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.

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

Emotional support

When you’re thinking about having fertility treatment, it’s probably the Injections, drugs and egg collection which sound challenging, but if you ask people who’ve had IVF what makes it so hard, most will say it’s dealing with your emotions which is the really tough part. It’s often described as an “emotional rollercoaster” and although that’s become rather a cliche, it’s true that it’s the ups and downs of treatment that are so hard to handle. IVF can feel like a series of hurdles and no sooner are do you get past one, than you find yourself facing the next along the way.

All fertility clinics offering IVF have to provide people with the opportunity to see a counsellor but it doesn’t have to be included in the cost of treatment. Some people are keen to have counselling support from the start, but others may feel they don’t want or need to see a counsellor, and it’s worth bearing in mind that it is fine to change your mind if you feel you want to access support further down the line.

It may be that part of your concern about counselling is that you aren’t quite sure what it might involve and you may have visions of yourself lying on a couch talking about childhood traumas. If you want to know more about fertility counselling and how it might help, Angela Pericleous-Smith, chair of the British Infertility Counselling Association (BICA) will be speaking on the subject at the Fertility Forum in London on March 30. BICA trains the counsellors who work in the UK’s fertility clinics and offers a “find a counsellor” service to help you to ensure that you can access specialist support no matter where you live. Angela will be talking about  the pressures on yourself, your relationships and your friendships. She will explore coping strategies and explain how to manage anxieties.

The Fertility Forum is a non-commercial evidence-based day which has been organised by patients and all the professional bodies in the field working together, and aims to help those who have been trying to make sense of the overwhelming mass of information on offer.

Tickets for the Fertility Forum are on sale here – and you can see more details of the day including a full programme here.

Fertility Forum – bringing professionals and the public together

If you’ve ever wanted access to clear, reliable information about fertility problems and treatment, the Fertility Forum on 30 March is for you. Set up by patients working with all the professional bodies in the field, the Fertility Forum aims to be a day of pure evidence about fertility with no promotion for particular clinics or treatments, and no one selling anything. It’s all about evidence.

The Fertility Forum will take place at the Royal College of Obstetricians and Gynaecologists (RCOG) in London, and many of the UK’s leading fertility specialists will be speaking at the day, and there will be three strands of talks. They will cover everything from nutrition and lifestyle advice to the latest developments in fertility treatment. There will be talks on specific fertility issues such as endometriosis and polycystic ovary syndrome (PCOS), on donor treatments and surrogacy, on recurrent miscarriage, on stress and fertility support, on male fertility problems and how men deal with infertility. The HFEA will give advice on how to choose a fertility clinic and there will be a talk on deciding whether to opt for treatment abroad. How embryos develop and why IVF does and doesn’t work will also be discussed along with an assessment of the evidence on additional treatments like endometrial scratch or embryo glue, and there will be a session on accessing NHS funding. You will be able to choose which talks you attend when you get your tickets. There is a charge for the tickets (£25) to cover the cost of putting on the day, but there are no additional charges.

The day has been organised by the Royal College of Obstetricians and Gynaecologists (RCOG) and the British Fertility Society working in partnership with the Human Fertilisation and Embryology Authority (HFEA) and Fertility Network UK alongside the Association of British Andrologists, British Andrology Society, Association of Clinical Embryologists, British Infertility Counselling Association, Royal College of Nursing and the Senior Infertility Nurses Group. The Donor Conception Network will be taking part in the event along with other patient groups including the Miscarriage Association. The day will be opened by the RCOG President, Professor Lesley Regan, and the Chair of the HFEA, Sally Cheshire CBE.

To find out more and to buy your tickets go to http://bit.ly/FertilityForum

Can you help with a survey?

The National Institute of Health Research wants to fund some research to compare different therapies offered to women with premature ovarian insufficiency (POI), also called premature ovarian failure or premature menopause.

They are a team of doctors, researchers and women with personal experience of POI who are signing a trial to compare the treatments. To ensure that the trial is all right for  women who have POI, they are seeking your opinions. The survey should take no more than a couple of minutes to complete. Your answers are completely anonymous and it is really important as it will help improve treatment for women with POI in the future. You can find the survey here 

You are not alone

One of the most difficult things about living with fertility problems is the loneliness and isolation you can feel as everyone around you seems to be getting pregnant effortlessly. If you don’t tell other people what you are going through, you get questions about when you are going to have children and warnings that you don’t want to leave it too late. If you do tell people, you can end up with lots of advice you could do without (“why don’t you just relax/get a dog/go on holiday…”).

Last night, I facilitated a fertility group for the charity Fertility Network UK in South East London and it really struck me, as it does every time we meet, how beneficial it can be to spend some time with other people who really understand how you are feeling and who know what it is like. Fertility Network has groups meeting across the UK, mainly run by volunteers like me, which offer a haven for anyone experiencing fertility problems. It’s a unique opportunity to be with people who share similar experiences and to be able to talk openly and honestly about how you are feeling.

It’s National Fertility Week and there’s lots of work going on to raise awareness about many important fertility-related issues, but one of the most important messages for me is that you don’t need to go through this alone. There are opportunities to meet other people who can offer support, and the groups aren’t miserable or depressing, but rather an opportunity to help yourself to feel less lonely. There are 3.5 million people living with fertility problems in the UK and meeting some of the others may be just what you need.

Have you had your smear test?

Figures released today by Public Health England show that there has been a drop in the number of women having regular cervical screening tests. They show that around three million women under 50 have not had a smear test for more than three years, and another million women in the 50 – 64 age bracket have not had a test for more than five and a half years. These rates are at their lowest levels for almost twenty years.  This matters to anyone worried about their fertility as treatment for cervical cancer may leave you unable to have children in the future.

It is vital that we all go for regular smear tests as cervical cancer as the screening test is estimated to save more than 4,000 lives every year. Having regular screening means that if there are any unusual changes in the cells in your cervix, this will be identified at an early stage and if you need treatment, it can be given early to stop cancer developing.  You can read more about cervical cancer screening on the NHS website and there is information about screening and cervical cancer on Jo’s Cervical Cancer Trust and the Eve Appeal’s websites.

Royal pregnancy announcement

Pregnancy announcements are never easy when you’re trying to conceive, but one which has swamped the media and is this morning taking up endless pages of many newspapers is particularly difficult to avoid. What makes this announcement even more challenging is that the Royal couple were only married a matter of months ago, and seem to have conceived with effortless ease.

It was unfortunate that the announcement came during Baby Loss Awareness Week, on a day when many people were preparing to light candles for the Wave of Light in memory of their own losses. Although the couple have been criticised online for this, the most likely reason is that they simply didn’t know the significance of the day.

The endless discussions about the Royal pregnancy are going to go on – and on, and on – during the next few months. One of the best ways of dealing with that is to spend time with other people who understand how you feel about this because they share similar experiences. Why not try one of Fertility Network UK’s fertility groups which run across the UK? They’re an ideal opportunity to meet others and can be really empowering. I admit I am biased about this as I run the group in South East London, but that’s because I know how much it can help. Being with other people who understand, and who share your conflicted feelings about pregnancy announcements can make all the difference. It can help you to realise that you are not having a personality change and becoming an unkind person, but are reacting in a perfectly normal way to an emotional challenge. You can find details of all FNUK’s groups here, and it there isn’t a group near you, they can offer other support too – have a look at their website

Music to support fertility charities

If you are in London on September 29, why not take the opportunity to attend a concert to help raise funds for two fantastic charities, the Donor Conception Network and the Daisy Network.

Taking place in St Mary’s Church in Rotherhithe, the  concert is with Dunajska Kapelye, a trio who play beautiful gypsy and Eastern European music and are led by one of London’s most respected violinists, Polish Piotr Jordan. The concert will feature plaintive Gypsy ballads, tub-thumping Romanian wedding dances, elements of tango and klezmer. It promises to be a wonderful evening – and great to be able to be raising money to support such important charities with their work at the same time.

You can find more information on Facebook https://www.facebook.com/events/710467139299822  and you can buy tickets here  http://tunedin.london/tunedin.php

Why exercise is good for you

A new study suggests that “vigorous” exercise may be linked to an improved chance of getting pregnant, but that more gentle exercise doesn’t seem to make the same difference. So, what counts as “vigorous”? Apparently that’s exercise like jogging, running, football or aerobics which leaves you out of breath, and you have to do more than four hours a week!

You can read more about it on the NHS Choices website – and the results are interesting. If you are obese, the vigorous exercise thing doesn’t work, but instead more moderate exercise such as walking does. As NHS Choices points out, assessing how likely it is that these results are actually widely applicable and correct can be difficult as the results were slightly odd. It isn’t clear why exercise only counts if you do more than four hours a week, or why walking makes a difference to obese or overweight women but not to any others. It is also not clear what they women ate, or whether their weight changed during the study as these factors could make a difference – as could any existing fertility problems so it may be that one of these other factors was in fact responsible.

It does, however, add to the growing body of evidence that keeping active is a good thing!