IVF or ICSI?

Anyone going through fertility treatment wants to maximise their chances of success, and you may have heard that opting for ICSI will mean you are more likely to end up with a baby whatever the nature of your fertility problems.  In fact, ICSI is a treatment for male fertility problems which is also used when IVF hasn’t worked in the past because eggs haven’t fertilised.  When it is used in these circumstances, it can increase the chances of success.  There is, however, no benefit from using ICSI for those who don’t actually need it.

I’ve just been reading a really interesting paper on this in the journal Human Fertility which looked how fertility clinics in the UK approach ICSI and found wide discrepancies with some clinics using it for around 20% of their IVF cycles and others using it in more than 80% of IVF cycles.  The criteria they used to decide when to use ICSI also varied, with many offering it for sperm that would be considered perfectly normal and letting patients to choose whether they wanted IVF or ICSI regardless of the nature of their fertility problems. 

You may feel that it’s up to you to have that choice, but patients aren’t always presented with clear evidence about what ICSI can and cannot do.  Research shows that using ICSI when you have normal sperm doesn’t increase success rates, and in fact there is even some suggestion that it could lead to a reduced chance of success.  ICSI is more expensive and there have been questions raised about the potential risks of the technique.

For men with fertility problems, ICSI has been a hugely important development allowing many couples to have the children they long for - but it’s not something that should be undertaken as some kind of optional add-on,  If you don’t need ICSI, why pay more money for something which could carry more risk and which will not increase your chances of a successful outcome?  It’s time fertility clinics started spelling this out more clearly to their patients...

Improving your chances of IVF success

Anyone going through fertility treatment wants to try to maximise their chances of success, and a number of new reports out today suggest that there are some lifestyle factors that can make a real difference.

The first report looked at caffeine consumption, and found that women who drink five or more cups of coffee a day reduce their chances of getting pregnant after IVF by a shocking 50%. Up until now there have been conflicting results from investigations into caffeine consumption, but this new study was a large one, following up nearly 4,000 women who'd had IVF or ICSI. Interestingly, for women who drank coffee but consumed fewer than five cups, the coffee didn't have any effect.  So, there's no need to cut out your wake-up coffee altogether, but just make sure you limit your consumption.

The second study looked at consumption of saturated fats, and found that women who had a higher than average intake didn't have as many mature eggs ready for collection in IVF treatment. This was a far smaller study, but showed that different types of fat had different effects.  The doctors who carried out the research said it was too early to make any firm recommendations to patients, but as it's not good to eat lots of saturated fats anyway, this may perhaps emphasise that healthy eating when you're trying to conceive may make a difference.

The final study looked at smoking, and found that it affected the environment in the Fallopian tube and uterus, which may explain why women who smoke are more likely to have ectopic pregnancies.  The vast majority of women who get as far as fertility treatment have already given up smoking because it reduces the chance of success and increases the risk of miscarriage - but this new research provides yet more evidence of the way smoking can damage your fertility.

All of these research projects are interesting, but perhaps not entirely surprising as they sum up what we may well have suspected already - that moderation, common sense and a healthy diet can make a difference when it comes to IVF success.

Another day, another IVF scare story

Have you noticed how every IVF story begins with a couple's "desperate bid" for a child? Perhaps that should be every cliche-ridden story, but it's such a horrible phrase.  I desperately longed for a child, but I wasn't making a "desperate bid" for one by having IVF - I was having the treatment needed to sort out a medical problem.  Do people make "desperate bids" for treatment for any other medical condition I wonder? Anyway, enough...

The newspaper story I've just been reading (which begins with the formulaic "desperate bid")  is about a couple who had ICSI twins delivered prematurely, and it suggests that the problems they experienced must be down to the ICSI - without any consideration of the fact that they were multiples born prematurely when we know that multiple birth is the biggest health risk to IVF babies. 

The article in question went on to catalogue virtually every scare story about IVF just in case you weren't sufficiently freaked out (with a small caveat admitting that actually there was some conflicting evidence). It even suggested that parents of IVF children were constantly worried about what their fertility treatment might have done to their children's health when they were much older, concluding that if you have fertility treatment it will always continue to cause you "unimaginable anxiety" - I interviewed dozens of IVF parents for my book Precious Babies and can assure you that this is simply not true.

Please don't get taken in by scare stories - talk to your fertility specialist and get an expert's insight into the situation. I'm not posting a link to the original story - if you've read it, I hope this reassures you - if you haven't, please don't bother.

Fertility treatment in the news

There seem to have been a spate of scare stories about fertility treatment in the news in the last couple of weeks, and it can be very hard if you're going through it yourself to know what you should believe or whether you should be worried. When I was having IVF, the safety of using frozen embryos was quite an issue, with many people refusing to even consider the idea, and it seems ironic now as there have been a number of studies suggesting using frozen embryos may actually be a very positive thing. The latest story focuses on ICSI, and is far from the first surrounding the treatment as most experts are clear that there may be risks that we are not yet sure about as ICSI is a far newer treatment than IVF itself. At the same time it is important to stress that the real risks are small and that many thousands of healthy babies have been born after ICSI treatment, which has allowed many men who would never have been able to have their own genetic children otherwise to become fathers, If you're ever worried about any aspect of infertility or treatment, you should always discuss it with your fertility specialist or doctor.

The Two Week Wait by Sarah Rayner

There's a shortage of good novels about IVF and infertility, and The Two Week Wait by Sarah Rayner fills a gap in the market. The novel is about egg sharing, deftly weaving together the two separate stories of an egg donor and her recipient, and showing the huge impact they have on one another's lives although they never meet.

Sarah Rayner shows a real understanding of the emotions of infertility and the book will resonate with anyone who has personal experience of fertility problems. I particularly liked the ghastly sister-in-law Sukey, who epitomises those self-righteous people most of us have come across somewhere along the way on our fertility journeys who make a point of telling us that they "don't believe" in IVF - you know the type I'm sure, the people who tell you that you'd get pregnant if only you stopped obesessing about it, that it may all be in your mind, that a bit of chanting or standing on your head would probably sort you out...

The Two Week Wait features a number of characters from Sarah Rayner's last hugely successful novel, One Moment, One Morning - having really enjoyed that book, it was great to revisit their lives. The Two Week Wait is a refreshing read and leaves us with the thought that a happy ending isn't necessarily the ending we thought we were looking for - I finished the book with tears in my eyes.

My only issue with the book was a medical one as in the story it is suggested that ICSI (a form of IVF where the sperm is injected directly into the egg rather than being left to fertilise it naturally) can boost IVF success rates even when the sperm is perfectly normal. The characters pay an extra £800 for this despite having perfectly good sperm and it worries me that readers might be left thinking they should opt for ICSI when they don't need it. In fact, ICSI is a treatment for male infertility that may also be used after unsuccessful treatment where fertilisation has been a problem. Research shows that ICSI does not increase the chances of a live birth after treatment for couples who don't need it. Some clinics do carry out a lot of ICSI where the sperm is normal and it certainly boosts their profits, but if anyone recommends this for you, make sure you know exactly why they are suggesting it before you fork out any money.

Apart from that, I really enjoyed the book and would recommend it - it's a great read and you won't be able to put it down!

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.

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

Research into implantation rates after ICSI

A team from the University of Bonn in Germany have been researching implantation rates after ICSI, and believe they may have found a way of identifying the fertilised eggs that are most likely to implant successfully.

The German researchers have just published their findings, and suggest that by inspecting the outer layer of the egg in a particular way under the microscope, they may be able to identify the embryos that are most likely to implant and to result in a pregnancy. They have now developed software to analyse the data from the microscope and help select the best embryos.

The major stumbling block for scientist and medical teams when it comes to IVF is implantation. Eggs and sperm can produce wonderful-looking embryos, but once they are transferred to the womb, no one really knows why some implant and others don't. There's more about this new research on the University of Bonn website

IVM - is it for you ?

Anyone with an interest in fertility is likely to have heard the recent news about the first babies born in the UK after a new type of treatment called in vitro maturation, or IVM. The glowing newspaper reports on the subject suggested IVM was about to revolutionise fertility treatment. Cheaper than IVF, less invasive and less risky, it sounded the perfect solution and patients could be forgiven for rushing off to their clinics to demand it immediately. The reality is that IVM is not yet widely available, and is not suitable for everyone anyway.

IVM doesn't use drugs to get women to produce lots of eggs. Instead, it involves taking immature eggs straight from the ovaries, maturing them in the laboratory, and then injecting them with sperm. The technique relies on women having lots of immature eggs, and success rates are low for anyone with normal ovaries who is unlikely to have sufficient quantities to make it worthwhile. IVM is most suitable for younger women with polycystic ovaries because they tend to have an abundance of immature eggs, but even then, success rates are not particularly high at between 20 and 30%.

IVM is a relatively new technique, which has only produced 400 babies worldwide so far, and at the moment only one clinic in the UK is licensed to carry it out. It is cheaper than IVF because you're not using any drugs to stimulate the ovaries, so you save on the hefty drugs bill. It also cuts out the risk of hyperstimulation, which is a particular danger for women who have polycystic ovaries when they take the stimulating drugs.

IVM is undoubtedly an exciting step forward in reproductive medicine, but the revolution the news reports may have led us to expect is still some time away.