Every so often there’s an article like this one in today’s Guardian, about “twins” born years apart… The writer of this piece has a son and daughter born as a result of one fresh IVF cycle and a further frozen embryo transfer from the same batch of embryos.
It is a fortunate, yet far from uncommon, experience after fertility treatment, but it doesn’t make the children “twins”. Twins are two babies who are carried together and born at the same time, which these children were not. They are siblings rather than twins.
Often fertility trials are only open to those who are going through their first cycle of IVF treatment, but the E-Freeze trial is now also taking patients who are having their second or third treatment cycles.
E-Freeze is investigating the theory that using frozen thawed embryos may lead to improved pregnancy rates. When frozen embryos are used, there is a delay in embryo transfer of at least a month, and the theory is that allowing the hormones used in ovarian stimulation to wear off and giving the womb time to return to its natural state may increase the chances of success.
Without more research we cannot say if fresh or frozen thawed embryo transfer is better for the first cycle of fertility treatment. E-Freeze will compare these two types of embryo transfer in more than a thousand couples from IVF centres throughout the UK to find out which, if any, gives the best chance of having a healthy baby.
I owe Diane Chandler a huge apology as I’ve been meaning to review her book Moondance for months – and it’s a novel that will resonate with many fertility patients. We should always welcome novels about fertility problems and IVF because they really do help to normalise what can seem a very lonely experience, and also educate other people about the realities of what it’s like not to be able to get pregnant.
In Moondance we follow Cat and Dom through their attempts to conceive, fertility tests and the crashing ups and downs of treatment. There is much that will be familiar to anyone who has been through this themselves, especially in the way that treatment takes centre stage and comes to dominate everything else in life. Cat is not a sympathetic or likeable character – almost unbelievably self-centred, arrogant and selfish – which makes it hard to feel much in the way of empathy at the start of the novel. And yet seeing how someone so obsessed with controlling everything in their life is completely thwarted by their inability to conceive adds strength to the portrayal of the nature of infertility.
This is the sort of book that you sit down with and find yourself speeding through – despite being a thick book it’s a fairly quick read. There are a couple of niggling inaccuracies, for example, a type of post-coital sperm test which is medically impossible, but these don’t detract from what is otherwise a detailed account of the realities of treatment.
For most people, it’s probably the worst part of an IVF cycle – the notorious 2ww when you get to spend a fortnight (which seems to last about ten years) on tenterhooks, worried about everything you do and don’t do in case it affects the chances of a positive outcome. One of the most frequently asked questions is what you should and shouldn’t do during this time.
You will find all kinds of advice from all kinds of experts about activities, diet and supplements during the two week wait. There are those who advise that you should take the time off work and do as little as possible, spending the first day or two lying on the sofa. Others may advise going back to work right away to try to keep your mind occupied and suggest that it’s best for your mind and body to keep active and busy. I’ve heard of people drinking pints of milk and others avoiding dairy products. There are women who don’t take baths because they might overheat, and others who are lying around with hot water bottles on their stomachs.
If you visit any fertility forum, you will find it awash with questions and suggestions about the two week wait. Some are quite bizarre – a quick trawl produced all the usual stuff about eating pineapple core and brazil nuts, but the idea that you shouldn’t eat anything uncooked and that you need to wear socks 24 hours a day were both new ones to me!
I will always remember the nurse who cared for us during our first IVF cycle telling me that any rules about what not to do during the two week wait weren’t really set because they would cause an embryo not to implant or induce a miscarriage but rather because they were things that fertility patients often worried about. So, having a glass of wine during the two week wait is not going to stop you getting pregnant, but if your treatment doesn’t work and you’ve had a glass of wine, you are likely to question whether it was to blame.
I think the bottom line with all of this is that if you are sufficiently worried to be asking whether it is OK to do something, it’s probably a good idea not to do it. Two weeks seems a lifetime during the 2ww, but in reality it isn’t a long period to have to give anything up. There are no hard and fast rules, but following your own instincts and doing what feels right for you rather than allowing yourself to be driven to distraction by conflicting suggestions is probably the best advice anyone can give you about what to do and not to do.
NHS Commissioners in yet another area are considering cutting fertility services. This time, it’s Richmond Clinical Commissioning Group which is consulting on whether to continue to offer one fresh and one frozen cycle of treatment or to cut the service entirely. You can give your views by completing their survey – https://www.surveymonkey.co.uk/r/IVFandICSIconsultation
The consultation closes on Tuesday 4 April 2017, so please do let your views be heard especially if you live in or near Richmond.
Could you help a researcher by filling in a survey? I know I am always posting links to surveys and research – but I do think it’s a good idea to do these whenever we can because every piece of research helps further understanding of what it’s really like to be a fertility patient and how it feels to go through treatment.
This particular survey is being carried out by an MBA researcher who previously worked in a fertility clinic and is totally anonymous but will be used for part of her MBA. Do feel free to share the link with anyone who has had or is having fertility treatment in the UK – you can access it here https://www.surveymonkey.co.uk/r/JSXXS25
New research suggests that if you want to find out about outcomes from fertility treatment at a particular clinic, the best place to go is not the clinic’s own website. Researchers from Manchester University discovered that fertility clinics use a variety of different ways to present their data which makes it very difficult for anyone trying to compare one clinic with another. They found that clinic websites often use league tables which they construct themselves using their own parameters to compare clinics in their area and that these are “invariably constructed so that the comparison was favourable to the reporting clinic.”
If you do want to look at outcomes, it is worth bearing in mind that most clinics have broadly similar success rates and that relatively small percentage differences can be pretty meaningless and may have more to do with the patients being treated at any given time than anything else. The HFEA publishes outcomes broken down by age and this is by far the best place to go for information if you want to look at treatment outcomes as the figures are collected and collated the same way for all clinics across the UK
When it comes to factors that could possibly have an impact on IVF success, the things that often spring to mind are often those we can influence ourselves – a healthy diet, not smoking or drinking too much – or the kind of add-ons that have become increasingly popular in many clinics such as embryo glue or time-lapse.
For most fertility patients, the type of liquid embryos are placed in at the clinic would not be the first thing to consider when it comes to treatment outcomes – in fact, it’s not something most of us think about at all. However, new research carried out at Boston Place Clinic by Dr Stuart Lavery of IVF Hammersmith, suggests that the culture medium used by the clinic can make a difference to the way that embryos grow. You can read more about the research here
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.
The 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.