Ovarian hyperstimulation

When we think about the risks associated with IVF, we tend to either worry about the possibility of long-term health risks or more often about the risk of the treatment not working. In fact, one of the most serious, and not uncommon, risks of IVF is ovarian hyperstimulation, often known as OHSS.

Stimulating the ovaries to produce lots of eggs is not a natural process, and hyperstimulation is not something that can occur naturally but is a direct result of fertility treatment. Some women are more at risk of OHSS than others, and the team treating you will be keep a particularly close eye out for this if you have polycystic ovary syndrome, if you are underweight or if your have had OHSS in the past. Hyperstimulation can occur during treatment or after successful treatment when the rising hormone levels in early pregnancy can have an effect, which is why women who are pregnant with twins are at greater risk.

When the ovaries are hyperstimulated they become enlarged and the balance of fluids in the body is affected. Fluid can start to gather in the abdominal cavity and this can lead to swelling, dehydration and bloating. Fluid may collect in the lungs too, and the condition can also lead to an increased risk of blood clots. Although OHSS is often mild, the condition can be very dangerous.

Clinics can usually spot women who are at risk of hyperstimulating when they carry out the regular scans during treatment as there will be large numbers of follicles developing. Blood tests can confirm that a woman is at risk. Symptoms of OHSS can include discomfort and swelling in the abdomen, nausea, reduced urine output, dehydration and breathlessness. The first thing that women notice is often a swollen stomach, and the swelling can seem to increase very rapidly.

Ovarian hyperstimulation is thought to occur in about 5% of women having IVF treatment. Although the condition is often mild, it is always important to get medical advice immediately if you suspect you may have OHSS as it can be dangerous. If you are in the middle of a treatment cycle, you may be advised to "coast" for a few days without taking more stimulating drugs to see what happens. If you are close to egg collection, the embryos may be collected and frozen so that they can be replaced safely later.

Mixed Blessings

I've just been reading a great new booklet from the Donor Conception Network written for anyone who is creating a family that includes children conceived without the help of a donor and also children conceived with donor sperm and/or eggs - hence the booklet title 'Mixed Blessings'.

The Donor Conception Network had seen an increasing number of families in this situation, or considering donor treatment after having a first child either naturally or with treatment such as IVF or ICSI. It was apparent that they wanted specific help and information, and that's the reason the booklet was written.

It has a reassuring common sense tone, and not only gives lots of practical advice and information, but also includes the experiences of a number of parents. Their situations are all very different but their stories help explain the many reasons why people may have a family where their children are conceived both with and without donor gametes.

I'd really recommend this booklet if you're in this situation - you can download it through the Donor Conception Network website here.

Calling anyone in Belfast...

If you live in Belfast and are trying to conceive, you will be interested in a series of workshops organised by the wonderful Infertility Network UK team in Northern Ireland.

The five workshops cover a range of topics relating to fertility problems, starting with a workshop on nutrition on 26 January. Further workshops will cover dealing with your emotions, relationships, complementary therapy and solutions for stress.

Not only will the workshops prove to be informative, but they also provide a great opportunity to be with others who are in a similar situation and who understand exactly how you are feeling. For more information, see the Infertility Network UK blog.

Three parent IVF...

The papers have dubbed it "three parent IVF" which is likely to send the anti-IVF brigade off on a familiar rant but in fact a new technique currently being investigated could prevent serious genetic conditions being passed from mother to child. The HFEA has launched a consultation into the process, which replaces the faulty genetic material in the mother's egg, to consider whether the technique should be offered.

The new technique involves using a donor egg and taking out the nucleus, which is replaced with the nucleus from the mother's egg. The faulty material, which is contained in the rest of the contents of the egg, is therefore eliminated which means that the resulting embryo should be healthy. The donor would only have a limited genetic link to the child as the crucial nuclear DNA would still be inherited from the mother.

Scientists are still investigating the technique which has the potential to prevent diseases that are currently incurable and a change in the law would be necessary in order for it to be offered to patients.

You can read a statement from the HFEA about the consultation at www.hfea.gov.uk

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.

The benefits of using frozen embryos

I'm just back from the annual meeting of the British Fertility Society where there were some fascinating presentations, including one detailing some new research about babies born from frozen embryos. Researchers found that babies born from frozen embryos are heavier and have a longer gestation than babies born after fresh IVF cycles - and are therefore more likely to be healthier.

It's important news at the current time when more and more people are putting back one embryo at a time and using freezing techniques. We often assume that using fresh embryos must be better when possible, but this new research suggests that may not be the case. It isn't yet certain why frozen embryos do so well, although previous research had suggested that it was linked to the fact that only the strongest, healthiest embryos would survive the freezing and thawing process.

Whatever the reasons, this is reassuring news for anyone having fertility treatment. You can read the press release from the British Fertility Society here.

Surrogacy - so easy to condemn...

I've just been reading a piece by Julie Bindel about how selfish it is for couples to opt for surrogacy when there are so many children languishing in care who need adoptive and foster parents. I normally like her writing, but on this occasion she has managed to link people who choose to go to developing countries to find a surrogate mother with anyone else who needs help to get pregnant in one damning line referring to "expensive complicated medical interventions such as IVF and surrogacy".

I recently interviewed two women who'd had a surrogacy arrangement who agreed to speak to me because they wanted to give their response to the endlessly negative press that surrogacy receives. They were friends, and one had decided to help the other to have the child she longed for but couldn't carry (she'd had to have a hysterectomy for medical reasons). There was no exploitation and no money changed hands. They did it twice and it resulted in two children - now teenagers. They are still incredibly close friends and their families spend a lot of time together. Speaking to them was really moving - they were both strong, positive women who were very proud of the children and of what they'd done. The interview was published in the last edition of the Infertility Network UK magazine.

I'm also never entirely convinced by the argument that people are choosing to go to such lengths without considering adoption. Many couples who can't conceive would love to adopt a baby, but their chances of ever being able to do this are extremely slim as the numbers of babies adopted each year in this country are tiny. That's not due to a lack of couples who would jump for joy if they were able to adopt a baby - it's just that decisions about adoption are not often made so early in a child's life and can take years. It's not fair to blame couples who have fertility problems for what may be seen as shortcomings in the adoption process. Many of the children who need adoptive families are much older and have lived through extremely difficult times which can mean that they need experienced carers - and the adoption process is about finding the right adoptive parents for the child, not about making sure that people who might consider surrogacy or fertility treatment are able to adopt instead.

Of course, Julie Bindel is right that the exploitation of poor women in developing countries is utterly wrong and should be condemned - but it's a shame that she has muddied the waters by appearing to conclude that any surrogacy arrangement or even fertility treatment is somehow just as exploitative and wrong.

You can read her piece here