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.

Choosing a fertility clinic

800px-Woman-typing-on-laptopOn Saturday, I’ll be speaking at the Fertility Show at London’s Olympia about what you need to think about if you are choosing a fertility clinic. If you are fortunate enough to have NHS-funded treatment, you may not have a wide range of clinics to choose from, and in some parts of the country there are fewer clinics than in others – but if you live in London or the South East and you are paying for your treatment, the choice can be overwhelming.

I’ll be explaining how to make sense of what can seem an overwhelming array of different clinics all claiming to be the best, and what factors you should take into consideration when making your choice. I’ll cover treatment outcomes – how to make sense of the IVF success rates published by the HFEA and why they may not be the only thing you want to look at when making a decision – and will look at a number of other issues that can affect which clinic might be right for you.

If you’re at the Show on Saturday, I look forward to meeting you – make sure you come and say hello!

Taking part in clinical trials

proline_level_measurement_in_eurasian_national_universityPeople often email asking about clinical trials, and there are a couple of big multi-centre trials taking place at the moment which may be of interest. Taking part in a trial can be a really positive thing to do as you will be helping to improve understanding of techniques which may help make IVF more successful in future.
The first trial is called EFreeze and is investigating whether using frozen thawed embryos rather than fresh ones may lead to improved success rates in IVF. The theory behind this is that if the embryos are frozen rather than replaced straight away, the delay in embryo transfer means that any effects of the hormones used to stimulate the ovaries have worn off and the womb has time to return to its natural state.

Couples taking part in the study will be randomised to either have embryo transfer straight away as usual in IVF, or to have their embryos frozen and replaced later to see if this does improve outcomes. There is a lot of information for anyone considering taking part, including a list of participating centres, and a video to explain more on the trial web pages. You need to be under the age of 42 to take part in the trial which is being conducted across England and in Scotland.

The other trial is looking at endometrial scratch – a process which involves scratching the womb lining in the month before IVF treatment. There has been some research looking at this in women who’ve had repeated unsuccessful IVF cycles which suggest it may improve outcomes, but this new trial is looking at those who are having their first cycle. The study is based in Sheffield, but will be taking place at clinics around the country. It involves placing a small tube about the size of a drinking straw through the neck of the womb and gently scratching the womb’s lining.

Those taking part will be randomised to receive the scratch or not. If you want to find out more you can look at the information on the University of Sheffield website and there is a video to explain more about what is involved,

Can people without fertility problems be infertile?

flag_of_who-svgWhen a story about the World Health Organisation apparently deciding to revise their definition of infertility to include single men and women without fertility problems who wanted to become parents, there was an inevitable media flurry of stories about the NHS having to offer them fertility treatment.

The Daily Mail heralded the story with a headline shouting “Single, childless but want a baby? You could be labelled infertile“, while The Telegraph told us that “Single men will get the right to start a family under new definition of infertility” and The Sun went one better with “Gay couples and single men who want kids will be branded ‘INFERTILE’ – to make accessing IVF easier“…

In reality, the chances of this happening in the UK in our current fertility funding climate is very slim. It is already hard for couples with proven fertility problems to access treatment in many parts of the country, let alone those without them. We have seen cuts to fertility services in recent months and fewer and fewer fertility patients are now being offered the treatment that NICE recommends – which is three full cycles of IVF for those who are 39 and under. So the idea that commissioners are going to rush to start offering treatment to single men and women is far from likely…

Men speaking out

Sex_educationWhen you read about fertility problems, it’s nearly always women who are speaking out and telling their stories, but I’ve been really heartened to see that more and more men are opening up about their experiences of fertility tests and treatment. This article by Dan Rookwood in the Evening Standard is a great example.

Dan makes it clear that it isn’t just women who find it difficult when other people announce their pregnancies, that it isn’t just women who feel the disappointment when every period comes, that it isn’t just women who come to dread that question about when they are going to get around to having children… And anyone who has struggled with a diagnosis of unexplained infertility and who has been told that being less stressed might help will know exactly where Dan is coming from when he says that “nothing stresses you out more than someone who can’t give you any definitive answers telling you not to stress out“.

It’s a great article and well worth a read – it’s really important that we start to realise that fertility problems affect men just as much as they affect women.

One small quibble though – Dan says that he and his partner opted to transfer two embryos in order to “double our chances of success“. It is very important to be aware that although it may feel that way in fact putting back two embryos most definitely doesn’t double your chances of success – it just increases your chance of having twins. Dan explains that he and his partner began their treatment in the US, and if that’s where they had their IVF, it would explain this entirely as not all clinics in the States are as concerned as we are here in the UK with reducing multiple pregnancy. Here, a team would usually recommend single embryo transfer for a first IVF cycle if the embryos were good quality. Although we all know twins who are fine, many others are not – and multiple pregnancy is the biggest health risk from IVF, which is why it is so important to choose a fertility clinic which has a good success rate combined with a low multiple rate.

Do you live in Lancashire?

ivf_science-300x168Fertility services in Lancashire are under threat with all eight Lancashire Clinical Commissioning Groups(CCGs) proposing cuts to NHS-funded IVF. They have a survey which you can complete to make your feelings known about this – it needs to be done by tomorrow, October 14 – http://tinyurl.com/Assisted-Conception-Services

You may also want to write to your MP, as this may help to ensure the CCGs realise that the guidance from NICE which they should be following is both clinically effective and cost effective. Fertility Network UK have a draft email you can use, and if you wish you can add details of your own personal situation which will help to explain to your MP why this is so important – if you are able to help them see how your fertility problems make a difference to you emotionally, financially and socially this will really help. You can find the draft letter which you may wish to email, half way down this webpage http://infertilitynetworkuk.com/nhs_funding_2
The MPs for the areas covered by the eight Lancashire CCGs are:
NHS Blackburn with Darwen CCG:
Kate Hollern MP
Email: kate.hollern.mp@parliament.uk
Jake Berry MP
Email: jake.berry.mp@parliament.uk
NHS Blackpool CCG:
Paul Maynard MP
Email: paul.maynard.mp@parliament.uk
Gordon Marsden MP
Email: gordonmarsdenmp@parliament.uk
NHS Chorley and South Ribble CCG:
Lindsay Hoyle MP
Email: Lindsay.hoyle.mp@parliament.uk
Seema Kennedy MP
Email: seema.kennedy.mp@parliament.uk
Nigel Evans MP
Email: evansn@parliament.uk
NHS East Lancashire CCG:
Andrew Stephenson MP
Email: andrew.stephenson.mp@parliament.uk
Julie Cooper MP
Email: julie.cooper.mp@parliament.uk
Graham Jones MP
Email: graham.jones.mp@parliament.uk
Jake Berry
Email: jake.berry.mp@parliament.uk
Nigel Evans
Email: evansn@parliament.uk
NHS Fylde & Wyre CCG:
Paul Maynard MP
Email: paul.maynard.mp@parliament.uk
Cat Smith MP
Email: cat.smith.mp@parliament.uk
Ben Wallace MP
Email: wallaceb@parliament.uk
Mark Menzies MP
Email: mark.menzies.mp@parliament.uk
NHS Greater Preston CCG:
Mark Hendrick MP
Email: mark.hendrick.mp@parliament.uk
Seema Kennedy MP
Email: seema.kennedy.mp@parliament.uk
Ben Wallace MP
Email: wallaceb@parliament.uk
Nigel Evans MP
Email: evansn@parliament.uk
NHS Lancashire North CCG:
Cat Smith MP
Email: cat.smith.mp@parliament.uk
Ben Wallace MP
Email: wallaceb@parliament.uk
NHS West Lancashire CCG:
Rosie Cooper MP
Email: rosie@rosiecooper.net
Seema Kennedy MP
Email: seema.kennedy.mp@parliament.uk

Possible IVF cuts in Wiltshire?

ivf_science-300x168Wiltshire is the latest Clinical Commissioning Group to be considering cutting their provision of fertility services – and sadly one of their reasons for doing so appears to be because other Clinical Commissioning Groups have taken the decision to do so. A spokesperson for Wiltshire told the BBC that they needed to reduce treatments to match what was happening in neighbouring areas where commissioners were offering fewer cycles.

Wiltshire is facing financial problems with a predicted overspend of more than two million pounds – but cutting IVF will make a minuscule reduction in this overspend and may actually end up costing more money in the future if the potential cost of multiple pregnancies from couples who end up going overseas for treatment are taken into consideration.

The latest from Bedfordshire

4cell_embryo.tifWhat a sorry state of affairs in Bedfordshire where the CCG was recommended to continue funding one cycle of IVF treatment, but instead delayed making a decision until November. Anyone needing IVF in the region was only ever getting one of the three full cycles recommended as being clinically effective and cost effective by NICE, and their consultation on cutting all IVF had led to the recommendation to continue instead.

A spokeswoman for the Bedfordshire Clinical Commissioning Group told Bedfordshire on Sunday that the evidence base and associated research was “complex”.  It is really not cost effective for the Clinical Commissioning Group to spend time trying to make sense of this when NICE has already looked into this in very great depth making use of the knowledge of some of the country’s leading experts in the field and also using skilled health economists to work out what would be most cost effective. Let’s hope that Bedfordshire CCG use this evidence when they make their decision in November, and rather than considering cutting the one cycle they currently offer, instead start funding what NICE recommends.

Proposed fertility services cuts in St Helens

ivf_science-300x168Yet more proposed cuts to fertility services. St Helens CCG is proposing a two-year suspension of IVF services for people aged under 37 – one way to stop this is to contact your MP.  The MPs for St Helens are:
Marie Rimmer MP marie.rimmer.mp@parliament.uk
Conor McGinn MP conor.mcginn.mp@parliament.uk

If you are comfortable doing so, it is helpful to include details of your personal situation: how fertility struggles affect you physically, emotionally, financially and socially. Not all MPs understand this and it can make a real difference if you explain why cutting IVF can have such a devastating impact.

If you might find it helpful, the charity Fertility Network UK have a draft letter you can use which you can find here – http://infertilitynetworkuk.com/nhs_funding_2.

The influence of embryo culture

4cell_embryo.tifAnyone who has had or is having IVF may be interested in some new research published in the journal Human Reproduction which looks at the influence the liquid that eggs, sperm and embryos are put into in the laboratory has on the babies born from the treatment. The liquid is known as the culture medium, and the researchers have found that it has an impact on the birthweight of IVF babies.

At the moment, the manufacturers don’t publish detailed lists of the ingredients of their culture media for reasons of commercial secrecy – but given the impact it may be having on IVF babies, there are now calls for the exact make-up of the culture media to be made public. You can read more details about this here and you can find the research paper itself here.