going through IVF. More details can be found here

Donor sibling link

People who have been born as a result of donor conception will be able to contact others who share the same donor from today. Once they reach 18, those conceived through donor treatment can join the Donor Sibling Link, a new service launched by the HFEA (Human Fertilisation and Embryology Authority), which will enable them to get in touch with any genetic siblings who have also joined. As donors usually make more than one donation, there may be a number of genetic siblings in different families and this will allow them to find out about one another.


The Donor Sibling Link can only be used by those who were conceived using donor eggs, sperm or embryos and their parents or other family members are not able to access the information.
See more here

Important information for all UK IVF patients

You may not know that as from April 6, identifying details of anyone who has had IVF since 1991 may be available to researchers. Most people who've had IVF may be quite happy for researchers to be able to use identifying details from their records in order to carry out projects which could be beneficial to future patients, but there are others who don't tell anyone about their treatment and may be worried about this - especially as most people believed this information was confidential when they had IVF.

It is possible to opt out by using a form on the HFEA website but both you and your partner will need to opt out, and you will need to put in the dates of your treatment and where you had it.

There's more information here for anyone who wants to know more about this.

Peckham miracle babies

The case of the "miracle" babies born to women attending a church in Peckham has been the subject of another BBC radio investigation today.

An "archbishop" who is wanted by the authorities in Kenya to face charges of stealing children is apparently still in the UK, where he had claimed to be able to help women who were often medically unable to have children. The women would go to Kenya and return with babies he claimed they'd given birth to, despite the fact that their DNA did not match that of their "parents".

It is a sad story of the exploitation of both poor Kenyan women and couples with fertility problems in the UK - see more here

Fizzy drinks and male fertility

Did you know that too many fizzy drinks may affect male fertility? A study from Denmark looked at more than 2,000 young men and investigated their diet and intake of caffeine (including fizzy cola which contains caffeine) before analysing their sperm. They found that there was no clear link between semen quality and caffeine consumption, BUT there was a link when they looked at fizzy drink consumption.

Men who drank more than 14 bottles of fizzy drinks a week (that's about a litre a day) were far more likely to have poor fertility. However, it isn't clear what the cause of this might be. Researchers say it can't be the caffeine, as getting the same amount of caffeine from coffee didn't have the same result. It could be that those who drink lots of cola have other lifestyle factors that may come into play - on the whole they were less healthy, eating less fruit, vegetables and fish and consuming more fast food and alcohol. The one thing that does emerge very clearly from the research is that lifestyle and eating habits certainly do play an important role in male fertility.

You can read the full paper here

IVF and ICSI information evening

There's a free fertility information evening at Homerton Hospital in Hackney on Wednesday 7 April from 7-8.30pm. Consultants from the hospital's fertility centre will give a presentation on IVF and ICSI and answer any questions. I will also be there, representing Infertility Network UK. The evening will be held in the main lecture theatre, Education Centre, Homerton University Hospital, Homerton Row, London E9 6SR. If you'd like to come along you can email fertility@homerton.nhs.uk or call 020 8510 7660.

US egg donors paid too much?

The human egg raffle (see previous post), raised quite a lot of debate here about payment for egg donors and whether that might help solve the shortage of donor eggs. Indeed, recompense for donors is something the Human Fertilisation and Embryology Authority is considering in the UK.

However, a new study from the US shows how careful you have to be once you set that ball rolling. It discovered that many egg donors are currently being paid considerably more than the guidelines suggest, particularly those with good grades at good universities. Apparently ads appear in University newspapers across the US offering considerable sums in exchange for eggs. Is that really a route we'd want to follow here? Is it possible to pay donors more than the paltry amounts they currently receive in the UK and still keep the situation under control? And if so, how can that be done?

The egg raffle

You've probably heard about the human egg raffle taking place to promote a link-up between a London fertility clinic and a centre in the US. Apparently, we are told, this is pretty standard practice in the States and it's not exactly a raffle as you don't buy tickets - in order to qualify you have to go along to an information seminar to find out more about the treatment on offer.
Whether it's a dubious marketing strategy or a slippery path to something far more sinister depends on your point of view.

It's interesting that when another London clinic gave away a number of free treatment cycles, there was no outcry. Is this really no more than a similar free treatment offer for those who need donor eggs? In theory, perhaps not, but in practice the idea of a human egg raffle is highly distasteful - and all the more so to us in the UK because the winner will choose the donor from a wide selection of women who are willing to sell their eggs.

The HFEA came out and condemned the raffle as "inappropriate" and said it "trivialises altruistic donation". But what of the clinic concerned? Splashed across the pages of our newspapers and discussed on radio and TV, it certainly got publicity - and if you're of the opinion that any publicity is good publicity, then perhaps it worked. But will it have encouraged patients to dash off to the seminar for the chance of winning a cycle of donor treatment? Or would it be more likely to encourage them to seek treatment elsewhere?

Acupuncture guidelines

Complementary therapies for fertility problems are becoming ever more popular, and acupuncture in particular is generally accepted to be a successful alternative or addition to conventional treatments. Having a session of acupuncture before and after embryo transfer is thought to increase the chances of implantation. Indeed, it’s now so popular that some fertility clinics have acupuncturists working on site to provide an integrated service alongside the medical treatment due to patient demand. However, the British Fertility Society has now questioned the accepted wisdom that you're more likely to get pregnant if you've had acupuncture alongside your IVF.

They've issued guidelines which say there's no evidence that having acupuncture (or using Chinese herbal medicine) increases your chances of having successful fertility treatment. They examined the results of fourteen existing trials, which included more than two and a half thousand patients, and found no evidence that acupuncture made any difference to the outcome of fertility treatment. Acupuncturists question the methods used for the trials, but the lack of evidence cannot be entirely meaningless given the number of patients involved.

When The Complete Guide to IVF was published, I was questioned by an acupuncturist who didn’t feel I had been sufficiently positive about acupuncture during treatment in the book. In fact, I am not against the idea of complementary therapies at all, and I think that if they can make you feel calmer and more relaxed, this can only have a positive outcome. I had, however, pointed out that scientific evidence was not clear cut when it came to backing up claims that having acupuncture during an IVF cycle increased success rates. If you find that acupuncture makes you more able to deal with the ups and downs of IVF, then there’s every reason to use it while you’re having treatment. If on the other hand, you are spending money you can ill afford looking and are expecting miracles, it may be worth reconsidering.

You can read more about the British Fertility Society take on this at www.britishfertilitysociety.org.uk

The cost of fertility drugs

As a quick addition to the previous post about cost-price drugs from Asda, I was with some consultants from an NHS fertility clinic this week who informed me that they sell IVF drugs through their clinic at cost price, and that they are even cheaper than Asda! So do check out all your options...

An existing child...

Whether you qualify for NHS-funded IVF doesn't just depend on where you live in the UK, it can also depend on your personal circumstances. Women who are overweight, who are over a certain age or under another, couples or single women who need donor eggs or sperm may all find that their situation makes them ineligible. In many areas, having an existing child from a previous relationship means that you won't qualify for NHS help.

If both you and your partner have been in previous relationships and you have one or more young children from either of those relationships living with you in your home, discovering that you don't qualify for fertility treatment may be upsetting as you'd like a child together, but you do have "an existing child". However, what about a woman whose partner has an adult "child" from a previous relationship? She may have absolutely no contact with that young person and it's a very different scenario - yet she will also be deemed ineligible for treatment by many PCTs.

Fertility patients understand that these are difficult financial times and the NHS doesn't have unlimited funds, but is it really right to make up rules which treat people unfairly in order to disguise the fact that fertility treatment is rationed?

Cost price IVF drugs from Asda

Congratulations to Asda on the decision to sell IVF drugs at cost price. So many people who need fertility treatment have to pay for it privately, and the expensive drugs needed for each IVF cycle make it an even more costly business.

Whilst I'm delighted by Asda's decision, what shocked me most was the profit most other outlets are currently making when they sell fertility drugs. Asda say that if you buy your IVF drugs from them, you will pay around £1,170.00 - buying the same drugs elsewhere could cost you at least £800 more! When you're already spending a lot of money on your treatment, that's not a saving to be sniffed at. Most of us tend to imagine that pharmaceutical companies are to blame for the high cost of drugs, but this reveals that High Street pharmacies could be making a very healthy profit from those of us with fertility problems too.

The Asda pharmacy is online at www.asda-pharmacy.co.uk

PCOS - not too late to book for the conference

If you have polycystic ovary syndrome, you will be interested in a one day conference due to take place later this month in Reading. Organised by Verity, the PCOS support network, on March 27, the conference covers a wide range of topics including complementary therapy, health issues and dealing with excess hair. See the Verity website for more details.

Get paid to give your views!

Are you interested in giving your views on the sort of information people need when they're considering fertility treatment. The HFEA are looking for people who would be willing to spare an hour to give their views - and they'll even pay you for it.

Find out more below...

The HFEA needs your views
The Human Fertilisation and Embryology Authority Authority (HFEA) is developing a new publication for people who are considering fertility treatment.

What can you do?
We are looking for people who are considering or have had fertility treatment to attend a focus group in London on Wednesday, 3 February at 5:30pm to 6:30pm. You will be paid £50 for your time.

This is your chance to tell us what you think about our new publication and help others thinking about treatment.

Interested?

Email sharon.neaves@hfea.gov.uk with your name and a contact number. Please also tell us a little about what stage you are at with fertility treatment.

Your travel expenses will be reimbursed after the focus group. Everything you say will be treated confidentially.

New support group for British Asians

You may have read here before about the new infertility support group planned for British Asians. Things are now progressing, and the first meeting looks likely to be in March. It will be in Central London. If you'd like to know more, email katebrian@infertilitynetworkuk.com

Rocking embryos!

Well, this is a weird one - scientists have discovered that if you rock embryos gently during the IVF process, pregnancy rates improve. So far, the experiments have only been done on mice, but the results are promising.

When embryos are fertilised in the body in the normal way, they move all the time for the first day or two as they go down the fallopian tube and into the womb where they implant. During IVF, the eggs are left in a dish in an incubator and don't move at all. So, the team at the University of Michigan invented a device to gently rock embryos during IVF, and it increased pregnancy rates by 22% in mice. They believe it worked because the embryos that were gently rocked felt more at home. Trials in humans have now begun.

You can find out more about it at www.ns.umich.edu

Fertility crisis?

The Mirror is asking if Britain is in a fertility crisis... I thought perhaps they'd discovered something new or exciting, but there's not much in their feature that anyone with a fertility problem wouldn't know already, and a lot of the article focuses on age-related fertility problems.

It always fascinates me that with so much emphasis now on age-related issues, many GPs are still telling women in their 20s who are concerned about not getting pregnant that they are "too young" to be worrying about it. In fact, if you discover you've got a fertility problem in your 20s, you have a far better chance of being able to sort it out with treatment than you do if you are older. Maybe it's time for doctors to read the papers! See www.mirror.co.uk

Why should the NHS fund IVF?

Anyone who wonders why the NHS should fund IVF should read this moving letter printed in the Cambridge News

Age limits for IVF?

So, should a woman of 59 be offered IVF treatment? The story has been widely covered this week - a woman who already has a young child conceived in Russia is now looking to have a second child using a donor egg, and this time a London clinic has offered to treat her.

It's always a controversial issue, and raises hackles on both sides of the argument. Should you set a mandatory upper age limit for women to have a family if you don't set one for men? Why do we seem to think it is so wrong for women to have children in their fifties, when a man becoming a father at that age would not raise many eyebrows? There is of course no question of the NHS funding treatment for a woman of 59, so do we have a right to intervene if she is happy to pay and a clinic is happy to treat her? However, the most important issue here is the welfare of the child and the mother. Pregnancy and giving birth at 59 carry all kinds of age-related risks for them both. And is it fair for a child to have a mother who will be 70 by the time he or she reaches 10? What do you think?

You can read more on the story here

ESHRE says women who drink too much should be refused IVF

There's been a lot of interest today in the statement issued by the European Society of Human Reproduction and Embryology (ESHRE) about alcohol and IVF. ESHRE has advised that women who drink any more than moderately and do not cut back on their alcohol consumption should be refused fertility treatment. This is because there is evidence that excess alcohol consumption can make it harder to conceive, can increase the rate of miscarriage and can have a serious impact on a baby's future health.

In general, moderate drinking for a woman is considered to be no more than two or three units a day, with a couple of alcohol-free days in the week. For women trying to conceive, however, or for those who are pregnant, the advice is not to drink at all or to have a maximum of one or two drinks a week.

The ESHRE statement also looked at smoking and obesity, both of which can have a considerable impact on your chances of getting pregnant and staying pregnant. It was suggested that doctors should help patients make any necessary lifestyle changes before treating them. I suspect the reality is that the vast majority of those going through fertility treatment will be only too willing to make every lifestyle change that they can in order to increase their chances of success.

You can read more about the statement at www.eshre.com

PCOS conference

If you are affected by polycystic ovary syndrome, you will be interested in a conference taking place in March in Reading. The conference is organised by Verity , the PCOS support network and will take place at the Hilton Hotel on March 27. There are a range of speakers covering topics such as health, nutrition and complementary therapy. You can book online at the Verity website.

Calling all London IVF babies

The BBC are making a documentary series with Lord Robert Winston, and one of the programmes is looking at IVF. The team are looking for parents and their IVF babies who might be free early on Friday afternoon in London for some filming for the documentary. You won't need to be interviewed - but if you like the idea of your baby being on TV with Robert Winston, this is your golden opportunity! For details, contact Polly.Billam@bbc.co.uk

The Power of Positive Thought

I was fascinated by a piece in The Guardian recently about a new book by a woman who discovered that she had breast cancer rallying against the current obsession with the power of positive thought.

Barbara Ehrenreich soon found that expressing anger about her cancer was deemed to be the wrong way of dealing with it. Indeed, a whole industry of positive thought has emerged, promoting the idea that positive thinking alone can help reduce your risk of cancer, and that giving vent to negative feelings of frustration and hurt is simply unacceptable.

I find this whole idea really interesting, as a similar view seems to be gaining credence in the fertility world. Those going through IVF are encouraged to visualise a positive outcome, to imagine the baby they long for growing in their womb. They are told that thinking positively and remaining calm will increase the chances of a successful outcome.

I am sure that there is some merit in this for some people, but not for everyone. The reality is that IVF is often unsuccessful, and imagining that you can help yourself to get pregnant by thinking positively just gives you one more way to blame yourself if it doesn't work for you - you must have failed to visualise successfully, you must have allowed too many negative thoughts to cross your mind.

When I wrote The Complete Guide to IVF , I felt very strongly about this and did all I could to encourage people to see that what they did was most unlikely to alter the outcome of their treatment as long as they were sensible. Perhaps what we need now though is a Barbara Ehrenreich book about the fertility industry!

Octuplet doctor accused of gross negligence

There's an interesting article in the LA Times about the latest on the fertility doctor involved in the case of the American octuplets. He's been accused of gross negligence by the Medical Board of California.

It seems that in this particular case he continued to keep treating his patient, using high doses of fertility drugs, sometimes just three or four months after she'd given birth to one of her six children. She was stockpiling embryos as she kept having fresh treatment cycles, but he allowed her to carry on, and replaced more embryos than considered acceptable for a woman of any age, let alone one who'd already had a number of treatment cycles. There was never any assessment of her mental health. What's perhaps most saddening is his lawyer's defence of what occurred, saying that at all times the doctor concerned was only trying to comply with patient preferences.

I know that some people do consider our system here in the UK to be over-regulated, and the HFEA to be interfering, but if this is what happens when you don't regulate, it's pretty clear which system works best...

New Year wishes

Just to say I hope you all had a very happy Christmas - and best wishes for a good 2010