Being unhappy doesn't affect IVF outcomes...

I was hugely heartened by the recent research, published in the journal Fertility and Sterility (awful title but it's an academic journal!),  which showed that feeling anxious or depressed when going through fertility treatment didn't affect the outcome.  I've always maintained that it's unhelpful to tell people who are embarking on fertility treatment that they should be cheerful and positive when they are living with  the huge emotional ups and downs of infertility - it just seems completely unrealistic.  I know I felt stressed, anxious and worried when I was having IVF.  I was not happy, I was not positive, I was unable to "visualise success" or any of the other things that we are often told will increase our chances of a successful outcome - and yet my treatment worked.

We need to be realistic, to accept that infertility is stressful, that it often makes you unhappy and miserable.  There's a growing industry surrounding conventional fertility treatments of complementary therapists and coaches who make a lot of money telling us how they feel we can improve our chances of success. Some of this can be very helpful, but it is perhaps inevitable that when those who have no personal experience take an objective view of infertility and treatment there are sometimes fundamental misunderstandings which can lead to this kind of advice that's often way off the mark. It's just like the friends who tell you that you'd probably get pregnant if you stopped thinking about it...

I've seen too many people who've blamed themselves for their unsuccessful treatment, somehow feeling that they've failed when it doesn't work, and that it must be something they've done or haven't done, that it might have worked if they'd been able to be more upbeat and positive.  Now there's research to show that this simply isn't the case - infertility and unsuccessful treatment makes you depressed - depression doesn't lead to infertility and unsuccessful treatment.

Fresh or frozen?

An interesting new piece of research has looked at the effectiveness of freezing all the embryos created during an IVF cycle and then replacing them in a later cycle where no stimulation has been used.  It seems there are concerns that when you stimulate the ovaries, this may have an impact on how well the lining of the womb receives embryos. Not only this, but replacing frozen embryos in a later cycle also reduces the risk of hyperstimulation (OHSS).

The suggestion is that freezing embryos and transferring them later could actually increase pregnancy rates and also make IVF far safer for women by cutting the risk of hyperstimuation - although most women who get OHSS have fairly mild symptoms, it can be extremely dangerous.  Now, researchers from Spain have reviewed all the relevant studies in this area and analysed the results, coming to the conclusion that the chance of a pregnancy is as much as 30% higher if all the embryos are frozen for a later transfer rather than transferring them right away.

As is often the case with these rather interesting news stories, those responsible for the study have said that more research is needed to confirm their findings before making any changes to routine treatments for patients - but it will be reassuring for anyone who is having frozen embryos transferred. We often assume that this reduces the chances of success, but the evidence seems to suggest it could be quite the opposite.

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.

New research on how many embryos to transfer

There has been some interesting coverage today of the study published in The Lancet about how many embryos should be transferred during IVF treatment. Sadly, some of it does illustrate a lack of understanding about current practice and the move towards single embryo transfer.

The research in the Lancet found that the difference in chances of success between single embryo transfer and transferring two embryos was much greater for women of 40 or more and so recommended that there should be some flexibility in the decision about how many embryos to transfer for older women. Interestingly, the researchers found that transferring three embryos did not increase the chances of a live birth in women of any age.

This new research has been used to suggest that the move towards single embryo transfer is somehow flawed, but in fact the research backs up very well the current policy in the UK which is that single embryo transfer is recommended for those who are most at risk of twins - in other words, younger women with a good prognosis. Single embryo transfer would usually only be suggested for women of 40 and above when using donor eggs. IVF success rates for women in their forties are not high, but the age of the donor is the deciding factor when women are using donated eggs.

You can read more about the research on the Lancet website.

Ideal number of eggs for IVF success?

If you've had IVF treatment, you'll know how important the number of eggs collected during the cycle can seem - but other than assuming that lots is good, most of us have little idea of what would be the perfect number to maximise the chances of success.

Now, researchers have analysed data from more than 400 000 IVF cycles using information from the Human Fertilisation and Embryology Authority to see if they could find a pattern of success related to the number of eggs collected. Looking at the live birth rate, they were attempting to produce a model to predict the chances of success based on the number of eggs and the age of the woman having treatment.

Their research showed the live birth rate rose gradually depending on the number of eggs collected until it reached 15 eggs, at which point it stayed stable until it got to 20 eggs, after which it began to decline. For women under the age of 34 who had 15 eggs, the live birth rate was 40% across the UK, and even for women of 40 and over, it reached 16% if they had reached the desired 15 eggs at collection. So 15 has been deemed as the ideal number of eggs in order to maximise the chances of achieving a live birth after IVF treatment.

You can read more details of the research, which has been published in Human Reproduction, here

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

Exciting new advance for IVF

Despite all the advances in IVF over the years, the one big hurdle has been knowing which embryos were most likely to implant in the womb. Now, a new screening technique can be used to check for genetic abnormalities which can lead to a miscarriage. Using this technique, researchers have had success rates of more than 66%, a remarkable level considering that most of those in the trial were around the age of 39 and had tried IVF a number of times before. Although the numbers involved in the trials have been quite small, if this could be replicated elsewhere, the potential is enormous.

More on this story here

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