Anyone who needs fertility treatment and lives in the East of England should be celebrating today with the announcement that the area is to be the first to fully implement the guidelines on fertility treatment and offer three full cycles of IVF.
This fantastic news will offer new hope to many couples living in Norfolk, Suffolk, Essex, Cambridgeshire, Hertfordshire and Bedfordshire. There are some criteria, but unlike those used by many other primary care trusts, these are perfectly reasonable - the female partner must be between the ages of 23 and 39, they should not smoke and there should be no existing children from the current relationship.
The funding will start next April - just five years after the initial guideline from the National Institute of Clinical Health and Excellence which recommended that all primary care trusts should be funding three full cycles of treatment. It may have taken time, but maybe now more trusts will realise that these guidelines are meant to be followed rather than ignored, and perhaps couples in other parts of the country will eventually be able to access the treatment they need.
You can read the full details of the proposals for the East of England at www.eoe.nhs.uk/news
Friday, 22 August 2008
Monday, 18 August 2008
To rest or not to rest
I've been thinking about the two week wait after IVF recently - not something I too often choose to remember, but I've been addressing the debate about bed rest after embryo transfer and whether it's a good thing in the new book I'm just completing.
Nowadays some holistic fertility centres recommend that you lie flat on your back for a few days after embryo transfer (once you've got home from the hospital, of course..), Back when I had treatment, I'd always been told that being fairly active was beneficial as it increased the oxygen levels in the blood. It seems that although doctors in the UK don't generally recommend bed rest, in other parts of the world they often do, which makes it all even more confusing for anyone having treatment.
I've been looking up the available research on the subject and it seems that most studies have found no increase in the pregnancy rate amongst women who have gone to bed for a few days after embryo transfer. In fact, one paper found that women who opted for bed rest had a LOWER pregnancy rate. However, many women do say that it helps them feel calmer and more relaxed. I think I've concluded that you just have to do what feels right for you, but whether that's lying on the sofa watching television for a few days or dashing about as normal, you should feel assured that whichever you choose is unlikely to have much influence on the outcome of your treatment.
Nowadays some holistic fertility centres recommend that you lie flat on your back for a few days after embryo transfer (once you've got home from the hospital, of course..), Back when I had treatment, I'd always been told that being fairly active was beneficial as it increased the oxygen levels in the blood. It seems that although doctors in the UK don't generally recommend bed rest, in other parts of the world they often do, which makes it all even more confusing for anyone having treatment.
I've been looking up the available research on the subject and it seems that most studies have found no increase in the pregnancy rate amongst women who have gone to bed for a few days after embryo transfer. In fact, one paper found that women who opted for bed rest had a LOWER pregnancy rate. However, many women do say that it helps them feel calmer and more relaxed. I think I've concluded that you just have to do what feels right for you, but whether that's lying on the sofa watching television for a few days or dashing about as normal, you should feel assured that whichever you choose is unlikely to have much influence on the outcome of your treatment.
Friday, 8 August 2008
A cause of endometriosis?
Scientists think they may have worked out why some women get endometriosis - a common condition where tissue similar to the womb lining starts growing elsewhere in the female body. Endometriosis occurs in about 15% of women, and it can affect their chances of getting pregnant.
Now scientists at Liverpool University have identified an enzyme called telomerase that they believe may be responsible. They hope that this will enable them to diagnose and treat endometriosis more effectively. You can read more details about the research, and the enzyme, at www.liv.ac.uk
Now scientists at Liverpool University have identified an enzyme called telomerase that they believe may be responsible. They hope that this will enable them to diagnose and treat endometriosis more effectively. You can read more details about the research, and the enzyme, at www.liv.ac.uk
The treatments that don't work for unexplained infertility
It seems that two commonly used fertility treatments are a waste of time when they're used to treat couples with unexplained infertility. A research project in Scotland looked at the use of Clomid (clomifene citrate) and IUI (intra-uterine insemination) and concluded that they neither of them really made much difference to the chances of conceiving.
The study followed 580 women with unexplained infertility. Some were prescribed Clomid, some were given IUI and some weren't given any treatment at all. Perhaps surprisingly, the lowest pregnancy rates were amongst the group who took Clomid. Although the IUI group did have a slightly higher pregnancy rate than those who had no treatment, the research team say the differences are small enough to be statistically meaningless, and have concluded that there may be no medical justification at all for prescribing Clomid or attempting IUI in women with unexplained infertility.
No one would want to be given a treatment that isn't going to work, and we must welcome any research that looks into the efficacy of fertility treatment. However, it does worry me that this may make it easier for local trusts to cut their spending on infertility yet further - at the moment many will pay for Clomid and IUI, but not for IVF. If they decide to stop spending on Clomid and IUI for unexplained infertility, I fear they are not going to increase their spending on IVF, and some couples may find that they can't access any kind of treatment at all. What's more, commissioners may start to assume that couples with unexplained infertility would all get pregnant eventually if they left it to Nature. I know from personal experience of more than 13 years of unexplained infertility, that this is not the case. So although it's helpful to know that these treatments may not be much use if you don't know why you aren't getting pregnant, it may not be so helpful if you end up not being able to access any other treatment instead.
You can read more about the research which is published in the BMJ at www.bmj.com
The study followed 580 women with unexplained infertility. Some were prescribed Clomid, some were given IUI and some weren't given any treatment at all. Perhaps surprisingly, the lowest pregnancy rates were amongst the group who took Clomid. Although the IUI group did have a slightly higher pregnancy rate than those who had no treatment, the research team say the differences are small enough to be statistically meaningless, and have concluded that there may be no medical justification at all for prescribing Clomid or attempting IUI in women with unexplained infertility.
No one would want to be given a treatment that isn't going to work, and we must welcome any research that looks into the efficacy of fertility treatment. However, it does worry me that this may make it easier for local trusts to cut their spending on infertility yet further - at the moment many will pay for Clomid and IUI, but not for IVF. If they decide to stop spending on Clomid and IUI for unexplained infertility, I fear they are not going to increase their spending on IVF, and some couples may find that they can't access any kind of treatment at all. What's more, commissioners may start to assume that couples with unexplained infertility would all get pregnant eventually if they left it to Nature. I know from personal experience of more than 13 years of unexplained infertility, that this is not the case. So although it's helpful to know that these treatments may not be much use if you don't know why you aren't getting pregnant, it may not be so helpful if you end up not being able to access any other treatment instead.
You can read more about the research which is published in the BMJ at www.bmj.com
Wednesday, 30 July 2008
Polycystic ovary syndrome support
If you have PCOS, you may be interested in attending a one-day conference organised by the polycystic ovary syndrome support network, Verity. The agenda for the day has now been set, and includes discussions on nutrition, acupuncture and complementary therapies as well as fertility.
The event will take place in Manchester on 25 October, and you can see the agenda and book online at www.verity-pcos.org.uk
The event will take place in Manchester on 25 October, and you can see the agenda and book online at www.verity-pcos.org.uk
Monday, 28 July 2008
IVF rationing in Yorkshire
In one of the most ludicrous attempts at rationing IVF I've come across, women who need IVF in one area of Yorkshire will only qualify for funded treatment once they are approaching their fortieth birthday. North Yorkshire and York Primary Care Trust now only offers IVF to those who happen to be in the six months between the ages of 39 and a half and 40.
What possible logic can there be to limiting treatment to women who've reached an age at which it is far less likely to succeed? How can anyone consider this to be a sensible use of limited funds? It would perhaps be more honest to admit they are not really funding any treatment at all. The way treatment is being restricted by eligibility criteria in some parts of the country just goes to show how little understanding those who make decisions have of the things they are making decisions about...
I can only imagine that perhaps this is a deliberate attempt to make it impossible for anyone to qualify for NHS-funded treatment in the area, and to have so very few successful NHS-funded cycles that they can then claim IVF is simply not cost effective and stop paying for it altogether. The government keeps making noises about the unfairness of the postcode lottery, but surely a decision like this illustrates that it is time to give primary care trusts very strict guidance as many are clearly incapable of making sensible funding decisions themselves. You can read more about the situation in North Yorkshire and York here
What possible logic can there be to limiting treatment to women who've reached an age at which it is far less likely to succeed? How can anyone consider this to be a sensible use of limited funds? It would perhaps be more honest to admit they are not really funding any treatment at all. The way treatment is being restricted by eligibility criteria in some parts of the country just goes to show how little understanding those who make decisions have of the things they are making decisions about...
I can only imagine that perhaps this is a deliberate attempt to make it impossible for anyone to qualify for NHS-funded treatment in the area, and to have so very few successful NHS-funded cycles that they can then claim IVF is simply not cost effective and stop paying for it altogether. The government keeps making noises about the unfairness of the postcode lottery, but surely a decision like this illustrates that it is time to give primary care trusts very strict guidance as many are clearly incapable of making sensible funding decisions themselves. You can read more about the situation in North Yorkshire and York here
Lifestyle issues
You've probably heard a lot in the last week about the survey of fertility experts that showed they thought people's lifestyles should be taken into consideration when deciding whether they should have IVF. The survey, for the British Fertility Society, questioned about 200 experts in the field, and just 29% of them thought that treatment should be offered to all, regardless of their lifestyle. So anyone who couldn't get pregnant and was overweight, who drank or who smoked should beware...
It is true that all of these things can affect your chances of conceiving, but it is also true that many people who smoke, who are overweight and who drink get pregnant naturally without any trouble. No one in their right mind would smoke or drink to excess when they were pregnant, but it does seem that those of us who don't get pregnant easily are expected to turn into paragons of virtue in order for others to feel we should be allowed to try to have children. We shouldn't forget the immense stress of living through year after year of trying to conceive unsuccessfully, and perhaps should forgive rather than chastise those who end up succumbing to bad habits every now and again. And when it comes to weight, one of the most common causes of female infertility, polycystic ovary syndrome, makes it harder for women to lose weight.
When I wrote The Complete Guide to Female Fertility , I gave lots of advice on lifestyle changes you can make to try to maximise your chances of getting pregnant because I know that people want to do whatever they can. However, it is also important to recognise that making your life utterly miserable in order to have the best possible lifestyle for conception may be counterproductive.
Professor Bill Ledger , one of the country's leading fertility experts, gave an absolutely fascinating presentation on this at National Infertility Day, in which he explained how guilty fertility patients are made to feel about their lifestyles, and how this can cause stress, which is known to damage fertility. It was a refreshing look at the subject, as all too often we end up feeling we are to blame for our fertility problems. Of course you should try to give up smoking, of course you shouldn't drink too much, and if you are overweight you should try to lose some excess pounds, but if you don't reach your ideal weight, or get drunk at a party, or find yourself having the occasional sneaky cigarette, you shouldn't feel you've ruined your chances of ever being allowed to try to have a baby. Guilt, Professor Ledger told us, is the new black!
But getting back to the
British Fertility Society survey ... Apart from the stuff on lifestyle issues, one of the main findings was that most experts in the field wanted to see more research into new techniques used in IVF, such as immume therapy and PGS, and felt they were offered to patients too quickly before scientific trials had shown them to be effective. This is something patients would welcome, as it is impossible to know who to believe or what to trust when the evidence on these treatments is so scanty. From the patient perspective, perhaps the most reassuring finding of the survey was that the majority of the experts believed fertility treatment should be funded by the NHS - maybe one day we'll see the implementation of the government's own advisory body's recommendation of three funded cycles for those who need them...
It is true that all of these things can affect your chances of conceiving, but it is also true that many people who smoke, who are overweight and who drink get pregnant naturally without any trouble. No one in their right mind would smoke or drink to excess when they were pregnant, but it does seem that those of us who don't get pregnant easily are expected to turn into paragons of virtue in order for others to feel we should be allowed to try to have children. We shouldn't forget the immense stress of living through year after year of trying to conceive unsuccessfully, and perhaps should forgive rather than chastise those who end up succumbing to bad habits every now and again. And when it comes to weight, one of the most common causes of female infertility, polycystic ovary syndrome, makes it harder for women to lose weight.
When I wrote The Complete Guide to Female Fertility , I gave lots of advice on lifestyle changes you can make to try to maximise your chances of getting pregnant because I know that people want to do whatever they can. However, it is also important to recognise that making your life utterly miserable in order to have the best possible lifestyle for conception may be counterproductive.
Professor Bill Ledger , one of the country's leading fertility experts, gave an absolutely fascinating presentation on this at National Infertility Day, in which he explained how guilty fertility patients are made to feel about their lifestyles, and how this can cause stress, which is known to damage fertility. It was a refreshing look at the subject, as all too often we end up feeling we are to blame for our fertility problems. Of course you should try to give up smoking, of course you shouldn't drink too much, and if you are overweight you should try to lose some excess pounds, but if you don't reach your ideal weight, or get drunk at a party, or find yourself having the occasional sneaky cigarette, you shouldn't feel you've ruined your chances of ever being allowed to try to have a baby. Guilt, Professor Ledger told us, is the new black!
But getting back to the
British Fertility Society survey ... Apart from the stuff on lifestyle issues, one of the main findings was that most experts in the field wanted to see more research into new techniques used in IVF, such as immume therapy and PGS, and felt they were offered to patients too quickly before scientific trials had shown them to be effective. This is something patients would welcome, as it is impossible to know who to believe or what to trust when the evidence on these treatments is so scanty. From the patient perspective, perhaps the most reassuring finding of the survey was that the majority of the experts believed fertility treatment should be funded by the NHS - maybe one day we'll see the implementation of the government's own advisory body's recommendation of three funded cycles for those who need them...
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