Fertility funding

The news of cuts to funding for fertility services has made depressing reading over recent days, with more and more areas cutting IVF in order to save money. As many people realise, cutting funds for IVF is a questionable way to save money in the longer term – you end up with dejected, unhappy people who are far more likely to need medical help for depression and related illnesses (we know from a Fertility Network UK survey that the majority of people with fertility problems have experienced depression and that more than 40% have had suicidal feelings as a result of their fertility problems).

People struggling to fund their own treatment often end up going overseas where IVF can appear cheaper, but where there are not always the same measures in place to reduce the numbers of multiple pregnancies, which is the biggest health risk from IVF.  It doesn’t need many sets of prematurely-born triplets conceived after multiple embryo transfers overseas to wipe out any savings from cutting IVF funding here in the UK.

What was more depressing was the reaction to the news about the cuts from some quarters – people with absolutely no understanding or knowledge about infertility who felt the need to try to grab centre stage by offering ill-informed opinions. We all know that not everyone agrees with the NHS funding IVF treatment, but most of those who think this way have the good grace to recognise that infertility is tough and that anyone experiencing it deserves some empathy. Not so one person writing in the Independent who suggested that fertility treatment “only serves to fulfil people’s whimsical obsession with baby-making”, that the NHS should not pay for people to become parents “if they fancy it” and that there is no justification for treatment “just because it will make some people feel more fulfilled in their life”. It was quite breath-taking to read such a glib and insensitive dismissal of a medical problem. Right back to biblical times, the huge impact of infertility has been understood with Rachel, who was unable to get pregnant, crying “Give me children, or else I die”. Infertility is recognised by the World Health Organisation as an illness, and NICE says that IVF is a clinically and cost-effective treatment.

I’m not adding a link to the article in the Independent, or addressing the poorly researched claims as to why we shouldn’t fund IVF one by one. Suffice to say that a few hours after the piece appeared, the person who wrote it tweeted “So I’m about to go on Newsnight. No big deal, right? RIGHT?!?!”… The tweet explained everything about the lack of empathy, understanding or any shred of human kindness in the piece. This article was never meant to be a thoughtful response to a social problem, but was all about trying to create the sort of stir that gets you noticed and on television. It’s just a shame that the media desire for controversy and debate means that ignorance often gets to masquerade as valid opinion.

Leap In by Alexandra Heminsley

This is a book about swimming, about how Alexandra Heminsley overcame her fear of water and learnt not only to swim, but to enjoy swimming outdoors in choppy seas, cold rivers and dark tarns. Heminsley’s earlier book, Running Like a Girl, is about running when you don’t think you’re a runner and Leap In is the swimming version. It’s her honesty, the detail and her beautiful writing which make this such an engaging book; I could completely envisage the sweaty attempts to squeeze her body into a wetsuit, the feelings of panic in deep water, the anxiety about her bare feet when she does her first river swim.

Leap In is about pushing yourself, about facing up to difficulties – and we learn more than half-way through the book that Heminsley is going through fertility problems and IVF as she continues her swimming journey.  At that point, her battles to overcome her fears have an undercurrent of a more fundamental challenge.

Heminsley doesn’t tell us much about her fertility problems or the experiences of tests and treatment, but what she does say is rich with meaning for anyone who has been there. “When I think about never having a child, a sort of breathlessness, almost a vertigo, comes over me,” she writes, explaining in just one sentence the overwhelming hollow bleakness of infertility. She has a positive pregnancy test after her second IVF cycle, but miscarries – something she deals with in two poignant paragraphs in which she describes the sense of crushing grief and how this transforms her relationship with her body which she feels has betrayed her and which she now rejects.

I really love this book – it manages to be funny, sad, inspiring and thought-provoking. The last chapter of the first part ends with Heminsley pondering what lessons swimming has taught her and where her future lies. She says she doesn’t know if she will ever have a child, or even the strength to try IVF again, but her attitude to life is that we must Leap In, living life as a participant rather than a spectator, that we must not give into our fear of the unknown and must be courageous when we need to adapt or amend our plans and discover our inner strength and resilience. These are certainly thoughts to ponder for anyone who is in the midst of fertility problems.

Leap In is published by Hutchinson.

 

 

Fertility worries for women

800px-Woman-typing-on-laptopNew 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.

Can you help save fertility funding in Suffolk?

images-21Ipswich and East Suffolk clinical commissioning group (CCG) and West Suffolk CCG have announced they are consulting on cutting the number of NHS-funded IVF cycles they offer from two cycles. They will either cut to one cycle or stop offering any treatment at all. The CCGs have asked for people to comment on these proposals before 5 September by filling in a feedback form on their website here .

If you live in the area, don’t forget that you can also write to your local MP about the proposals.  The local MPS are:

Rt Hon Matthew Hancock MP West Suffolk Matthew@matthewhancock.co.uk

Mr James Cartlidge MP South Suffolk james.cartlidge.mp@parliament.uk

Jo Churchill MP Bury St Edmunds jo.churchill.mp@parliament.uk

Dr Daniel Poulter MP Central Suffolk and North Ipswich daniel.poulter.mp@parliament.uk

Rt Hon Ben Gummer MP Ipswich ben@bengummer.com

Dr Therese Coffey MP Suffolk Coastal therese.coffey.mp@parliament.uk

Susan Seenan, co-chair of Fertility Fairness and chief executive of Infertility Network UK said of the proposals; ‘Why is it increasingly deemed acceptable to remove access to NHS treatment for people with fertility problems? Infertility is defined as a disease and is as deserving of NHS treatment as any other medical condition. To ignore the plight of the approximately 3.5 million people in the UK who are unable to have children without medical help is cruel and unethical.’

Why you need to look at IVF as a course of treatment

Embryo,_8_cellsAll too often, IVF is criticised as being “unsuccessful” when people look at the chances of getting pregnant from an individual cycle of treatment – but now a new study shows that the majority of couples are successful if they are able to have more than one cycle.  The research, published in the Journal of The American Medical Association, has found that 65% of patients will have a baby if they have six or more cycles.

The recommendation here in the UK is for three funded cycles, and in many parts of the country fertility patients can’t even access that, but this research suggests that more people could be successful with more treatment.  The researchers found that in all women, the cumulative percentage of live births across all cycles continued to increase up to the ninth cycle.

You can read more about the study, whose main authors were Professor Debbie Lawlor of  the University of Bristol and Professor Scott Nelson from the University of Glasgow’s School of Medicine, on the Bristol University website here

This is really welcome research as all too often when NHS funding is cut, local commissioners claim that IVF has very little chance of success after one or two cycles, but this research suggests there could be benefits to extending the number of IVF cycles beyond three or four.

The study included 156,947 U.K. women who received 257,398 IVF cycles between 2003 and 2010 and were followed up until June 2012. It was funded by the Wellcome Trust and the Medical Research Council.

Can I test early?

images-1I know, I know – it’s tempting. The two-week wait after fertility treatment seems about six years long and you may spend a lot of time analysing every tiny twinge that you feel, or don’t feel, and trying to work out if it has any significance in terms of the outcome. So, the idea of doing a test a few days – or even a week – before you are meant can seem very attractive. And yet, it can end up making the rest of the wait even more difficult…

In the very early days of pregnancy, there are often no symptoms at all that you could notice and it may take a while for the hormone changes to be at the right levels to start to show up on a test.

I’ve heard so many people recently talking about testing early and they’ve either had a negative result, which may not mean that the treatment hasn’t worked but rather that they tested too early, or had a very slightly positive response and then spent hours peering at faint lines on the test kit before dashing off to purchase yet more to try to get a clearer result.

It really is worth waiting until the time indicated on your test kit if you possibly can. These do vary so check out which you can do earliest if you feel you really can’t wait `but do remember that testing early can sometimes lead to more questions and confusion rather than a definitive answer. .