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ALICE PAKENHAM, PHILANTHROPY MANAGER, WELLBEING OF WOMEN “Endometriosis and my pregnancy journey” Online Exclusive
BRITISH FERTILITY SOCIETY “Young people should be better prepared for their future fertility” » p2
PROFESSOR NEIL JOHNSON, WORLD ENDOMETRIOSIS SOCIETY A treatment that may improve chances of fertility » p5
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Young people will be better prepared for infertility Could you have been better prepared to face fertility problems? If you are trying to get pregnant in your 30s or 40s, the answer is almost certainly, ‘yes’. WRITTEN BY: PROFESSOR ADAM BALEN Consultant in Reproductive Medicine, Leeds, and recent past-chair, British Fertility Society
eenagers sit in a classroom, failing to supress laughter while their teacher rolls a condom onto a banana. She goes on to tell them that condoms are the best way to prevent unwanted pregnancy and protect against STIs (sexually transmitted infections). Sound famililar? That is what most people in their 30s and 40s remember of sex education. Perhaps the old model helped prevent teen preg na ncies a nd protected the sexual health of young people. But, as the age at which people begin tr ying to become pregnant rises, and family structures change, we notice a major gap in relationship and sex education. • More women in the UK are now having children over the age of 35 than under the age of 25 • More than 50% of babies born in the UK are to women over 30
• 20% of UK women will never have a child - that’s twice the percentage of their mothers’ generation • Older age at first birth often means longer exposure to risk factors for reduced fertility for men and women (e.g. smoking, alcohol consumption, obesity) • A national survey of 1,000 16-24 year olds shows worrying gaps in knowledge about fertility and reproductive health. Unprepared for fertility issues People in their 30s and 40s are totally unprepared for the fertility difficulties that they or their friends are experiencing. Nobody told them that women’s fertility typically declines gradually from their 20s and falls off a cliff after the age of 35. And recent research shows that men’s fertility
WRITTEN BY: PROFESSOR JOYCE HARPER, Deputy Chair, British Fertility Society (Institute for Women’s Health, University College London)
also declines throughout adulthood, dropping quickly after the age of 45. Technological, political and legal developments have made it easier for single people and LGBTQI+ people to become parents too, but they don’t necessarily know that reproductive technologies are available to all people, regardless of their marital status or sexuality. And although we are taught that condoms prevent STIs, many young people don’t know that some STIs can affect their fertility. Teaching young people Beginning this academic year and rolling out through 2020, there’s a big difference in relationships and sex education: young people will now be taught about “the facts about reproductive health, including fertility and the potential impact of lifestyle on fertility for men and women.”1
WRITTEN BY: PROFESSOR JACKY BOIVIN Deputy Chair, British Fertility Society (Fertility Studies Research Group, Cardiff University)
We have produced resources, including two animations and a fertility education poster to support the new curriculum. Research shows that young people want – and benefit from – fertility education, but it needs to be tailored to their specific ages.2 Career or babies? People are choosing to wait until their 30s or even 40s to have children for a number of reasons. For many, starting a family means addressing conflicting timelines (self versus partner, biological versus psychological). For some, it is also about becoming established in their career before taking time out to become a parent. Many people are not in a relationship and want to wait until they are. And among those women who choose to preserve their fertility by freezing eggs, the reason is more commonly that they have yet to find
a partner they wish to parent with.3 P reser v ing fer t i l it y t h rough freezing eggs or sperm is an option, but it is not an easy one and is no guarantee of success. Currently, there is also a 10-year limit on the storage of frozen eggs or sperm for ‘social reasons’, which is simply not long enough for many people to plan their family. The new curriculum deals with the technologies available to support fertility so that young people are, firstly, aware of their existence and, secondly, have a realistic expectation of treatment and success. Don’t despair The next generation should be better prepared. And we can help some of those who are currently struggling. Read more at britishfertilitysociety.org.uk
1: www.britishfertilitysociety.org.uk/press-release/experts-welcome-guidance-for-teaching-children-about-their-fertility/ 2: academic.oup.com/humrep/article/33/7/1247/4996985 & https://doi.org/10.1080/14647273.2018.1486514 3: www.bionews.org.uk/page_137015
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Going abroad for IVF? Here’s what you should know: UK patients going abroad for fertility treatment may worry about the standard of care they’ll receive. But that can be unfounded, says one clinician in Spain, where fertility laws are strictly regulated.
atients who have trouble accessing fertility treatment i n t he U K m ay de c ide to investigate the possibility of receiving it overseas. Of course, they may then start to worry about the standard of care they’ll receive when they get there. Yet, in many cases they shouldn’t, says Dr Jennifer Rayward, Co-Founder of ProcreaTec clinic in Madrid, Spain — and particularly if they have done their research properly. “I completely understand why UK patients might worry about going abroad to have fertility treatment,” she admits. “I’d be wary if I was in a country I didn’t know and where I couldn’t speak the language. But, take Spain; what many people don’t realise is that assisted reproduction here is strictly regulated by central government. Plus, fertility clinics are regulated by autonomous regions and audited every year by Sociedad Española de Fertilidad (Spanish Fertility Society).”
Strong research base and more ﬂexible laws In June, the European Society o f Hu m a n R e p r o d u c t io n a n d Embryology reported that Spain was the most active country in assisted reproduction in Europe, with a record 140,909 treatment cycles performed. “The worldwide medical community thinks of Spain as one of the best countries for assisted reproduction – and rightly so,” says Dr Rayward. “We’re home to some of the strongest research groups in the world and we have lots of egg donors because our laws are more flexible than those of other countries.” Also, in Spain, fertility treatment is open to anyone over the age of 18, including same-sex and unmarried couples and single parents. Studying patients to boost chances of fertility Nat u ra l ly, t re at ment s c a n b e
expensive and no clinic — wherever it is in the world — can guarantee pregnancy. “Nature is nature,” says Dr Rayward. “But the high success rates we see in Spain are partly due to the range of technologies and techniques t hat are used. For example, pre-implantation genetic testing allows us to biopsy the embryo to ensure it’s healthy before we transfer it. And, while we can’t improve the quality of sperm, embryologists are able to select the best sperm from a sample for micro-injection.” If patients are studied closely before treatment in order to get a good diagnosis, the chances of a better outcome will be increased. When deciding on a fertility clinic in a different country, patients should ensure it will offer them a summary of every treatment they receive and every test they have. Clinicians should also be able and willing to speak to patients’ doctors in the UK, and pledge to remain
in close contact in the pre- and post-natal periods. “This can be a worrying time,” agrees Dr Rayward. “But that isn’t only the case for those having fertility treatment in a foreign country. It’s the same for any patient having fertility treatment in any country in the world.”
WRITTEN BY: TONY GREENWAY DR JENNIFER RAYWARD Co-Founder, ProcreaTec
Info box Being the third-largest group of fertility clinics in Spain we also hold monthly consultation days in London.
To find out more about ProcreaTec by IVF-Spain or our consultation days visit: procreatec.com
Connecting women across fertility and motherhood
WRITTEN BY: MICHELLE KENNEDY Founder and CEO, Peanut
One in seven women will experience fertility challenges. One in three women will experience miscarriage. There is not enough support for women going through their fertility journeys, and that’s something that must change. Our Q&A with Michelle Kennedy, Founder and CEO of Peanut, explores this disconnect. Q: Is there enough support out there for women when considering fertility? A: Simply put, no. There are still so many conversations on issues that typically impact women that are considered taboo. Sadly and frustratingly, fertility still seems to be one, where women dealing with their fertility reality feel stifled and unable to ask for support or adv ice. But, we need – and deserve – a platform to have these conversations, and to share our anxieties, concerns, frustrations and experiences. If you are going through a fertility treatment, for example, where can you find support? Or talk to someone who understands what it’s like to face the two week wait after implantation? What it’s like to start on another hormone cycle? What it’s MEDIAPLANET
like to face infertility, and change your horizons? Being able to connect with women going through that same experience becomes critical; otherwise it feels deeply isolating. Q: Why is there a need to connect these women? A : One i n seven women w i l l experience fertility challenges. One in three women will experience miscarriage. Women going through fertility journeys need support outside of medical intervention. After all, the emotional impact of what women go through is, in many cases, all-consuming. Frankly, it’s just not easy to find another woman who is on a TTC journey – it’s not obvious. There are no visual signals for a woman who has experienced loss or who is trying for a baby. Having a safe, private space
to ask open and honest questions to other women who ‘get it’ is not just long overdue, it’s a critical part of any woman’s fertility experience. Q: What is the value of women sharing their stories? A: In this world of sharing our ‘real selves’, there are still some fertility stories that we don’t share. For example, women are told not to announce their pregnancy until they are 12 weeks in. Therefore, if a woman experiences loss during that period, she is silenced. This doesn’t make sense because it is still a loss and that woman is still in need of support. Sharing fertility stories is so important because it makes other women feel less alone. Q: What advice would you offer to women considering
their fertility journey? A: People who haven’t had fertility difficulties may struggle to fi nd the right words or know how to be there in times of pain, struggle and loss etc, so it’s important to surround yourself with other women who are on the same journey. Finding support through shared experience is crucial. You should never feel lonely, isolated or muted on such an important issue.
About Peanut Peanut was created with the idea that no one should have to navigate womanhood alone. Especially the hard parts. Their mission is to provide a social network for women to connect across fertility and motherhood. Peanut’s community of over one million women is a place to build friendships, find support and learn from one another. The Peanut app is free to download on the app store. To find out more, please visit: peanut.app.link/ttc HEALTHAWARENESS.CO.UK
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Why you should have an HSG test What an HSG test is, what it does and why this can be a test for everyone. We’re dispelling the myths and explaining the benefits for natural fertility.
In couples with unexplained infertility the HSG is not only diagnostic but may also offer them an increased chance of natural conception.
WRITTEN BY: PROFESSOR ANNE HEMINGWAY Consultant Radiologist
hysterosalpingogram (HSG), is an X-ray to look for abnormalities in the womb, or blockages in the fallopian tubes, which may explain why a woman is unable to get pregnant or is suffering miscarriages. Sometimes we undertake the investigation in women who have had surgery to their womb or tubes to check all is well before they try to conceive.
FIG. 1: A normal HSG
For couples, the infertility journey can be a stressful time. We should recognise that and treat them with dignity, respect and empathy. Who should have an HSG test?
What are the side-effects?
FIG. 2: An HSG showing a hydrosalpinx (dilated blocked tube) on the left
A woman will be referred for an HSG by her fertility team. The HSG, together with ultrasound (which looks at the ovaries, the lining and wall of the womb), blood tests (which check how the ovaries are working) and her partner’s sperm test, give the fertility team a picture of what is causing subfertility and informs them how best to treat the couple. How is an HSG performed? The examination is undertaken in the first half of the woman’s menstrual cycle, after she has stopped bleeding. She is asked not to have intercourse from the first day of the period and until after the test to ensure she is not pregnant at the time of the examination. It is important to remember that, for these couples, the infertility journey can be a stressful time. We should recognise that and treat them with dignity, respect and empathy.
Side-effects – these are few and should be discussed in detail with the doctor undertaking the procedure. Discomfort – patients’ pain thresholds vary. Some women don’t feel a thing, some find it uncomfortable – a bit like period cramps. Only a very few, in our experience, find it very painful. Infection – this is uncommon and most likely to occur in women who have had an infection before. In our practice, all ladies are given a single dose of antibiotics to minimise this risk. Reaction to fluid (contrast) – this is very unusual with modern contrast; we check beforehand if women have any significant allergies. Radiation – radiologists work within very strict regulations regarding about the amount of radiation that can used and there are national guidelines to minimise any risk from radiation. The beneﬁts of an HSG
FIG. 3: An HSG showing a polyp in the uterus (blue arrows)
Our emphasis is to be kind, gentle and not to rush On arrival, the woman will be asked to change into a gown and brought to the X-ray room. After taking a brief history, the procedure is fully explained, and the woman is given time for questions and is asked to give her consent to proceed. She then lies on the X-ray table in a similar position to having a smear. A speculum is very gently inserted into the vagina. A very soft tube or catheter is then passed into the canal that leads
from the cervix to the womb. A clear liquid (called ‘contrast’) is then gently passed into the womb. It contains iodine, which can be seen on X-ray images. Using an X-ray camera the doctor watches on a TV screen as the fluid passes into the womb and the tubes. Four or five pictures are taken to make a record of what is seen. The X-ray table may be tilted, or the patient asked to roll from side to side to help the tubes to fill. Coughing and laughter are great aids to tubal filling!
FIG. 4: An HSG showing both fallopian tubes are blocked close to the womb (blue arrows)
There are two types of fluid (contrast) we can use for an HSG – one is water soluble and the other is oil soluble. There have been many anecdotal reports of enhanced natural pregnancy rates after an HSG. In 2017, a detailed study undertaken in the Netherlands proved conclusively that, in women under 38 with unexplained subfertility, an HSG with oil-based contrast resulted in higher ongoing pregnancy and live birth rates than an HSG with water soluble contrast. So, in couples with unexplained infertility, the HSG is not only diagnostic but may also offer them an increased chance of natural conception.
Read more at healthawareness.co.uk MEDIAPLANET
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Women should know about this simple treatment for infertility Women considering fertility treatment should be aware of a simple procedure that may increase their chances of becoming pregnant without the need for expensive and involved IVF.
omen experiencing infertility problems may feel under pressure to start IVF (in vitro fertilisation) treatment immediately. But there is a quick, minimally-invasive intervention they could explore first, potentially increasing their chance of becoming pregnant without the need for IVF. The procedure involves using iodised poppy seed oil, which probably flushes fertility-hindering debris from the fallopian tubes and appears to have a positive immuno-biological impact on fertility. However, many patients are unaware this treatment exists — and that’s wrong, says Professor Neil Johnson, a fertility specialist based i n Auck la nd, New Zea la nd, a nd President of the World Endometriosis Society. “IVF is involved, expensive and carries the possibility of complications,” he notes. “This intervention, however, is low-invasive, cost-effective, carries a very low chance of complications and is very effective.” What to expect during the procedure The iodised poppy seed oil can be administered in a hysterosa lpingog ram (HSG). “ The patient lies on an X-ray bed,” Professor Johnson explains. “A speculum is then inserted into the vagina and tubing is sent through the canal of the cervix. The solution is then gently instilled into the uterus, through the fallopian tubes and bathes the pelvic cavity. “Very occasionally, there may be some discomfort, but it is not usually painful, and the vast majority of patients tolerate it extremely well. Appointments take around half an hour, but the main part of the procedure usually takes just 10 minutes.” Particular success for woman with endometriosis A n H SG was once a purely d iag nost ic intervention, where dye is injected into the cervical canal in order to investigate the shape of the womb and fallopian tubes. However, between 1999 and 2004, Professor Joh n son a nd h i s tea m re cog n i se d it s remarkable therapeutic effects when iodised poppy seed oil doubled fertility within a trial group with unexplained infertility. The procedure was particularly beneficial for women with a history of endometriosis, an inflammatory disease where tissue that normally lines the inside of the uterus is also found outside of the uterus. “Endometriosis is a benign condition that can cause abdominal pain, pelvic pain and infertility,” he says. “In New Zealand, we’ve discovered that this procedure has increased the fertility of women w it h endomet r iosi s, wh ich can have a substantial negative fertility MEDIAPLANET
Tubal flushing during HSG with oil contrast – from diagnostics to fertility enhancement Hysterosalpingography (HSG) was initially introduced as a diagnostic test to evaluate the patency of the fallopian tubes in the fertility work-up patients presenting with infertility. WRITTEN BY: PROFESSOR VELJA MIJATOVIC Consultant Gynaecologist Department of Reproductive Medicine, Amsterdam University Medical Center, on behalf of the H2Oil study group
D PROFESSOR NEIL JOHNSON Fertlity Specialist, President of the World Endometriosis Society impact even when the disease itself is not extensive. “Indeed, we found that those with a history of endometriosis in our trial group experienced around a four-fold improvement in fertility. We thought it was amazing and have been offering it as a routine treatment for infertility since 2004.” Patients who are unsuitable for treatment Nevertheless, there are women who are unsuitable for the intervention. “For example, if a patient’s fallopian tubes are blocked or damaged, then the treatment is not going to work, and they should proceed to IVF,” says Professor Johnson. “Other patients who won’t find it beneficial include women who don’t release an egg — they will need ovulation induction instead — and those whose partners have a low sperm count. However, it is absolutely appropriate for the majority of women who have relatively mild endometriosis-related infertility that hasn’t damaged their fallopian tubes. In fact, it’s probably their best first-line treatment because it’s so effective.” There’s now growing interest in the procedure around the world. “That’s very exciting,” says Professor Johnson. “I think every woman visiting a fertility service should have the opportunity to explore this treatment as a first option, instead of moving straight to IVF.” WRITTEN BY: TONY GREENWAY
Read more at healthawareness.co.uk
ebates on the therapeutic effects of tubal flushing during HSG started over six decades ago. Summarizing the available evidence, the 2015 Cochrane systematic review showed a non-significant higher amount of ongoing pregnancies in favor of tubal flushing with oil-based contrast in infertile women (Mohiyiddeen et al., 2015).
contrast compared to water-based contrast of $8,198 for an additional ongoing pregnancy (Rijswijk van et al., 2018). This is less than the cost of one IVF treatment (US$11,500). Moreover, it is less time consuming and burdensome for women. Thus, there is a strong argument to incorporate tubal flushing with oil-based contrast during HSG in clinical practice.
The H2Oil study
Limitations in older or higher-risk women
In order to clarify the uncertainty around the use of oil- or water-based contrast for HSG, the H2Oil study, a large randomised trial, in which 1,119 infertile women participated, was conducted in the Netherlands. This landmark study, published in the New England Journal of Medicine, showed significantly 10% more ongoing pregnancies as well as live births in the first six months following HSG with oil-based contrast, as compared to HSG with water-based contrast (Dreyer et al, 2017). Publication of the study generated a worldwide renewed interest in tubal flushing and the use of oil-based contrast for fertility enhancement. Two recent and updated systematic reviews confirmed these findings (Fang, et al, 2018, Wang, et al, 2019). Flushing debris and mucus from the fallopian tubes The principal theory is that tubal flushing with oil-based contrast flushes accumulated debris and mucous plugs from undamaged tubes, which will enhance tubal patency (openness). Several safety concerns on oil-based contrast have been raised. Firstly, venous intravasation occurs in approximately 2-7% of the cases in HSG, and occurs more frequently when using oil contrast. While intravasation can potentially result in pulmonary embolism, no cases of embolism were reported in the published trials, which is reassuring. Pelvic infection is another potential safety concern. However, data from the available trials are also reassuring showing that it is a rare event. The cost-effectiveness of tubal-ﬂushing An economic analysis based on the data of the H2Oil study and 2017 US prices (using consumer price index data and considering a cost difference between oil-based and water-based contrast in the United States being globally the highest) showed a cost-effectiveness ratio for oil-based
However, the data from the H2Oil study are limited to infertile women at a low risk of tubal pathology, who were younger than 39 years and without ovulation disorders. Therefore, a clear knowledge gap exists with respect to women who were not evaluated in the H2Oil study, i.e. women with ovulation disorders, women who are at high risk for tubal pathology, or women who are above 38 years of age, in whom infertility is driven by decreased ovarian reserve. Since the mechanism of infertility in these women is completely different, it is unknown if tubal flushing with oil-based contrast increases fertility chances in these women. What’s next? In 2019, two randomised trials started. The first trial will test the hypothesis that HSG with oil-based contrast will increase the pregnancy – and live birth rate as compared to HSG with water-based contrast in the above mentioned groups of infertile patients – and the second one will investigate cost-effectiveness of direct versus delayed (six months after fertility work-up) tubal flushing during HSG with oil contrast in infertile women. The hypothesis is that direct tubal flushing will lead to a shorter time to pregnancy and thus reduce the need for IVF and therefore also reduce the costs. More info on www.H2Olie.nl. Sources: Mohiyiddeen L, Hardiman A, Fitzgerald C, Hughes E, Mol BW, Johnson N, Watson A. Tubal flushing for subfertility. The Cochrane database of systematic reviews 2015: Cd003718. Dreyer K, van Rijswijk J, Mijatovic V, Goddijn M, Verhoeve HR, van Rooij IAJ, Hoek A, Bourdrez P, Nap AW, Rijnsaardt-Lukassen HGM et al. Oil-Based or Water-Based Contrast for Hysterosalpingography in Infertile Women NEJM. 2017, pp. 2043-2052. Fang F, Bai Y, Zhang Y, Faramand A. Oil-based versus water-based contrast for hysterosalpingography in infertile women: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril 2018;110: 153-160 e153. Wang R, van Welie N, van Rijswijk J, Johnson NP, Norman RJ, Dreyer K, Mijatovic V, Mol BW. The effectiveness of tubal flushing with different contrast media on fertility outcomes: a systematic review and network meta-analysis. Ultrasound Obstet Gynecol. 2019;54(2):172-181. doi: 10.1002/uog.20238. van Rijswijk J, Pham CT, Dreyer K, Verhoeve HR, Hoek A, de Bruin JP, Nap AW, Wang R, Lambalk CB, Hompes PGA, Mijatovic V, Karnon JD, Mol BW. Oil-based or water-based contrast for hysterosalpingography in infertile women: a cost-effectiveness analysis of a randomized controlled trial. Fertil Steril. 2018 Sep;110(4):754-760.
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Jessica Hepburn is the founder of Fertility Fest and author of two books: The Pursuit of Motherhood and 21 Miles. Read more about her journey at jessicahepburn.com
It’s time to end the IVF postcode lottery WRITTEN BY: NATALIE AMINOFF Digital and Media Communications Officer, Fertility Network UK
The postcode lottery is cruel and unjust. Access to fertility treatment should be dependent on your medical need, not your postcode or pay packet.
he UK pioneered IVF over 40 years ago, but that achievement means nothing if only those who can afford to pay for private fertility treatment benefit from it. This is why, in September 2018, Fertility Network UK, together with IVF Babble, launched the #Scream4IVF campaign, to fight against the postcode lottery. In just two months, this petition was able to raise over 102,000 signatures, signifying the true depth of feeling and anguish against this unfair system. Cross-party support for improving access to IVF Now, Fertility Network UK are proud to support Dr Emily Scott’s petition #EndTheIVFPostcodeLottery, which is campaigning for fair access to IVF. This petition has cross-party support. The Early Day Motion for the #EndTheIVFPostcode petition has been signed by Liberal Democrat’s Layla Moran, Independent’s Ed Vaizey and Labour’s Steve McCabe, among many others. Former Health Minister, Jackie Doyle-Price, has also written a letter to all clinical commissioning groups (CCGs), calling the postcode lottery a ‘disgrace’. The National Institute for Health and Care Excellence recommend that all CCGs offer three rounds of IVF for women under 40 who have not conceived in two years. In reality, the situation is much more bleak. Some CCGs are cutting IVF services due to ﬁnancial restrictions According to Fertility Fairness data, only 12.2% of CCGs in this country offer the recommended three cycles of IVF, and there are five CCGs who currently do not offer any fertility treatment for those living in the area. The last few CCGs who have held consultations on IVF funding have all made decisions that have devastated those who need fertility treatment in that area. For example, in August of this year, after months of consultations, Cambridgeshire and Peterborough CCG decided to continue to cease funding until their financial situation improves. In September, Stockport CCG released a statement, saying they are considering reducing funding to one cycle or cutting fertility services altogether, also due to financial challenges. Price isn’t everything However, the cost impact of fertility services is majorly exaggerated. According to Fertility Fairness data, on average, CCGs that funded a single cycle spent 0.0089% of their total commissioning budget on fertility treatment. CCGs that funded the maximum three cycles spent 0.108% of their total budget on fertility services. Both economically and emotionally, funding fertility treatment will only cause a positive impact on society. Every year, our net population decreases. The small cost investment into IVF can save the NHS a huge amount. It is not only funding for those who are facing infertility, but it also creates future taxpayers who will eventually invest back into society and the NHS, more than the CCG spends on fertility services. Read more at healthawareness.co.uk
“Infertility is a disease of the mind and body” WRITTEN BY: JESSICA HEPBURN Author and Fertility Campaigner
IVF is undoubtedly a miracle of modern science. Pioneered in this country some 40 years ago, it has created over six million babies worldwide. But, the worst part of treatment is not what’s being done to your body – the drugs, the injections, the operating table – it’s what’s going on in your head.
he World Health Organization classifies infer tilit y as a ‘disease’ of the reproductive system defined by failure to achieve pregnancy after 12 months of trying. IVF has become the ubiquitous treatment for that disease. I want infertility reclassified as a disease of the mind as well as the body. Nor should it be seen as a condition that is the prevail of heterosexual couples, as it is increasingly affecting same sex couples and single people who are turning to medical intervention to achieve their dreams of a family. IVF isn’t a magic bullet IVF doesn’t work every time for everyone. In fact, according to HFEA statistics, on average, roughly only a quarter of all cycles work. This means that many people find themselves on the fertility rollercoaster for years and it is likely to be one of the biggest struggles of their life. Feelings of inadequacy and shame that you cannot do what everyone else finds so easy to do are common in both women and men. Social isolation from family, friends and colleagues who have achieved parenthood status can make you feel extremely lonely. It puts intense pressure on your
Many people find themselves on the fertility rollercoaster for years and it is likely to be one of the biggest struggles of their life. relationship and decimates your self-esteem. Perhaps the hardest thing is not knowing how your fertility story is going to end; living life in limbo wondering if you’ll ever be pregnant. The mental health impact of all of this is nothing short of devastating. Get some emotional support That’s why I always say that the worst part of treatment is not what’s being done to your body – the drugs, the injections, the operating table – it’s what’s going on in your head. I urge anyone going through IVF to make sure they get help – whether that’s in the form of counselling and complementary therapies or social media communities, support groups and events. I also want all fertility clinics to make sure they prioritise patient psychosocial care alongside clinical treatment. These things might not influence the outcome of IVF, but they will make people more equipped to face whatever is ahead.
From pond to peak to raise awareness of fertility struggles I went through eleven rounds of unsuccessful IVF and lost a decade of my life to ‘Project Baby’. I then started writing about it and set up an arts festival that explores the emotional and societal aspects of the science of making babies. I have also been taking on some of the world’s most iconic physical and mental endurance challenges to raise awareness of the toll that fertility problems have on your mind as well as your body. I’ve swum the English Channel, run the London Marathon and, next year, will attempt to climb Mount Everest. If I get to the summit, I will become the first ever woman to achieve the ‘Pond to Peak Challenge’. Not bad for a middle-aged woman who is terrible at spor t, hates the cold and didn’t know what a crampon was a few years ago. But, hey, I went through eleven gruelling rounds of I V F and it was ver y good training. MEDIAPLANET
Look for the pineapple to know that you’re not alone on your fertility journey One in six people worldwide will be affected by infertility, but undergoing treatment for fertility problems Sponsored by doesn’t have to be a lonely, isolating process, say Jude Fleming, Chief Operating Officer of The Fertility Partnership and Tracey Bambrough and Sara Marshall-Page, co-founders of IVF Babble. Q: Why is there a need for good information about sources of support for fertility problems? A: (JF) When people first seek help for infertility, they are usually nervous and unsure of the process. There is a lot of information available online but the problem is knowing which sources are reputable. As well as accessing credible facts and information about the medical process a head, people need to feel that they are not simply on a ‘conveyor belt’; they often need an ‘emotional cuddle’. At a good clinic, people should leave feeling that they are not on their own and that there is someone available to answer their questions. People need to be able to communicate their goals and aspirations. If people are left thinking: ‘What if?’, without getting the information that they need, they can come away feeling unsupported and uncertain of the best course of treatment for them.
Q: Why do people struggle emotionally with fertility problems? A: (JF) Most women grow up thinking that having a baby is ‘what women do’. So, when conceiving proves difficult, many people can feel like they have let themselves, and others, down. It’s important that people are supported during their treatment to get the care they need. The reality is that not every fertility story ends in success. People need to feel that they did everything they could. We know this helps people to get closure. Q: What can people do to help themselves on their fertility journey? A: (TB/SM-P) At IVF Babble, we often hear how mental wellbeing is as important as physical health during fertility treatment. Practicing mindfulness is increasingly recognised as an important part of your health and wellbeing and it will be a better experience for people if their journey is as
supported as possible. Looking after your overall health – from eating the right foods, keeping fit and taking time out to relax – can help you to be as physically and mentally strong as possible. Q: How are you working to promote a feeling of community? A: (JF): We are delighted to have teamed up with IVF Babble to create a pack including small gifts such as a pineapple-shaped lapel pin, that we will give to people on their first appointment. We feel that the pin is a subtle but meaningful symbol that creates a sense of community and solidarity among people who are affected by infertility: many people describe themselves as grieving for the loss of a child they have never had. We feel that the ‘Pineapple Pack’ can help people to start to talk about how they are feeling, and that it will help them to feel more supported and cared for on their fertility journey. WRITTEN BY: AILSA COLQUHOUN
JUDE FLEMING Chief Operating Officer, The Fertility Partnership INTERVIEW WITH:
The Fertility Partnership (TFP) has nine fertility treatment clinics in the UK. Some 98% of customers said The Fertility Partnership provides exceptional nursing care and 99% would recommend its services. IVF Babble was created in 2016 to offer people access to a trusted and current IVF community. The pineapple symbol represents togetherness, support and positivity.
LEFT: TRACEY BAMBROUGH RIGHT: SARA MARSHALL-PAGE Co-Founders of IVF Babble
Read more at thefertilitypartnership.com ivfbabble.com
Your fertility journey and what to consider along the way
WRITTEN BY: DR CESAR DIAZ-GARCIA Medical Director, IVI London, UK
Like a well-planned trip, any fertility journey should start by pulling together any useful information that could help you to make decisions during the process.
e t ’s f ac e it: u nd e r g oi n g fertility treatment is stressful. Fluent com mun icat ion with your treating doctor is a key step of the process. Individualised treatment based on your specific case is the best standard of care to offer to patients, as well as space and time for discussion where you
can be involved in the decisionmaking process. Like a well-planned trip, any fer t i l it y jou r ney shou ld st a r t by pulling together any useful information that could help you to ma ke decision s du r i ng t he process. Here you have some tips that could make your fertilit y journey smoother. The very basics to help you conceive A healthy lifestyle, including a balanced and varied diet with very moderate to no alcohol consumption and frequent exercising, is highly recommendable. It is a fact that there is a link between obesity and poorer reproductive outcomes. Likew ise, smoking and other habits that may impact your fertility should be abandoned, given the impact they can have on both egg and sperm quality.
When you might need an even more tailored approach If you have already had several failed IVF attempts, you have a family history of a serious genetic condition or you are over a certain age, your consultant may recommend genetic testing to help provide you with the best chance of a successful pregnancy and healthy child. Preimplantation genetic testing for chromosomal abnormalities (PGT-A) involves the biopsy of embryos during IVF to assess for chromosomal abnormalities before selection for transfer. Although some argue this treatment to be invasive, we have seen survival rates of over 96.7%. If you have a euploid (normal) embryo to be transferred, your chances of getting pregnant are more than 70% every time you put an embryo back, regardless of your age. Don’t be confused: PGT-A will not increase your chances of getting pregnant per cycle, but it
will decrease your chances of having a miscarriage or serious embryo chromosomal abnormality.
Assisted reproduction and twin pregnancies D id you k now t h at t he mo s t i mp or t a nt c au s e of ne on at a l mortality and morbidity in the UK is prematurity? Did you know that the main cause of prematurity is multiple pregnancies? UK guidelines advise that a single embryo should be transferred whenever possible but, despite this, some clinics still put back more – sometimes because the patient wrongly thinks it improves their chances. Studies have shown that cumulative pregnancy rates are not different when compared to single embryo transfer versus double embryo transfer.
IVI has a policy in place to only transfer one single embryo during each cycle wherever possible. This policy is applied in almost 100% of treatments and, as a result, IVI has a multiple pregnancy birth rate of less than 0.9% – very far from the Human Fertilisation and Embryology Authority (HFEA) cut-off point of 10% and all that without compromising our pregnancy rates, which are over twice the national average according to the last HFEA data. Find out more at - www.ivi.uk HEALTHAWARENESS.CO.UK
YOUR OPTIONS FOR TUBAL PATENCY ASSESSMENT
Infertility can have a number of causes such as Fallopian tubes or uterine abnormalities, endometriosis, ovulation factors, or deficiencies in the semen. Sometimes, it may be unexplained. Tubal Patency Assessment is one test that may be offered as part of the female fertility evaluation.
Scans for fertility testing are done to provide information on the uterus and whether the fallopian tubes are open or blocked. The type of scan offered varies depending on equipment, individual patient characteristics and physician preference.
Hysterosalpingogram (HSG) A contrast dye is introduced into the uterine cavity via a catheter (thin plastic tube) to visualise the uterus and fallopian tubes using x-rays.
Sonohysterosalpingography (sonoHSG) An ultrasound technique (called HyFoSy or HyCoSy) that involves introducing a contrast material into the uterine cavity via a catheter.
Thin plastic tube used for infusion of the contrast dye
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ASK YOUR DOCTOR FOR INFORMATION ON WHICH TUBAL PATENCY ASSESSMENT IS APPROPRIATE FOR YOU