A team from University College London found that two of the most popular flavours put into e-cigarettes were particularly damaging to sperm – bubblegum and cinnamon were both found to affect male fertility. You can read more details about their research, which was presented at the Fertility 2017 Conference earlier this month, here
If you haven’t already seen this fabulous article from The Guardian by Alexandra Heminsley, it is worth a read.
You may have come across Alexandra Heminsley before as she wrote a previous book, Running Like a Girl,, about her experiences of running (which I found really inspiring as someone who is not remotely sporty but who has discovered an unexpected love of running – albeit very slowly…).
This article is about her new book Leap In, which deals with swimming and fertility treatment. We learn that she has been through two rounds of treatment, one of which resulted in a positive pregnancy test followed by a miscarriage. There is always a feeling of connection when you read about someone going through fertility treatment – we all understand something that others never really can – and I found her article incredibly moving. She talks about her changing feelings as she goes through the unsuccessful treatment and miscarriage, about how she feels betrayed by her body and rejects it. Describing all this through a focus on swimming somehow makes it an even more powerful read. When she talks about the “sort of breathlessness, almost a vertigo” that comes over her when she thinks about never having a child, she captures in just a few words the vast hollow emptiness and fear which are so familiar to many of us.
I’ll be posting a book review soon, but in the meantime, do read the article.
When it comes to embryo transfer, some people still worry that putting one back will reduce their chances of success. In fact, for those who have good quality embryos putting them both back will just increase your chances of having a multiple pregnancy – and although twins or triplets may sound like a wonderful idea when you are trying to conceive, it is the biggest health risk from fertility treatment. Now, some interesting new research suggests that perhaps it isn’t just those who have good embryos who should be having one embryo transferred.
A study by scientists at Nurture in Nottingham found that putting back one low quality embryo alongside a high quality one reduced the chance of becoming pregnant by more than a quarter. It was only when neither of the embryos were good quality that putting back two actually increased rather than decreased the chances of a successful pregnancy. You can read more about the research here.
This does back up the idea that single embryo transfer is the best option for many – but not all – fertility patients. It should always be something you discuss with the team treating you but it is really important to be aware that putting back more than one embryo may not increase the chances of success.
In recent years, there has been a huge increase in the numbers of people offering fertility support services – often at premium prices from people who have no relevant qualifications and limited knowledge or expertise. What many people don’t realise is that the national charity, Fertility Network UK, provides an amazing range of support services which are all completely free.
The Fertility Network Support Line, run by a former fertility nurse, Diane, offers a unique fertility support service. Diane has a wealth of experience and has worked for the charity for more than 20 years, She can help not only with minor medical questions but provide you with the help you need based on her years of experience, and all calls to her are in complete confidence.
The Support Line has often been described as a ‘lifeline’ by those dealing with fertility issues. It is very normal to feel isolated, out of control, lonely or depressed when dealing with infertility, and Diane is there to help. No question is too trivial to ask and even if you just want to talk you can give her a call on 0121 323 5025 between 10am – 4pm on Monday, Wednesday and Friday, or email her at email@example.com.
Of course, that’s not all the charity has to offer. You can find a wide range of support groups right across the UK, an online community, a Facebook page and masses of information. Do check it out now at fertilitynetwork.org and save the money you were about to spend – or perhaps consider donating it!
We 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.
The only evidence to back up this suggestion are some figures which are apparently due to be released at the weekend claiming that 150 people have got pregnant who have used the device.
We learnt earlier this week that new figures from the Human Fertilisation and Embryology Authority show the number of babies born after IVF treatment now stands at more than a quarter of a million. I am not quite sure how 150 pregnancies leads the Daily Mail to conclude that this device is equally effective to the 250,000 babies from IVF…
I won’t say any more but if you are thinking of spending £100 on this device, please discuss it with a fertility specialist first.
New research has suggested that many young women are worried about their fertility, and that conflicting information and pressure from friends and family all contribute to the problem. It is not clear from the press release for this study how many women were surveyed or how the survey was carried out, but it has apparently suggested that:
- Nearly half (47%) of under 45s surveyed said they worry about not being able to have a baby and this rose to 62% among 18-24 year olds.
- Almost two thirds (63%) reported feeling upset, stressed or pressured by conflicting fertility advice, with one in three women saying that they found it hard to get information that they could trust.
- Women aged 18-24 said pressure to have a baby came from family and friends (33%), the media and celebrity culture (18%), or even people they didn’t consider close friends (8%).
- Women aged 25-34 reported the highest level of pressure from family and friends (52%), while older women (aged 35-44) felt less pressure from the media and celebrity culture than younger women.
For women who were concerned about getting pregnant, nearly half (49%) of those surveyed were worried that they may have a fertility problem that they didn’t know about..
Dr James Nicopoullos, Consultant Gynaecologist at The Lister Fertility Clinic, said:
“It’s understandable that women are feeling both worried and confused about their fertility. There is so much information (and also misinformation) out there which in some situations is causing unnecessary stress, but the truth is that there’s no one size fits all approach to fertility advice.”
The consumer research apparently suggested there was some confusion about factors that can affect fertility, and James Nicopoullos, Consultant Gynaecologist at The Lister Fertility Clinic, has addressed some of these issues.
Respondents to the survey said: Being on the pill for a long time could make it harder to get pregnant (41%)
James said: This is a common myth that I hear, but it’s actually false. 75% of women ovulate and cycle normally within a month of stopping the pill and 90% within 3 months. Those who don’t have regular cycles thereafter may have some underlying issue causing this (such as polycystic ovarian syndrome).
They said: Doing regular exercise can help improve fertility (64%)
James said: There is no consistent evidence that regular exercise negatively effects fertility so I would always suggest keeping in shape is a good thing. In extreme cases, there have been instances where women have decreased their body fat stores through exercise, leading the body’s hormonal production to switch off and prevent periods, which negatively impacts on fertility.
They said: Drinking alcohol can make it harder to get pregnant (60%)
James said: Some studies have indicated that alcohol can affect fertility so decreasing intake or stopping completely is never a bad thing. The evidence, however, at low levels is inconsistent. National guidelines suggest no more than 1-2 units of alcohol once/twice per week.
They said: Smoking can affect your fertility (66%)
James said: Smoking tobacco even a small amount can significantly impact on fertility and the evidence for this is much more clear-cut than with alcohol. There is evidence of a negative effect on natural fertility, an increase in miscarriage risk, ectopic pregnancy risk as well as lower chances with assisted reproduction. There is even a significant risk of earlier menopause. Some studies have also shown a correlation with number of cigarettes smoked. Just as important are the increases in risk in pregnancy of complications such as preterm labour, stillbirth and placental problems.
They said: A positive state of mind can help improve fertility (47%)
James said: Stress is a very hard thing to quantify but my motto is “don’t be stressed about being stressed”. At extremes, it can again cause periods to cease but in most this will not be an issue. A large study in the British Medical Journal suggested that stress caused by fertility problems or other life-events did not seem to impact on the outcome of fertility treatment.
They said: Being overweight or obese can make it harder to get pregnant (71%)
James said: Both extremes of weight can be detrimental. Those underweight may have issues with their cycles stopping affecting chances of natural conception and as body mass index rises above normal there are risks to fertility and once pregnant. Studies have shown that it may be harder to conceive naturally, as well as lower chance of success with fertility treatment. Miscarriage rate is also higher as BMI increases. Ideally we should aim for a BMI of 19-25 and strongly recommend a BMI of <30 when trying to conceive.
They said: ‘Wearing loose clothing can help improve fertility’ (12%)
James said: This is a myth. While some studies have suggested that wearing tight underwear may affect sperm production in men, the same can’t be said for women.
They said: Pilates and yoga can improve your fertility (21%)
James said: Anecdotally, I would say that being calm, happy and in good shape could help you conceive, but whatever works for you. I think it would be false to attribute good fertility to doing yoga.
It’s all too easy for those not affected to brush off the impact of fertility problems on people’s lives, but a new study from Fertility Network UK with Middlesex University London has come up with some bleak figures.
As Susan Seenan, Chief Executive of Fertility Network UK explains, “This survey paints an incredibly stark, distressing picture of what it is like to experience fertility problems in this country. Sadly, in the UK, the inability to have children without medical help means having to face a series of emotional, social and financial hurdles. These include often having to pay crippling amounts of money for your own medical treatment, a lack of affordable, accessible counselling and emotional support, and the deterioration of core relationships. Far more needs to be done to help individuals through the far-reaching devastation fertility issues wreak.”
Key findings include:
- 90 per cent of respondents reported feeling depressed; 42% suicidal
- 54% had to pay for some or all of their treatment; 10% spending more than £30,000 (the average was £11,378)
- 74% said their GP did not provide sufficient information
- 70% reported some detrimental effect on their relationship with their partner
- 75% noted the lack of a supportive workplace policy
- 75% would have liked to have counselling if it was free; only 44% did receive counselling and, of these, over half had to fund some of it themselves
You can read the full survey results here
It’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
It was these tributes from the Liverpool Echo which inspired me to write a few words here in memory of Iwan Lewis-Jones who very sadly died last weekend. Iwan was one of those doctors you long to come across as a fertility patient – kind, understanding, empathetic and brilliant at his job working as a male fertility specialist at the Hewitt Fertility Centre in Liverpool. Long before I ever met Iwan, I interviewed a couple who’d been treated by him. They were so enthusiastic about this wonderful doctor they’d seen, how he had immediately understood their fertility problems and had known the best way to help, how lovely he had been to them and how they didn’t think they would ever have had their much-loved children if they hadn’t happened to find him.
Iwan brought such joy into many lives, and was a really lovely man. He was a great supporter of Infertility Network UK and understood the needs of fertility patients. It is just so terribly sad that he is no longer with us. You can read more about Iwan in the Liverpool Echo and the Daily Post. He will be remembered with warmth and fondness by all those whose lives he touched. Our thoughts are with his wife Clare and family.