Come and say hello...

If you’re going to The Fertility Show at London’s Olympia tomorrow, do come and say hello.  I’m speaking at 11.45 about choosing a clinic, and then chairing a Q and A session with two overseas clinics at 3.30, so do come and find me if you’re there.   If you haven’t booked in advance, you can still turn up and pay on the door.

Piatkus, who publish my books, have very kindly donated some copies of The Complete Guide to IVF to the Infertility Network UK stand where they can be exchanged for donations to the charity, and I will also have some copies of Precious Babies, my latest book about pregnancy, birth and parenting after infertlity.

The Fertility Show is always a really interesting two days, and this year is on track to be the best yet with a fascinating array of seminars and exhibitors from around the world.  If you want to know more about exactly what’s on and when, go to www.fertilityshow.co.uk

Could you ask strangers for money to pay for IVF?

It may sound incredible, but apparently people are having to come up with ever more inventive ways to fund their fertility treatment in the current economic situation.  With many couples already living on overdrafts, cutting back on holidays or other luxuries will not free up the ready cash needed, and getting loans or using already overloaded credit cards is becoming increasingly difficult. So, in the States at least, some couples have apparently turned to the internet using websites or Facebook to ask strangers for money to fund their treatment – see this article.  Could you consider this? Should you have to?

Here in the UK, the postcode lottery for treatment continues to cause distress to many couples who find they can’t access IVF despite being eligible according to the national guidelines because in their local area the primary care trust has decided not to fund treatment – or to ration it.  It can be very difficult to find the money for private treatment which will cost more than the NHS would pay.  Lord Winston campaigned on this some time ago – saying that many clinics were hugely overcharging for fertility treatment and that it could be far cheaper.

Asking strangers for money may seem extreme, but does perhaps illustrate how difficult it can be to live with involuntary childlessness…

Is it ever right to raffle fertility treatment?

When plans for an IVF lottery were announced here in the UK, the overall response was far from positive with questions raised about the ethics and the finances, but in the US it appears that running lotteries for fertility treatment has become more common.  One clinic even asked people to enter a competition to win treatment by writing or making a video about their fertility problems and why they deserved treatment…

It’s true that our current access to funded fertility treatment is problematic to say the least, and that many couples simply can’t afford to go privately – but does that make running lotteries for treatment right? Those in favour argue that it offers hope, but if your chance of winning is one in a million, it’s probably more about raising unrealistic expectations.  Lotteries may be a good way for clinics to gain publicity, they may be a good way for individuals to make money – but I don’t see how a lottery can ever be a satisfactory way to offer healthcare.

If you’re interested, you can read more about the US lotteries here 

After embryo transfer...

One of the most alarming moments in an IVF cycle - for me at least - was standing up for the first time after embryo transfer.  I could never quite get over the idea that an embryo could just fall straight out when you get up after the transfer. Speaking to other people since, I've learnt that I'm not the only one to feel that way. It's quite common to worry that you might somehow jeopardise your chances of success if you stand up too quickly - or if you do too much in the days after embryo transfer.

Some complementary therapists advise a couple of days bed rest after embryo transfer, but research shows that this makes absolutely no difference to outcomes at all - and you can bet your bottom dollar that fertility specialists would all be encouraging their patients to stay in bed if there was any chance that this could possibly increase success rates.

When fertility treatment doesn't work, we want to know why and start looking for reasons.  Most often, there is no clear reason but you can rest assured that the one thing that really won't make a difference is how long you spend lying down in the first couple of days after embryo transfer.

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...

Eggs for sale

When the levels of compensation for egg donors were increased, it was generally welcomed as a good move.  £750 was seen to be an acceptable rate to repay altruistic donors who faced considerable disruption and discomfort for their kindness.  The HFEA was careful to point out that the fixed rate payment had been set at a level which would not attract "those who are merely financially motivated".

Having overheard a conversation between two shop assistants earlier this week, I am not sure this has turned out to be the case.  My ears prick up automatically at any mention of fertility treatments, and when I heard one explaining to the other that she would have to go through a full IVF cycle, I assumed she was talking about her own fertility problems.  Then, to my surprise, she went on to say that it was quite a lot to go through with the operation to collect the eggs and everything, but that she had concluded it was worth doing because it would be an awful lot of shifts in the shop to get the same amount of cash - and I realised she was talking about becoming an egg donor.

Admittedly, it was only a short conversation, but at no point at all was the thought of a child, of helping someone else or of the future consequences mentioned. Whether it was worth donating eggs or not focused entirely on how many shifts you'd have to work in a shop to get the same amount of money.

It made me feel terribly sad.  I know we need more egg donors and I was in favour of the changes to compensation, but I really hope that young women like this are getting the advice and counselling that they need before making decisions about donating eggs. Although £750 probably doesn't seem much to the professionals running the HFEA, it's enough money to make a huge difference to many women in the UK.  Of course, we want to compensate people properly, but we do have to be very wary of creating a situation where for young girls in need of cash, donating their eggs is a purely financial decision.

Eggs from skin cells

It's hard not to get excited about stories like today's news of Japanese scientists successfully creating embryos from skin cells which led to the birth of fertile offspring.  The reality is that this is a technique still in the very early stages which is not going to be available in your local fertility clinic in the foreseeable future, but it's still an amazing development.

The Japanese team had already managed to create sperm from stem cells, and this is their latest advance. They performed a very complex experiment, creating eggs from skin cells, building an ovary-like structure to support the eggs when they transplanted them into the mice, and then using IVF techniques to fertilise the eggs.  Not only did the embryos implant and lead to pregnancies, but the babies themselves have been shown to be fertile and able to reproduce.

There is still a very long way to go to find out whether this could work with human skin cells and eggs, but it does offer hope for the future.  Fertility treatments have become more successful in recent years, but cannot reverse the effects of the biological clock on female eggs - and women who don't have viable eggs of their own currently need to use donor eggs.  Today's news raises the possibility that perhaps one day in the future, there will be other options available.

Scottish funding - not good news for smokers or overweight women

Well, yes it's still great that Scotland is investing in fertility services, but the announcement was swiftly followed by the news that in Fife anyone who was overweight or who smoked would not qualify for treatment.  The weight rule applies solely to women who have a BMI, or body mass index, of 30 or above but the smoking ban applies to both partners.

This kind of rationing is often presented as being only sensible because we know that smoking affects IVF outcomes and that being obese can affect fertility - why not restrict treatment to those for whom it is most likely to work? The problem is that all kinds of medical treatments are more likely to be successful for average-sized non-smokers, and yet rationing in many other areas would be seen to be out of the question.

It's yet another example of the way that couples with fertility problems are judged - and divided into those who are deemed to be deserving of treatment and those who are not.

Scotland invests in fertility services

Great news if you live in Scotland where the Scottish government is investing 12 million pounds in fertility services over the next three years.  The aim is to reduce waiting lists so that no one waits more than a year for fertility treatment - and to improve access across all local health boards.  Maybe this will inspire an improvement in the rest of the UK where the postcode lottery means that your access to treatment depends entirely on where you live.

Infertility Network Scotland, who have been campaigning hard for improvements in access to treatment in Scotland, have welcomed the move - details here

The HFEA debate

I was really sorry to have to miss the recent debate organised by Progress Educational Trust on the future of the HFEA, and so was pleased to find a write up of the evening in this week's edition of Bionews.  It was clearly a lively and interesting debate - it may only be a snapshot view but it's interesting that those working in fertility clinics seemed keenest to be rid of the HFEA, while those on the outside were keener for it to remain.  I'd be the first to agree that streamlining and change are both necessary, but it's far too easy to focus on the negatives and to forget all of the good work that the HFEA has done and continues to do.

One of the speakers apparently claimed that people were travelling overseas for treatment because of over-regulation by the HFEA in the UK.  Having spoken to many people who've opted to have treatment abroad, I can't remember hearing one of them mention "over-regulation" as an issue - excessive costs and waiting lists were more likely to come up as reasons for having treatment abroad, as well as higher success rates in some other places and being treated as an equal by consultants.

Sadly the one thing that wasn't mentioned in the reporting of the evening was patient information, and I don't know whether this cropped up at all.  For most fertility patients, information provision is one of the most important functions of the HFEA.  It's the publication of success rates, the reliable information about new treatments and the calm response to fertility scare stories that is so vital - and yet it seems to be the one thing that most of the experts discussing this seem to entirely overlook.

The FertilIty Show

It's nearly that time of year again... I've just been sent posters and flyers for The Fertility Show, which this year runs over the weekend of November 3 and 4 at London's Olympia.  Promising to be a bigger event than ever before, there's an impressive range of speakers lined up covering pretty much everything you could want to know about fertility from the absolute basics to the latest new techniques in IVF.  The seminars also take in many related issues including complementary therapies, surrogacy, treatment for single women and lesbian couples, the male perspective, adoption, fostering, treatment abroad and help and support too.

This year there are around 100 exhibitors too, giving you a chance to talk to staff from fertility clinics around the world as well as complementary therapists, legal firms and support networks. The Fertility Show gathers together leading experts in the field along with a wide range of specialists all under one roof for one weekend - and provides an ideal opportunity to learn more in a supportive environment.

I know it's not always easy to get your head around going to a "show" about fertility when it can be hard to talk about the subject to your closest friends and family, but one of the real benefits of the weekend is being in one place with so many other people who know exactly how you're feeling - although infertility affects one in six of the population, it doesn't always feel that way when you're in the middle of it all.  

Take a look at the website - www.fertilityshow.co.uk- and see what you think. I'll be there on the Saturday, talking about how to choose a fertility clinic and chairing a question session with overseas clinics - so come along and say hello1

Obesity and your eggs

For some time, women who are very overweight have been told that they have a reduced chance of success with IVF - and in some areas have been denied access to funded treatment because of this - but now for the first time researchers may have found out why.  It appears that women who are very overweight are more likely to have abnormalities in their eggs and that this reduces the chances of fertilisation.

Researchers in the US examined almost 300 eggs that hadn't fertilised during IVF cycles, and found that the eggs belonging to women who were severely obese were much more likely to have abnormally arranged chromosomes.  It is important to stress that these weren't women who were just a little plump - the eggs were only shown to have a problem in women who had a BMI (body mass index) of at least 35.  Interestingly, the research team say that by losing weight woman could improve their chances of getting pregnant - so the damage is not irreversible. 

Losing weight can be difficult when you're going through fertility treatment and feeling generally rather down and depressed, but this new research suggests that for anyone who is seriously overweight, making an effort may prove to make all the difference.  Don't forget that you can always visit your GP for help and advice about weight loss - and that joining a group can sometimes give you the added impetus you need.  For anyone with PCOS who is finding it hard to lose weight, I'd suggest getting in touch with Verity - the PCOS network - not because they have some miracle weight loss magic, but because the support of others in a similar situation can make all the difference. 

Lower doses of IVF drugs?

There have been a number of articles about "mild" or "soft" IVF in the last few months, all suggesting that the higher doses of fertility drugs often used in the UK and USA during fertility treatment are potentially hazardous as they can lead to hyperstimulation. One recent piece described OHSS, or ovarian hyperstimulation syndrome, as a "little-known" side effect of treatment making it sound as if the condition had only just been discovered.   While it may well be little known to the journalist in question, it is hardly little known to anyone who knows much about infertility and treatment.

What's quite interesting about these articles is that they're all entirely one-sided, only quoting experts who happen to be great advocates of mild IVF and making it sound as if anyone who doesn't do this cannot possibly have their patients' best interests at heart.  Such articles would make far more credible reading if they also allowed space for those who don't use mild IVF to explain why.

While it's true that OHSS can be a very dangerous condition, it is also true that some women are at greater risk than others and that careful monitoring during treatment can reduce the chances of the condition developing.  Generally success rates are lower with mild IVF, which is why fertility specialists choose to stimulate the ovaries to produce more eggs in order to increase the chances of success.  Perhaps in the future we will be able to get excellent outcomes with far lower doses of drugs, but in the meantime it may be more prudent to continue to tailor the dose to the individual to increase the chances of success and reduce the risks.

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.

Lesley Brown

I hadn't read about the sad death of Lesley Brown, mother of the first ever IVF baby Louise Brown, earlier this month.  It makes you realise quite how long ago it is since Patrick Steptoe and Robert Edwards carried out the pioneering work that led to Louise's birth in 1978.  IVF is so common now that we may not always appreciate quite how extraordinary it seemed to people at the time, and how much suspicion there was about what Patrick Steptoe and Robert Edwards had achieved.  It wasn't just the media or the general public expressing fears and concerns - the medical establishment was very unsupportive of what had been achieved.

In the coverage in the papers of Lesley's death, I came across a wonderful line in the Daily Mail which explained that - Two years ago it emerged that Louise was actually grown in a jar rather than a test-tube. The idea that Mail readers - and journalists - had for the past 32 years been under the misapprehension that IVF babies were being "grown" in test-tubes was enough to make the mind boggle, and perhaps illustrates the level of misunderstanding that still exists about infertility and IVF today.

It's hard to imagine what it must have been like for Lesley Brown with all the fears and concerns about IVF at the time - and it makes it very clear what a brave woman she was - and how much she wanted Louise.

Fertility drugs for sale

I just came across a website where fertility drugs were being bought and sold, apparently from one fertility patient to another.  Judging by the number of posts put up in the last 24 hours, it's a popular business. People were reassuring one another that their drugs had been properly stored and that the dates hadn't expired.  Others were posting pleas for cheap fertility drugs, claiming that they needed them urgently.

I can't stress enough how unsafe this is.  If you're putting yourself through the trauma of fertility treatment - and often the expense too - there's really little point in trying to save a few pounds, or even a few hundred for that matter, by buying someone else's leftover drugs.  When you buy fertility drugs this way, you have no idea who you are buying them from or whether they've really been properly looked after - in fact, you can't even guarantee that they are what they say they are.  It's simply not worth the risk that you could ruin your chances of successful treatment by trying to cut costs this way.

Fertility treatment is hugely expensive - and you can save money on your drugs by shopping around - but just make sure you shop around from reputable suppliers rather than people trying to offload their leftover drugs online.

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.

What's the worst thing anyone's said to you...

If you haven't seen this video yet, it's worth watching - just to reassure yourself that you're not the only person to have come across some of these "helpful" comments from other people.  One thing we all find is that people who know absolutely nothing about infertility are more than happy to give their advice and suggestions as to what you ought to be doing or ought not to be doing - and there's often an underlying suggestion that somehow it might be your fault, which only serves to exacerbate the stigma that so many of us feel.

It's difficult. People can't always get it right, and they don't always mean to be unkind or hurtful, but most of us have out own lists of the most unhelpful things that people have come up with.  Do you have any particular favourites?  Mine include an agony aunt (surely she ought to know better?) who advised couples with fertility problems that they might want to consider buying a dog instead of continuing to try to have a baby and the person who seemed to need to remind me on a regular basis that she had got pregnant by mistake.

You're bound to recognise one or two from the video - the "maybe it just wasn't meant to happen" type comment is a regular one...  And the lose weight/gain weight/stop thinking about it/be less obsessed with your career comments are popular too...  Maybe we should compile a list...