Don’t bother with that detox

images-4Most people think about their lifestyle when they are going through fertility tests and treatment – there is so much information out there now about how diet and lifestyle can impact on fertility that it’s not surprising that people often feel a need to take measures to improve what they eat. It’s never a bad thing to eat healthily, but it’s also true that there’s little scientific evidence about so-called fertility “superfoods” or that supplements are going to make a real difference to the outcome of treatment.

At the start of a new year, many of us feel we want to use the opportunity to improve ourselves in some way and the idea of a detox to start the year is often very popular. However, doctors have issued a warning after one woman who did this last year became seriously ill as a result of taking herbal remedies and drinking too much water. She collapsed and suffered a seizure before being admitted to hospital.

Please don’t worry that eating your five a day and cutting back on alcohol is going to make you unwell – this was a full-on detox diet which is a very different thing. In fact, the British Dietetic Association told the BBC that the whole idea of detoxing is nonsense – so whilst eating well and cooking fresh wholesome food is always going to be good for you, this makes it clear that there is not only no need to follow extreme diets, it can also be very dangerous. You can read more about this here and here 

Other people’s fertility treatment

laptop-computers-1446068-mThe Internet can be a fantastic resource when it comes to finding out more about fertility and treatment, and many people gain important insights by reading other people’s fertility stories online. This can, however, have a less helpful side. Although it may be useful to get practical tips, to read about what happens during a cycle and to feel that you are more prepared for what is about to happen, it is also vital to remember that everyone’s treatment is different. The tests carried out, the protocols used, the drugs prescribed can all vary depending on your own individual situation.

Recently I’ve been contacted by a few people asking about their treatment who have become worried that something might not be right because they’ve come across other people who have had different tests or treatments – or who have been prescribed different drugs at different doses. Just because your treatment is not exactly the same as someone else’s, that doesn’t mean it is wrong or less likely to work. If you have concerns, you should never worry about asking at your clinic, but remember that fertility treatment is always tailored to an individual to some degree and that clinics may not all do everything exactly the same way.

Fertility funding schemes

unknown-6I’ve come across quite a few mentions of fertility funding schemes recently where you pay a lump sum and are then offered your money back if you don’t get pregnant. Of course, the usual criticism of these schemes is that they are only available for younger women who are most likely to get pregnant. So I was interested to read of one recently which was apparently open to women of all ages with no age cut off. However, reading further down the article, it was apparent that actually although there wasn’t an official age cut off, women did have to pass a “screening” – and it is highly likely that by their mid forties, very few women would pass such a test.

These schemes can seem a great option – but it is important to understand their limitations as they are not open to everyone.

Can you ever stop plans to cut IVF

images-10If there are plans afoot in your local area to reduce the number of IVF cycles offered to those who need treatment, or even to cut treatment altogether, you may be left wondering whether there is anything you can do to make a difference. Although there are sometimes public consultations when funding is due to be cut or reduced, it can be tough to have the confidence to put forward your point of view – and sometimes it may start to seem as if there is very little point anyway as people wonder whether those who commission treatment are really listening.

This excellent piece from Bionews written by Richard Clothier tells how he fought back against planned cuts to fertility treatment in his local area. It’s a great read – and you may be surprised by the outcome.

Will my IVF work?

ivf_science-300x168You may have heard about the new predictor tool for IVF/ICSI which has been developed recently which is available through the University of Aberdeen website.

It uses data from the Human Fertilisation and Embryology Authority which keeps records of all cycles of treatment carried out in the UK, to aim to give a picture of your individual chances of having a baby after IVF/ICSI treatment,

The reporting of this has been analysed by NHS Choices which points out that there are some gaps in the data which the researchers themselves have acknowledged as it doesn’t account for the woman’s body mass index (BMI), whether she smokes and how much alcohol she drinks.

Despite these limitations, it is certainly a very useful tool and one which may help many couples get some kind of realistic idea of the chances of an IVF cycle working. Of course, the experience of each individual couple is always different and this doesn’t allow you to include any detailed medical data either, but it does give a broad picture view which may prove very helpful.

Interview with Julia Leigh, author of AVALANCHE

7432976-1x1-700x700We spoke to Julia Leigh, author of Avalanche, at the start of our National Fertility Awareness Week and began by asking her what she thought of the idea.

It’s a wonderful idea which I hope will focus more attention on under-reported fertility issues. Also, it’s a special way to bring together those whose lives have been touched by infertility.

Do you think we are too reluctant to speak openly about fertility issues?
There’s no reluctance on the part of the multi-billion dollar worldwide fertility industry to promote this area of medicine. For example, this month [October] the American Society for Reproductive Medicine Scientific Congress & Expo took place in Salt Lake City, Utah. Exhibitors represented at the Expo included a fertility clinic network; a myriad of ‘bio tech’, ‘health technology’, ’genetic screening’ and ’diagnostic solutions’ laboratories; biopharmaceutical manufacturers; food and vitamin supplement manufacturers; pharmacists; surrogacy and donor organisations; laboratory equipment suppliers; attorneys; insurers; cryobankers and cryoshippers; marketing and brand strategists; a big data analyst; specialist software providers; and a joint venture partner who promised to turn growing medical practices into successful businesses. There’s also no reluctance on the part of the media to report successful ‘miracle’ births. There is a reluctance, however, to talk openly about the plain fact that most treatment cycles fail. To give some perspective, about 80% of treatment cycles fail. There’s also a disturbing reluctance to talk openly about the physical and emotional harms of treatment. It’s almost as if patients and doctors and others in the fertility world are so bewitched by the beautiful possibility of a ‘live birth’ that they turn a blind eye to the real harms.

Your book Avalanche about your own story is intensely personal – was it difficult to be so open in public?
At the time of writing I felt that I’d already lost so much I didn’t care about losing face – and that afforded me an enormous freedom. My heart goes out to anyone who is doing treatment now.

What made you want to write the book?
I wrote an Author’s Note for my publishers and I think it gives the best idea of why I wanted to write the book. Here it is:
A writer contemplating whether or not to begin a new work asks herself – Is this truly a story worth telling? Avalanche felt necessary. I’ve tried to tell an intensely personal story about a common experience that has largely remained unspoken. I wanted to offer a ‘shared aloneness’ to anyone who has desperately longed for a child. I hope I’ve brought into the light the way the IVF industry really works – and I could only do that in non-fiction. I wanted to transmit what it feels like to be on the so-called ‘emotional roller-coaster’, to deeply honour that complex experience in all its detail. Ways of loving, the mysteries of the body, the vagaries of science, the ethics of medicine – the material raised so many questions. I started writing it very soon after I made the decision to stop treatment because I wanted to capture my strong feelings before they were blanketed by time. I wanted to write something for all the women who are contemplating IVF, or currently undergoing it, or who have stopped or who are thinking about stopping (it’s so hard – the decision to ‘give up’). I wanted to speak to their family and friends. I wanted to speak to young women who in a misguided way might be relying on fertility treatment as a kind of back-up. And I wanted to speak to the policy-makers too. Since there is so much IVF failure I wanted to provide an alternative voice to the miracle stories we frequently see in the media. I wanted to counter the push – yes, the push – of the worldwide multi-billion dollar IVF industry.

Do you think people need more emotional support when they are going through treatment?
It’s difficult to discuss treatment with family and friends but in so doing a patient can lighten the emotional burden. There’s also the counselling option. In my case, the clinic offered free in-house counselling as part of the very expensive treatment package…but I would advise seeking an outside independent therapist. I say this because the decision to stop treatment, to give up, that incredibly painful decision, sits uncomfortably with the fact that clinics are making money from their patients. In my case, when I was 44, using my own eggs, and I’d already done 2 IUI’s and 6 egg collections plus subsequent transfers, my doctor suggested I try once more. It was my sister who had the courage to tell me firmly that I needed to stop. I feel an independent therapist would be well-placed to basically warn patients of the emotional pitfalls that can lay ahead. Is there such a thing as pro-active counselling? Identifying the traps for new players and advising how best to respond to them…identifying the tricks of the mind that don’t serve patients well…I think a therapist who was familiar with the IVF world, who had experience in this area, would be best.

And do you think there is adequate support when treatment doesn¹t work?
There was little to no follow-up from my clinic after I decided to stop treatment. I can’t recall exactly – there may have been one phone call. I saw an independent therapist.

Here in the UK, the individual success rates for individual clinics are collated and published by the fertility regulator, the HFEA, and are broken down by age too. Do you think access to information like this would have made a difference to you?
Yes I would have loved to see results for my individual clinic. That would have helped. But I also want to note that I did see the graphs on my clinic website which used our ANZARD data and clearly showed how fertility dropped away with age. (The ANZARD report collates data from all clinics in Australia and New Zealand but doesn’t identify individual clinics). And when I was 40 my first doctor at the clinic said I had about a 20% chance of ‘taking home a baby’. BUT as it happened, at age 43, when I was transferring a thawed 5 day blastocyst, using my own egg, I asked my new doctor what my odds were of being pregnant (please note, pregnancy not live birth). Even though I’d seen the fertility graphs I figured my chances would somehow be better than the average because unlike some patients my age I was both responding to drugs and producing blastocyts: “Pollyanna Juggernaut could do amazing things with the numbers.” In reply to my question about odds, the doctor said “A Day 5 blastocyst has about a 40% chance.” I took that to mean I had a 40% chance of being pregnant – but later I discovered the 40% figure was for women of all ages. I hope that illustrates how statistics can be malleable…

What changes do you think we could make to try to ensure that fewer women suffer the kind of anguish you went through?
That’s a good question and I don’t have any easy answers. I wonder if there couldn’t be a buffer between women – especially older women – who are prepared to do almost anything to have a child and the clinics who are prepared to put patients through almost anything even though there is no guarantee of a successful outcome, far from it. In Australia a well-respected doctor put a patient through 37 cycles. 37! He had no qualms about that since she did end up with a child. But what if she hadn’t? I’m not sure what happens in the UK but in my case it was my General Practitioner who referred me to the fertility clinic. My GP never asked how my treatment was going. I wonder if GP’s could step in as a buffer, walk patients through the facts and figures, help decide whether or not to do an experimental protocol advocated by the clinic that will cause physical harm but has limited evidence of benefit, to basically serve as a ‘reality check’. There’s a great deal clinics can do to change…For example, during an embryo transfer my doctor pointed to an image of the blastocyst on the ultrasound screen and said ‘That’s the baby’. At the time, I thought it generous and I was touched that the doctor might be the only person in the world who would ever refer to ‘my baby’ but in retrospect the comment – that’s the baby – only heightened my intense desire for a child.

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 goes to Manchester

the-fertility-show-london-logoIf you missed the Fertility Show in London at the weekend, you may be interested to know that there will be a second Fertility Show in Manchester for the first time this year. There will be the same wide range of seminars and exhibitors with lots of information and advice.

The Manchester Fertility Show will take place on March 25 and 26 in the Exchange Hall at the Manchester Central Convention Complex in Windmill St in Manchester. Tickets will go on sale in January 2017 and you can find out more on the Fertility Show website.

Finally, for those of you who came to my talk in London and are looking for the notes on my talk, I am hoping to put them up on the blog later this week so you will be able to find out all you need to know about choosing a fertility clinic!

Should you pay for add-ons when having IVF?

proline_level_measurement_in_eurasian_national_universityWhether you are at the point of considering IVF or have already had some treatment, you will be aware of the wide range of additional treatments which some fertility clinics offer on top of the standard treatment cycle. The idea is that these will improve your chances of success, and as people inevitably want to do all they can to boost the likelihood of a positive outcome, it can be very tempting to pay for at least some of these.

It is clear that they will certainly add to the cost of your treatment, but whether they will add any benefits in terms of outcomes is still very much up for debate. Few of these add-ons have a reliable base of scientific evidence to prove that they are likely to work, yet patients are often paying for them believing that without them there is a lower chance of a successful cycle.

Yacoub Khalaf who is Director of the Assisted Conception Unit a Guy’s and St Thomas’ in London, spoke on the subject at The Fertility Show at the weekend. If you missed it, you may be interested in his article on the Huffington Post about this.

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