Choosing a fertility clinic

800px-Woman-typing-on-laptopThose of you who came to my talk at the Fertility Show will know that I promised to put up some notes from my talk on the blog this week – here they are at last!

The HFEA website

We begin with the HFEA website which is the best place to start. You can search for your local clinic using the Choose a Clinic tool – just type in your postcode or local region and you will get a shortlist of local clinics.

You can see more about the treatments they are licensed to carry out, services, facilities and staff. It will tell you whether they take NHS patients, the opening hours, whether there is a female doctor and links to a map.

Of course, the one thing you really want to know is how likely am I to get pregnant there? Which is the one thing no one can honestly tell you. The HFEA publishes success rates for all licensed clinics, but they may not be as clear cut as you imagine. Most clinics have broadly similar success rates and the majority of clinics in UK have success rates which are consistent with national average. Don’t forget, the patients treated affect the success rates.

You may want to look at the success rate for someone of your age, and make sure you are comparing like with like. The HFEA also gives the multiple birth rate, but a high rate doesn’t suggest a good clinic which has your best interests at heart. Naturally multiple births occur in 1 in 80 of all pregnancies, it’s around one in six after IVF. That may sound positive, but in fact multiple birth is the single biggest risk after fertility treatment. 1 in 12 multiple pregnancies ends in death or disability for one or more babies, and it is also more risky for mothers. Good clinics should not have very high twin rates. A really good clinic will have good success rates and low multiple rates.

When it comes to success rates, don’t get bogged down in fairly small percentage differences – in general they’re probably not that meaningful.

NHS Funding 

You will also want to know if you qualify for NHS funding. The guideline from NICE recommends 3 full cycles (fresh and transfer of any frozen embryos) for women of 39 and under and one full cycle for women of 40-42 who have had no previous treatment, who have a good ovarian reserve and who have spent 2 years trying)

In England funding comes from your local CCG (Clinical Commissioning Group) not your clinic so you need to find out their rules – and unfortunately they all make their own up as the NICE guideline is only a guideline. You can find out what your CCG is offering by visiting the Fertility Fairness website. The CCG will also set eligibility criteria – and each will have their own

Location 

Think about how close the clinic is to your home or workplace. Be realistic as a long journey is fine as a one-off, but think about doing it three or four times a week. Ask the clinic how often you will have to visit as some will want you in every day of the cycle, but others just a few times a week.

Think about how you will get there and how long the journey will take? Are you going to use public transport or drive? Will you be travelling in the rush hour? Can the clinic offer early morning appointments or will you need to take time off work? Will it fit around your job?

Cost 

Fertility treatment prices are not regulated and can vary hugely. Clinics that charge more are not necessarily better so do look into prices. The headline figure on clinic websites is rarely the total cost of treatment  – ask instead what the average person actually pays

The HFEA does require clinics to offer you a personalised costed treatment plan, but check what is included – drugs, counselling, scans and bloods, freezing and storing spare embryos, follow-up consultations etc.

Unproven treatments 

Many clinics offer unproven additional treatments. Many are not scientifically proven. The HFEA has advice on some of these . Additional treatments can be very expensive, and you may risk paying a lot for something that may not make a difference – and may even bring additional risks.

Support

Will there be someone you can call with any problems/concerns? You should be given a contact to call if you are concerned about anything at any time. And is counselling included in the cost of treatment? You may think you don’t want or need it, you may may find it helpful once you have started treatment. So check if you are going to have to pay for counselling, and if it is included, ask how many sessions.

Is there a counsellor based at the clinic? Some counsellors also offer telephone counselling and you can find a list of fertility counsellors on the British Infertility Counselling Association website. Is there a patient support group?

Waiting 

How soon could you get an appointment and when could you start treatment if it is recommended ? How long are waiting times for donor eggs or sperm? At some clinics,
there are still waiting lists for donor eggs and sperm but others have plenty of donors, so do check.k

Do you like the clinic?

I think this is far more important than you might initially think.

Talk to anyone else you know who has been there, look online for views – but remember that everyone is different. Go to any open days or meetings for prospective patients and think if the clinic feels right for you. It may sound ridiculous, but it matters.

Trust your instincts, and don’t hink they don’t matter. Make sure that you have chosen a clinic that you will be happy with.

Treatment isn’t always easy, but it is certainly much easier if you are being looked after by people you like and trust.

The Fertility Show London – 5 and 6 November

the-fertility-show-london-logoIt’s next weekend and if you haven’t booked your tickets yet, there is still time. It’s true that the Fertility Show can feel a bit like some kind of Ideal Home Exhibition for fertility problems, but it’s well worth visiting for the amazing seminar programme alone where you can catch many of the country’s leading experts and benefit from their wisdom and advice.

Talks on Saturday include:

  • How To Get Pregnant (and to have the best possible pregnancy) with Zita West
  • Innovations in embryo selection. Do they really make a difference? with Rachel Cutting MBE, Chair 2010-2014 of the Association of Clinical Embryologists and Principal Embryologist at Jessop Fertility in Sheffield
  • Stress and its impact on fertility with Jacky Boivin, Professor of Health Psychology at Cardiff University and Lead Researcher at Cardiff Fertility Studies
  • Surrogacy in the UK with Sarah Templeman, Nurse Manager at Herts & Essex Fertility Centre and Helen Prosser from Brilliant Beginnings
  • Natural Cycle and Mild IVF – fertility treatment without the drugs? with Professor Geeta Nargund, Medical Director of CREATE Fertility
  • The Basics. What you need to know to get pregnant and how to prepare for pregnancy with George Christopoulos, Subspecialty Registrar in Reproductive Medicine and Surgery at IVF Hammersmith
  • Next Generation IVF? with Professor Simon Fishel, CEO of CARE Fertility
  • Dealing with recurrent miscarriage with Dr Vidya Seshadri, Consultant Gynaecologist & Specialist in Reproductive Medicine at The Centre for Reproductive & Genetic Health
  • Reduced ovarian reserve: Is anyone too difficult to treat? with Sam Abdalla, Director of the Lister Fertility Clinic
  • Factors to consider when choosing a fertility clinic with me! (Kate Brian, journalist, broadcaster, author of bestselling The Complete Guide to IVF, mother of two IVF children, Lead of Women’s Voices at the Royal College of Obstetricians and Gynaecologists and London Representative for Infertility Network UK)
  • Going abroad for treatment? Question time featuring 2 overseas clinics with Dr Bruce Shapiro of The Fertility Center of Las Vegas and Dr Natalia Szlarb from IVF Spain.
  • Counselling through infertility with Tracey Sainsbury, member of the British Infertility Counselling Association.
  • Boost fertility and prevent recurrent miscarriage with nutrition with Dr Marilyn Glenville
  • Immunology – potentially hazardous treatment or your best chance of success? with Mr Mohammed Mahmoud, Consultant in Reproductive Medicine of The Newlife Fertility Clinic and Siobhan Quenby, Professor of Obstetrics and Director of the Biomedical Research Unit in Reproductive Health at the University of Warwick.
  • Improving the odds of IVF working for you with Yacoub Khalaf, Consultant Gynaecologist and Medical Director of the Assisted Conception Unit at Guy’s and St Thomas’ NHS
  • Coping Strategies with Wendy Martin, specialist fertility counsellor with Bristol Centre for Reproductive Medicine NHS
  • Testing your fertility and the value of your ovarian reserve with James Nicopoullos, Consultant Gynaecologist at the Lister Fertility Clinic.
  • Freeing your mind to improve fertility with Russell Davis, Cognitive Hypnotherapist.
  • Dealing with Polycystic Ovary Syndrome (PCOS) with Adam Balen, Professor of Reproductive Medicine and Surgery at Leeds NHS Centre for Reproductive Medicine and Chairman of the British Fertility Society.
  • Issues for families created with donors with DC Network founding member Olivia Montuschi.
  • What men need to know about their fertility – testing it, boosting it, treating it with Allan Pacey, Professor of Andrology at the University of Sheffield and former Chairman of the British Fertility Society.
  • Complementary Therapies – can they boost your fertility? with Dr Gillian Lockwood, Medical Director of Midland Fertility Services and ethics spokesperson for the British Fertility Society, Andrew Loosely who practices herbal medicine and Barbara Scott, chair of the Association of Reproductive Reflexologists.
  • Fertility treatment for older women with Tarek El-Toukhy, Consultant in Reproductive Medicine and Surgery at Guy’s and St. Thomas’ Hospital.
  • How to keep costs down – do you really need those add-ons? with  Dr, John Parsons, part of the team that established the first IVF pregnancy to deliver at the Hammersmith hospital.
  • Sperm and egg donors from the UK with Laura Witjens, egg donor and former CEO of the National Gamete Donation Trust, and Venessa Smith, Donor Services Co-ordinator from the London Women’s Clinic.
  • Can acupuncture improve fertility? with Michael Dooley, Medical Director of Poundbury Fertility and Emma Cannon, acupuncturist.
  • The arguments for travelling to the USA vs Portugal vs Norway with Dr Angeline Beltsos of Vios Fertility Institute, Dr Vladimiro of Ferticentro and Dr Jon Hausken from Norwegian Klinikk Hausken.
  • Steps to choosing the right adoption agency with First4Adoption’s Gemma Gordon-Johnson.
  • Travelling to the USA for egg donor treatment – the patient’s perspective and the clinic that treated them with Sarah Esdaile and her partner who had treatment in the USA and Dr Michael Levy, Director of the Donor egg programme at Shady Grove Clinic.
  • A patient’s experience of the fertility rollercoaster and what to expect with Jessica Hepburn, trustee at Infertility Network UK and author of  The Pursuit of Motherhood.
  • Why should I give it another go? with Tim Child, Associate Professor and Subspecialist in Reproductive Medicine, University of Oxford and Honorary Consultant Gynaecologist, John Radcliffe Hospital.
  • Planning Treatment abroad? The arguments for travelling to Greece vs Spain vs Russia with Dr. Dimitrios Dovas of The NewLife IVF Centre in Greece, Dr Ramon Aurell, IVF Unit Medical Director of Hospital Quirón Barcelona and Dr Yulia Gurtovaya, a consultant at West Middlesex University Hospital who speaks on behalf of Russian IVF clinic CRM MAMA.
  • Single women and lesbian couples – options for conceiving with Dr Raúl Olivares, Medical Director of Barcelona IVF.
  • An overview of the common causes of infertility and the main approaches to treatment with Kamal Ojha, Medical Director of Concept Fertility and Honorary Senior Lecturer at St George’s Hospital.
  • Fertility treatment for older women with Dimitrios Nikolaou, Consultant Gynaecologist, lead clinician at Chelsea and Westminster NHS Hospital’s Assisted Conception Unit and Medical Director of Fertility for Life.
  • Options for adoption with Jan Fishwick, CEO of PACT
  • Unknown donor vs known donor vs co-parenting with fertility lawyer Natalie Gamble and Erika Tranfield of Pride Angel.
  • What to think about before going abroad for treatment with Ben Saer, who with his wife Becky had successful fertility treatment in the Czech Republic, Dimitris Kavakas of Embryolab based in Thessaloniki and Dr Carlos Doscouto of Spanish IVF clinic Women’s Health Dexeus.
  • Dealing with and treating, endometriosis with Haitham Hamoda, Consultant Gynaecologist in reproductive medicine and surgery at King’s College Hospital.
  • Top Ten ways to cope with infertility with Anya Sizer, rregional organiser at Fertility Network UK.
  • Surrogacy arrangements with Helen Prosser from non-profit UK surrogacy agency Brilliant Beginnings and Natalie Gamble, campaigner and founder of leading fertility law firm Natalie Gamble Associates.
  • Single woman in your 30s or 40s? Thinking about having a baby on your own? with Caroline Spencer, trustee for the Donor Conception Network.
  • New technologies in IVF with Lucy Richardson, Senior Embryologist at the UK’s Herts & Essex Fertility Centre and Dr Elizabeth Barbieri from US-based Oregon Reproductive Medicine.
  • Getting your head around treatments, clinics and statistics with Juliet Tizzard, Director of Strategy and Corporate Affairs at the HFEA
  • .Men Matter Too with fertility Counsellor Anthony Ryb.
  • Fertility treatment on the NHS? with Anil Gudi and Amit Shah, Consultant Gynaecologists who run the NHS fertility service at the Homerton Fertility Centre in East London.
  • Nutrition to help with PCOS, endometriosis and fibroids with Dr Marilyn Glenville.
  • How to deal with the diagnosis of unexplained infertility with Dr Jane Stewart, Consultant in Reproductive Medicine at the Newcastle Fertility Centre.
  • How to keep costs down – do you really need those add-ons? with Yacoub Khalaf, Medical Director of the Assisted Conception Unit at Guy’s and St Thomas’ NHS.
  • Overseas egg donors. Who are they and how are they chosen? with Dr Israel Ortega of IVI Madrid in Spain and Nancy Block of Fertility Source Companies in the US explain.

As you can see, there is something here for everyone and having access to so many experts under one roof presents a unique opportunity to learn more about fertility and the treatments which may help. You can buy tickets from the website www.fertilityshow.co.uk

The HFEA would like your views

logo-hfeaThe Human Fertilisation and Embryology Authority (HFEA) have launched the beta (draft) version of their new website to the public and it is aimed at people like you – fertility patients. They want to know what you think of it. Have they got it right?

They have put together a survey so you can give your feedback about the new site. This includes a number of questions about how the information on clinics is presented – including their birth statistics in the Choose a Fertility Clinic section. The HFEA are keen to hear your views about how they have chosen to present these.

The beta service is a work in progress, with new information and features planned for the next weeks and months. You can give your views by completing the beta survey that can be found on the website. Please take a look at https://beta.hfea.gov.uk

Should patients be able to travel abroad for treatment?

104px-GEO_GlobeThere’s a really interesting article here asking whether patients should be allowed to travel overseas for fertility treatment to a country which has different rules and regulations from those at home. We just assume that patients have the right to go wherever they want and do whatever they want, but this article is based on a  report in European Journal of Obstetrics and Gynaecology and Reproductive Biology which considers the idea that there are moral issues for doctors in supporting patients who want to travel abroad to avoid the laws in their own countries.

Apparently in 2012 the French Health Ministry sent out a warning to doctors that informing patients about egg donation overseas would carry a risk of five years in prison and a fine of 75,000 Euros because of concerns about human eggs being bought and sold – and in Germany and Turkey they have also had penalties for doctors referring patients overseas for certain treatments.

You can find the report itself, from the European Journal of Obstetrics and Gynaecology and Reproductive Biology here, which argues that governments should be tolerant to patients who wish to travel for treatment and suggests that their doctors who refer them are trying to act in their best interests. However, the article from Fox News quotes a Japanese health researcher from  Kanazawa University in Japan called Yuri Hibino who says that in Japan some hospitals are so worried by the risks of egg donation abroad, which can include multiple pregnancies and older mothers, that they won’t deliver babies conceived by egg donation.

 

What do you think? Should there be restrictions on treatment overseas? Or would that be a step too far and an interference with personal liberties? And what about doctors who refer patients overseas? It’s certainly an interesting issue…

Report on incidents in fertility clinics

images-6If you’re having treatment at a fertility clinic, you may be interested in a new report from the Human Fertilisation and Embryology Authority which looks at the number of incidents or mistakes that happen in the UK’s fertility clinics. It may sound alarming, but sometimes things don’t go exactly to plan and encouraging clinics to report to the HFEA when this happens can help them to prevent problems occurring in the future and to share experiences so that others can learn from what has happened too.

The new report shows that the number of incidents at fertility clinics is going down, and that they occur in less than one percent of treatment cycles.  However, that does mean a total of 465 occasions when something went wrong, and it can be distressing if this happens to you. Only two of these were in the most serious grade A category, and the largest group were in category C, the lowest grade, which might sometimes mean an administrative error, for example a patient being sent a letter meant for someone else.

The HFEA Chair Sally Cheshire urged clinics to use the practical help available from the HFEA to that we can offer to do more to improve patient care: “Whilst every incident that takes place is one too many, I particularly want clinics to concentrate on reducing their grade B and C incidents. Such mistakes are often distressing to patients, largely avoidable and frankly shouldn’t happen. The small reduction in incidents is a step in the right direction but more can and must be done by clinics, and we can help. Since our last report, we have worked with clinics to improve their systems and practices. For example, where clinics are struggling to recognise what changes need to be made to avoid future incidents, our clinical governance team offers bespoke incident training to individual centres. It is for clinics now to step up and make the necessary changes so that everyone affected by assisted reproduction receives the best possible care. I want to see these improvements realised by the time of our next annual report.”

You can download the report itself here 

Tripadvisor for fertility clinics?

If you missed the debate organised by Progress Educational Trust on the HFEA’s plans to include some patient feedback on clinics on the website, you can catch up with the podcast here.

You can hear the HFEA’s Juliet Tizzard, Infertility Network UK’s Susan Seenan, Yacoub Khalaf director of the fertility clinic at Guy’s and St Thomas and Antonia Foster, a media litigation specialist discuss the issue in a debate chaired by Adam Balen, the chair of the British Fertility Society.  It was an interesting and lively evening – and that link is at –http://www.progress.org.uk/tripadvisor

The latest fertility figures

The latest figures relating to fertility treatment in the UK have been released this morning by the Human Fertilisation and Embryology Authority (HFEA) and show a growing number of cycles of IVF with a total of more than 64,000 carried out in 2013.  The number of cycles of donor treatment have more than doubled in the last five years, and there has been an increase in the number of same-sex couples having treatment. Success rates have gone up very slightly, but the multiple birth rate from fertility treatment has fallen.

The majority of women having treatment are under 37, and the average age of fertility patients is 35.  The report shows that over a third of fertility treatment is carried out in London and the South East – and that in 2012, 2.2% of all babies born in the UK were conceived as a result of IVF.

You can see the full details at http://www.hfea.gov.uk/

25 free IVF cycles

London’s Lister Fertility Clinicivf_science-300x168 is giving away 25 free cycles of IVF in a draw.  There are certain criteria for entry – you have to be under the age of 42 with a BMI between 19 and 30 for women and you must be a UK citizen.  You must either have a clear cause for your fertility problem or have been trying to get pregnant for at least two years, and you can’t have any previous children from your relationship.

The draw is being administered by the charity Infertility Network UK, and you can find details of how to enter the draw for a free cycle of IVF here – http://www.infertilitynetworkuk.com

Emotional support at your fertility clinic

If you have a spare thirty seconds, could you help Infertility Network UK by answering a question – yes, just one! – about the level of emotional support you felt you got at your fertility clinic? Anyone who has attended a fertility clinic can answer the poll, so do please help if you have a moment  – results can help assess how well people feel they are being supported at present. The link is here – https://healthunlocked.com/infertility-uk

Thank you!

IVF as a “lifestyle choice”?

TV presenter Kirstie Allsopp has made headlines again with her views on women and fertility – this time claiming that women shouldn’t see IVF as a “lifestyle choice”. Last time she spoke out about age and fertility, I agreed with her – but this time I’m not sure I do.

I honestly don’t think people do see IVF as a “lifestyle choice” – no one wants to go through IVF, no one “chooses” it. I think perhaps sometimes people assume it can help if they’ve left it later to try to have children – and that can be terribly sad if it’s only then that they discover how low IVF success rates drop once you are into your forties.

She also talks about women having to “run the risk” of pumping drugs into their bodies during IVF. Again, although no one would choose to stimulate their ovaries in this way and ovarian hyperstimulation is a potentially dangerous side-effect if not managed properly, I don’t think it’s very helpful to talk about it as running a risk.  To read many newspapers today, you would believe that anyone who has had IVF is likely to develop all kinds of ghastly long-term conditions as a result of the drugs, when in fact there is no evidence of this kind of health risk.

I’m glad she’s speaking out about this and I think she’s right to encourage women to have children sooner rather than leaving it later if that’s a possibility – but I’m not sure talking about IVF as being risky, or as a lifestyle choice, is terribly helpful.