We're still trailing behind when it comes to IVF

Anyone who has any personal experience of IVF will know that our funding situation in the UK is patchy at best, but the report released from ESHRE this week showing quite how badly we're trailing behind our European neighbours was still something of a shock. We came third from the bottom in a European table for funding fertility treatment, with only Russia and Ireland behind us. Belgium and Denmark both fund around three times as much treatment per million inhabitants as we do.  Even Slovenia funds twice as much.

I've just been on Radio Humberside discussing the situation, and the presenter seemed not to have considered that infertility might be a medical condition. It always strikes me as odd that if it's your fallopian tubes or your ovaries that don't work, a medical problem becomes  a "lifestyle choice".  Where do we draw the line with "lifestyle choices" and medical treatment? Infertility is not going to kill anyone, people often say. No, it probably isn't, but surely the NHS wasn't set up only to treat people who would drop dead if they weren't helped right away?  Even funding three full cycles of IVF for all those who needed it would be a tiny drop in NHS budgets - and cutting all IVF funding entirely wouldn't begin to solve our financial problems (indeed it could make them far worse, if more and more fertility patients started going overseas and coming back pregnant with triplets).

I think this debate is about something much more than infertility - although our attitudes to families and children in the UK probably provide an interesting tangential discussion. It seems to me that deciding that some medical conditions are unworthy of treatment is the tip of a very large iceberg which rests on our decisions about what the NHS is for. What other treatments might constitute "lifestyle choices"? Hip and knee replacements perhaps? Might people decide that they aren't entirely essential?  Perhaps being able to walk long distances without any pain is a "lifestyle choice" - you don't have to walk far, you can take painkillers.

Cutting IVF funding is easy - some people even think it's a good thing.  People with fertility problems are often so distressed that they haven't told their closest friends and family about what's happening to them.  They aren't going to be outside the local PCT waving banners and shouting.  Just because something is easy, that doesn't make it right - and being oblivious to the longer term consequences of short-term financial decisions seems to be all too common at the moment.

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

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

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

New survey on treatment overseas

More and more people are travelling overseas for fertility treatment, often to escape rules and regulations in their own countries, according to a new cross-European study. For patients from the UK however, a major reason for travelling was the difficulty of accessing treatment. Many couples who need donor eggs find they face long waits in the UK and may choose to travel to Spain or the Czech Republic where there are more women willing to donate eggs. Age also played a part, as more than 60% of British women travelling for treatment were over the age of 40.

In Italy, freezing embryos is not permitted, so it is perhaps not surprising that Italians are the largest group of people travelling for treatment, whilst in France, lesbian couples are not eligible for IVF, so many same sex French couples travel for treatment. You can find out more about the new research at www.eshre.com