Infertility

Evaluate the treatments being offered to you. When going through IVF it is often easy to go down the route of alternative or unproven therapies. HFEA are the UK’s independent regulator of fertility treatment and research using human embryo’s. They are also the first statutory body of it’s type in the world. One feature of it’s website is a traffic-light rated list of add-ons which consists of three colours that indicate whether the evidence, in the form of high-quality RCTs, shows that a treatment add-on is effective at improving the chances of having a baby for someone undergoing fertility treatment.

Clinics may request many tests at very high prices in an already expensive process. Speak to your

GP when starting out and you will often find that many test, especially blood tests can be requested by them. This can save both money and time in some circumstances. Is there an ideal ‘mix’ or ‘formula’ for those trying to conceive?

If there was a formula then the process would be a lot easier. Each couple may have different reasons as to why they can’t conceive so unfortunately there is no one thing that works.

There are many suggested supplements and lifestyle inventions, some with little to no clinical evidence. As for progressing to treatment, this also comes in may ways and

National Sexual Health Strategy

can range from IUI to medicated natural cycles to IVF, ICSI, TESI, donor egg, donor sperm, embryo adoption or surrogacy and that is just to touch on a few.

Enjoying the success stories

My favourite success story is my own I’m delighted to say! I have two beautiful little people in my life now, a daughter of 4 and a son who is 8 months. It is easy to look back with rose tinted glasses, but it was tough at the time. Both physically and mentally it takes its toll, and you can look back and gloss over it when you have success. I had seven transfers in order to have my two children and I probably was medicated in some way for three of the last five years in doing IVF treatments.

I was lucky to be a pharmacist as sourcing medication sometimes alone can be a struggle. However I learned that most items are covered but I needed to often confirm this with PCRS. Often a clinic will call or email last minute with a change to protocol and this opened my eyes to being a patient on the other side of the counter. Couples going through IVF are often not just our patients but our colleagues. It is important to remember that not all infertility stories end as luckily as mine did. I know how privileged I am to have two children and it is something I hope remains with me.

For more information about NISIG: www.NISIG.com Twitter and Instrgram @NISIG1 Instagram is @nisig_ireland Email contact@nisig.com

The Minister of State with Responsibility for Public Health, Wellbeing and the National Drugs Strategy, Hildegarde Naughton, has welcomed the publication of the Review of the National Sexual Health Strategy.

Sexual health has been a priority for the Department of Health; the National Sexual Health Strategy 2015-2020 (NSHS) was developed as a core policy under the Healthy Ireland Framework and remains a priority under the Healthy Ireland Strategic Action Plan 2021-2025. Implementation of the Strategy is led by the HSE Sexual Health and Crisis Pregnancy Programme (SHCPP).

Minister Naughton welcomes the convening of the group to work on the development of the new strategy to be published by the end of 2023 and emphasised the following areas as priorities for consideration:

• improving sexual health information, focussing on positive menstrual health education and awareness, fertility, gynaecology and contraception

• implementing a model of care for STI and sexual health service delivery

• building capacity and meeting demand for HIV PrEP

• further developing and expanding the free contraception scheme for women and the National Condom Distribution Service, to better support people’s contraception and STI prevention needs and recognising the key role of hormonal contraception in treating the adverse symptoms of periods

New donor conception children’s book

The National infertility charity NISIG has launched the final in its series of donor conception children’s books on the “Solo Mammy” journey called A Special Gift- a solo mammy story! These books are a perfect tool for parents who have conceived using either donor egg, donor sperm, or both or who have embarked on the journey as a solo mammy. They are the first Irish books printed to support parents in discussing their donor family story with their child, and are part funded by the HSE.

NISIG Chairperson Caitríona Fitzpatrick said, “I’m really pleased that the final book in the ‘Special Gift’ series is now available. This has been a key project for us as our first time self -publishing children’s books, and the first of their kind in Ireland.

“However, I also want to take the opportunity today to call for discussions to get underway immediately on the future of fertility services in Ireland including public funding for IVF treatment, as announced in Budget 2023. With only 6 months to go before the promised start of publicly funded IVF, there is a need for stakeholder consultation to begin immediately. We are getting a significant number of requests from people who want to know how they can access this treatment and we have absolutely no information to give them. This is frustrating and needs to be addresses now.”

The key issues NISIG are calling for clarity and discussion on are:

1. Who will be eligible to receive this treatment?

2. What clinics will it be available through - will this be nationwide?

3. Will the treatment continue into 2024 and be expanded?

4. What restrictions will be put in place for those applying?

5. How will the application process work and when will it open?

Caitríona added, “Crucially, we would strongly request that the Department of Health include stakeholders to get their input on the roll out of publicly funded fertility treatment. We must get the foundations of this in place very soon to give people certainty. In our view it is neither practical nor sensible for the Department to exclude those who are at the coalface of this issue for over 25 years when planning for a new system in Ireland.”

Ryaltris™ 25 mcg/actuation + 600 mcg/actuation nasal spray, suspension.

Prescribing information

Please consult the Summary of Product Characteristics (SmPC) for full prescribing information.

Presentation: One delivered dose contains mometasone furoate monohydrate equivalent to 25 mcg mometasone furoate and olopatadine hydrochloride equivalent to 600 mcg olopatadine. White, homogeneous suspension.

Uses: In adults and adolescents 12 years of age and older for the treatment of moderate to severe nasal symptoms associated with allergic rhinitis.

Dosage: For nasal use only. Adults and adolescents (12 years of age and over) two actuations in each nostril twice daily (morning and evening). Elderly: no dose adjustment required. Children under 12 years: not recommended. Renal and hepatic impairment: no dose adjustment expected.

Contraindications: Hypersensitivity to the active substance or to any of the excipients. Presence of untreated localised infection involving the nasal mucosa, such as herpes simplex. Recent nasal surgery or trauma until wound healing has occurred.

Warnings and Precautions: Instances of nasal ulceration and nasal septal perforation have been reported. Not recommended in case of nasal septum perforation. Patients using Ryaltris™ over several months or longer should be examined periodically for possible changes in the nasal mucosa and for evidence of Candida infection. Instances of epistaxis have been reported. Visual disturbance may be reported with systemic and topical corticosteroid use. Consider referral to ophthalmologist with symptoms such as blurred vision or other visual disturbances as cataract, glaucoma or rare diseases such as central serous chorioretinopathy have been reported after use of systemic and topical corticosteroids. Hypersensitivity reactions, including wheezing, may occur - discontinue.

Immunosuppression: use with caution, if at all, in patients with active or quiescent tuberculous infections of the respiratory tract, untreated local or systemic fungal or bacterial infections, systemic viral or parasitic infections, or ocular herpes simplex. Potential systemic effects of corticosteroids include Cushing’s syndrome, Cushingoid features, adrenal suppression, growth retardation in children and adolescents, cataract, glaucoma and more rarely, a range of psychological or behavioural effects including psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression (particularly in children).

Hypercorticism and adrenal suppression may appear at higher than recommended dosages or in susceptible individuals at recommended dosages - discontinue slowly. Increased risk of signs or symptoms of hypercorticism and/or suppression of the HPA axis possible with concomitant use with other inhaled corticosteroids. Careful monitoring needed for acute adrenal insufficiency in response to stress in patients previously treated for prolonged periods with systemic corticosteroids and transferred to topical corticosteroids. In patients with asthma or other conditions requiring long term systemic corticosteroid treatment, too rapid a decrease in systemic corticosteroids may cause a severe exacerbation of symptoms. Somnolence has been reported following administration of Ryaltris™ in clinical studies. Caution in patients operating machinery or driving a motor vehicle. Avoid concurrent use with alcohol or other central nervous system (CNS) depressants. Increased risk of antihistamine adverse effects with concomitant use of olopatadine or other antihistaminic drugs administered via nasal, ocular or oral route. Paediatric population: It is recommended that the height of children receiving prolonged treatment with nasal corticosteroids is regularly monitored. Contains 0.02 mg benzalkonium chloride in each actuation. Benzalkonium chloride may cause irritation or swelling inside the nose, especially if used for a long time.

Interactions: No interaction studies have been performed with Ryaltris™. Any interactions from the combination of olopatadine and mometasone furoate are expected to reflect those of the components taken individually, no pharmacokinetic interaction between olopatadine and mometasone furoate was observed when administered in combination.

Olopatadine: No interactions with other drugs expected. Mometasone Furoate: Cotreatment with CYP3A inhibitors should be avoided unless the benefit outweighs the increased risk of systemic corticosteroid side-effects and patients should be monitored. Pregnancy and Lactation: Avoid use during pregnancy unless potential benefit to mother justifies potential risk to mother, foetus or infant. Assess before prescribing in lactating mothers.

Side Effects: Common: dysgeusia, epistaxis, nasal discomfort.

Uncommon: dizziness, headaches, somnolence, nasal dryness, dry mouth, abdominal pain, nausea, fatigue. Rare: bacterial vaginosis, anxiety, depression, insomnia, lethargy, migraine, blurred vision, dry eye, eye discomfort, ear pain, nasal inflammation, nasal mucosal disorder, oropharyngeal pain, sneezing, throat irritation, constipation, sore tongue, laceration. Frequency not known: pharyngitis, upper respiratory tract infection, hypersensitivity (including anaphylactic reactions, angioedema, bronchospasm, dyspnoea), cataracts, glaucoma, increased intraocular pressure and nasal septum perforation.

Pack Sizes: One bottle containing 30ml suspension (240 actuations).

Legal Category: POM.

Product Authorisation Numbers: PA 1543/002/001

Product Authorisation Holder: Glenmark Pharmaceuticals s.r.o., Hvezdova 1716/2b, 140 78 Prague 4, Czech Republic.

Marketed by: A. Menarini Pharmaceuticals Ireland Ltd. Further information is available on request from A. Menarini Pharmaceuticals Ireland Ltd., 2nd Floor, Castlecourt, Monkstown Farm, Monkstown, Glenageary, Co. Dublin A96 T924 or may be found in the SmPC.

Date of Preparation: June 2022.