Do you really need ICSI?

ICSI (intracytoplasmic sperm injection) is a successful treatment when there are male fertility problems, but it is often used more widely in fertility clinics – and some offer ICSI to many patients where there is no male factor problem at all. Now, new research presented at ESHRE (the European Society of Human Reproduction and Embryology) shows that there is no benefit to offering ICSI unless there is a male fertility issue.

ICSI was developed in the 1990s as a breakthrough treatment for men who would otherwise have had to use donor sperm to become a parent, but now it is used so often that twice as many ICSI cycles are carried out around the world as IVF cycles. In some countries all assisted conception cycles are ICSI.

This large study of almost 5000 patients in Belgium and Spain being treated with ICSI or IVF found there was no benefit to using ICSI where there was no male fertility problem. The results of the study were presented by Dr Panagiotis Drakapoulos from UZ Brussels, the Belgian centre where ICSI was developed more than 25 years ago. The study was a collaboration between the Brussels centre and 14 clinics in Spain.

The reason given for using ICSI is often that it is thought it results in a higher chance of fertilisation and more embryos, but this large study showed no overall difference in outcome using IVF or ICSI regardless of whether the female patients had large numbers of eggs (more than 15) or not so many (1-3) – so there is no rationale for using it to try to improve outcomes in cycles where there are just a few eggs.

The use of ICSI varies around the world, with the highest rates in many countries of Eastern and Mediterranean Europe. There is a slightly lower use in some Nordic countries, the UK and France. In its latest review of treatment trends in the UK, the HFEA reported that ICSI use ‘continued to increase until 2014, but it is now in decline, possibly due to clinical opinion that it’s not needed in all contexts of IVF’. 

This reflects the message from this study, which, according to Dr Drakapoulos, found ‘no justification for the use of ICSI in non-male factor infertility’. He added that the number of eggs retrieved ‘should not play any role in selecting the insemination method’. Dr Drakapoulos also highlighted the extra financial cost of ICSI over IVF.

Men have a biological clock too

We’re all very aware of the female biological clock, but what we don’t hear so so much about is the fact that male sperm counts decline and DNA damage in sperm cells may increase as men get over. The fact that some high-profile men have become fathers when they are pensioners perpetuates the myth that male fertility lasts forever.

In fact, evidence shows men do have a biological clock with a decline in natural male fertility and an increase in the miscarriage rate as men get older. New evidence at ESHRE from one London fertility clinic shows that IVF/ICSI is less likely to succeed if a male partner is over 51 too.

Dr Guy Morris from the Centre for Reproductive and Genetic Health (CRGH) in London presented results at the ESHRE (European Society of Human Reproduction and Embryology) conference of an analysis of more than 5000 IVF/ICSI cycles which found that although there was no difference in miscarriage rates, there was a significant reduction in the chances of success

The results showed that that clinical pregnancy rate declined as men got older – from 49.9% when men were under 35, to 42.5% for men aged 36-40, 35.2% for those aged 41-45, 32.8% for those aged 46-50, and 30.5% in the over 51s.

The researchers also noted that 80% of couples where the male partners were over 51 were treated with ICSI, a treatment developed for male infertility. Dr Morris said: ‘There may well be a public perception that male fertility is independent of age. Stories of celebrity men fathering children into their 60s may give a skewed perspective on the potential risks of delaying fatherhood. Indeed, in natural conception and pregnancy it is only recently that evidence of risks associated with later fatherhood has become available. These more recent studies contrast with decades of evidence of the impact that maternal age has on fertility outcomes. In the context of this emerging evidence for the deleterious effect of increasing paternal age, our data certainly support the importance of educating men about their fertility and the risks of delaying fatherhood.’ 

Fertility information research

Researchers are looking at patient information currently available about fertility treatment and are keen to talk to anyone who either has had treatment in the past or is thinking about it as an option. The study is called the Empowering Patient Informed Choices (EPIC) study and it is about developing better patient-centred information. The research team wants to know what helps when it comes to making decisions, particularly related to additional treatments. 

You can take part here – it takes about ten minutes to complete the survey https://lse.eu.qualtrics.com/jfe/form/SV_bdAnfkKd2YGp5qd

Experiences of miscarriage

Earlier this week, I was honoured to chair a moving session at the arts festival Fertility Fest looking at miscarriage. The evening began with four artists with personal experience of miscarriage presenting their work. Julia Bueno, a psychotherapist, read a passage from her new book about miscarriage, The Brink of Being, which is published today. Visual artist Foz Foster talked about the wonderful 76 foot scroll he produced to celebrate the three children he lost through miscarriage. Finally, theatre company Open Sky, writer Lisle Turner and director Claire Coaché, showed a section of their powerful new show Cold about a couple who experience miscarriage.

After the artists had presented their work, we had a discussion session with the National Director of the Miscarriage Association, Ruth Bender Atik, and the Medical Director of Herts and Essex Fertility Clinic, David Ogutu. The discussion raised some fascinating issues, about the reality of experiencing a miscarriage which we so rarely acknowledge, about the taboos around pregnancy loss and the fact that we assume it is somehow a women’s issue. My only regret was that we ran out of time as there were so many more things we could have talked about, and we had a fabulous panel.

If you’ve been affected by miscarriage, I would recommend Julia’s new book – and if you are ever able to see Foz’s work or catch Claire and Lisle’s show, make sure you take the opportunity. Most importantly, do get in touch with the Miscarriage Association who offer both support and information. They have a factsheet written for anyone who has been through a miscarriage after fertility issues, which feel as if it is the cruellest blow. It is sometimes hard to reach out for support, but it really can make all the difference to talk to someone who understands the experience.

When IVF doesn’t work…

You may have heard in the news recently about the latest statistics on IVF success for women in their forties, and seen that Sally Cheshire, Chair of the fertility regulator the Human Fertilisation and Embryology Authority (HFEA), has spoken out about the need for fertility clinics to be more honest and open with patients about their chances of IVF success.

The latest figures show that the number of women in their forties having IVF has doubled since 2004, but only 75 women aged 42 and 43 will get pregnant using their own eggs, and once you reach the age of 44, just two women a year are successful. To put that into context, approaching 11,000 women who were over 40 had IVF in 2017.

Some clinicians say that women are entering into IVF with their eyes open, well aware of the chances of a successful outcome, but you don’t have to talk to many women who have had IVF to know that is often far from the case. When you are longing for a baby, you tend to hear the positives rather than the negatives, and when there’s a 5% chance of success, it’s the 5% you focus on rather than the 95% chance of your treatment not working.

It is difficult as sometimes women feel that although they may be 44 or 45 and know it is unlikely that treatment will work, they still want some kind of closure and need to know they’ve done everything they possibly could.

Sally Cheshire talks in her interview about being approached by clinics at the Fertility Show in Manchester and being given unrealistic suggestions of her chances of having successful IVF treatment. It is vital for clinics to be honest about this – and it doesn’t take much searching to find clinics publishing clinical pregnancy rates for women in their mid-forties which many will see as their chance of having a baby – when in fact, miscarriage rates are high for women of this age and these clinics know only too well that the live birth rate is very different from the clinical pregnancy rate.

You can read more about Sally Cheshire’s interview with the Telegraph here

Fake posts

I’ve written before about the people who sometimes post on fertility chat rooms claiming to be patients who have wonderful success stories from particular clinics. Of course, many people do this genuinely but some are clearly not real patients. It is hugely disappointing that anyone working in this field and seeing the misery that fertility problems can cause would think it might be acceptable to promote their clinics by pretending to be patients, but apparently some do.

This morning I got up to find dozens of comments posted on Fertility Matters from people with a variety of names and with different email addresses, all claiming to have received the same treatment which had resulted in dozens of miracle births against the odds. They were incredibly detailed stories that someone must have spent a considerable amount of time concocting. I deleted the whole lot immediately, but it made me sad that anyone might feel this was a sales method they wanted to use to attract patients.

I hope the fake posts put people off the clinics and professionals who resort to it as it’s often pretty apparent what is going on. There was a fabulous spoof on one of the fertility websites a while ago from someone who had got thoroughly fed up with the endless fake people claiming to have visited a particular clinic – and it’s calling it out like this that helps everyone to see it for what it is.

Make sure you report any dodgy posts you come across online and let’s help to ensure anyone who uses this horrible kind of promotion finds it backfires.

Fertility Fest

It starts today at the Barbican Centre in London, and if you haven’t checked it out already, do have a look at what’s on offer. There’s a whole range of events spread over a couple of weeks covering all aspects of fertility starting with today’s session on The Queer Family. Many of the sessions are in the evening so if you’re in reach of London, you can choose to go along after work and then there’s an entire Festival Day on May 3.

I’m honoured to be chairing a few of the sessions and having done this at Fertility Fest in the past, I can guarantee that the sessions will be fabulous. It’s incredibly moving to explore the issues raised by fertility through art, and there are some amazing artists taking part this year, joined by experts in the field.

Come along if you can, you won’t regret it! Tickets can be booked through the Barbican here.

Cards for miscarriage

I was absolutely delighted to hear from the Miscarriage Association yesterday that they were launching a range of cards for people to send to friends, colleagues or family members who had experienced a miscarriage. It can be so difficult to know what to say when someone has a miscarriage, and sometimes the tendency is to just ignore it entirely if you are worried about saying something wrong or upsetting the person concerned.

In fact, although miscarriage is very common, it can be an incredibly distressing and lonely experience and most people would really welcome some recognition of what they have been through. Ruth Bender-Atik, the national director of the Miscarriage Association said, “Shockingly, greetings card retailers stock a card for almost every important life event, except one. These cards recognise miscarriage, and give words to those friends and loved ones who can’t find them. Losing a pregnancy is heart-breaking and can be very lonely. Close family and friends often don’t know what to say, say the wrong thing, or just say nothing at all. The new cards have been launched to fill that gap. They may even become a treasured memento, the acknowledgement of the briefest of lives.”

The cards have been created for the women and men who go through miscarriage, ectopic or molar pregnancy and the friends, families and colleagues who wish they knew what to say to them. The cards carry thoughtful messages, approved by a panel of women who have been through miscarriage themselves, and the details of the Miscarriage Association inside, putting help and support directly into the hands of the person who needs it the most.

The cards were launched today and are and stocked at PostMark’s London stores and online (https://postmarkonline.co.uk/). They were devised and created by creative agency MRM//McCann.

To The Moon and Back

At last year’s Fertility Fest I was lucky to be in a session with mother and daughter, Anna Furse and Nina Klaff, who gave an amazing performance about their experiences of IVF as a parent and as someone born through IVF. It was incredibly moving, and I was delighted to hear that Anna and Nina will be back performing at this year’s Fertility Fest at the Barbican where they will be joined in discussion afterwards with Channel Four News Health and Social Care Correspondent, Victoria MacDonald and Ann Daniels, a polar explorer and mother of IVF triplets.

The performance takes place on Friday 26 April at 7pm and you can book tickets here

Can you help an art student?

Completely off-topic of anything fertility-related, but could any of you help with a research project for an art student?

It’s Sonder, a project about the lives of strangers. The student asks you to think of someone you have something to tell, and anonymously leave a voicemail for them on 07514806822. You can say something mundane, meaningful, practical, confessional. be bitter, apologetic, excited, informative – whatever you like. If you want to hide your phone number you can dial 141 07514806822

Sonder will never know who you’re telling, and they will never know you’re telling sonder.

If you want to help, but would rather your voice wasn’t heard, you can write and send your message to someone by text or on this page https://www.surveymonkey.co.uk/r/W7DGBXD