New restrictions on IVF funding

It’s National Fertility Awareness Week and today the campaign group Fertility Fairness has released an audit which has found new restrictions on IVF funding. The survey covered all the Clinical Commissioning Groups (CCGs) in England and found that 80% are failing to follow the NICE guidance which says that all eligible couples under the age of 39 should be offered 3 full cycles of IVF treatment.

Many are also setting new criteria to limit eligibility for treatment. Despite the fact that neither male age nor weight affect the success rate of IVF, more than a quarter of CCGs have decided to use the male partner’s body mass index (BMI) to decide whether a couple can access NHS treatment, and 8% no longer offer NHS funding if the male partner is 55 or over. Around one in four CCGs also use AMH or antral-follicle count to check a women’s ovarian reserve (an estimate of the number of eggs in the ovaries) to decide whether she is eligible for IVF. The NICE guidance gives some guidance on levels at which these may be helpful to assess how a woman may respond to the drugs used in IVF to stimulate the ovaries, but there is no suggestion at all that this might be used to decide who should be eligible for treatment.

Consultant gynaecologist and Fertility Fairness committee member Raj Mathur, said: ‘ Male age and BMI are not in the NICE guidance as criteria for IVF and there is no strong evidence of impact on clinical outcomes of IVF. AMH and antral follicle count are in the NICE guideline as predictors of ovarian response, but NOT as predictors of the chance of having a baby through IVF. Commissioners are making unjustified extrapolation in using them for rationing.’

The audit found that

  • 3.6% of CCGs have removed NHS IVF entirely
  • 40% do not offer a full IVF cycle, limiting the number of frozen embryo transfers
  • 20% offer one full IVF cycle, transferring all fresh and frozen embryos
  • 23% offer two IVF cycles.
  • 13% offer three IVF cycles.

In the last two years, 30 CCGs have reduced NHS fertility services, and one in ten CCGs is currently consulting on cutting or removing NHS fertility treatment.

Sarah Norcross, co-chair of Fertility Fairness, said: ‘It is shocking to see CCGs introducing their own ‘access to IVF’ criteria, as well as reducing the number of IVF cycles they offer. It is not the CCG’s job to decide the criteria for accessing NHS fertility services. NICE has accessed the evidence in its guideline and developed access criteria for NHS patients and they do not include male BMI, male age, a woman’s AMH level or whether or not a couple has a child from a previous relationship. What criteria will CCGs introduce next; star signs and shoe size? CCGs need to remove their extra ‘access to IVF’ criteria now.’

Aileen Feeney, co-chair of Fertility Fairness and chief executive of leading national charity Fertility Network UK said: ‘ Fertility Network is extremely concerned about the effect that reducing access to NHS IVF has on already distressed patients. Infertility is a devastating disease causing depression, suicidal feelings, relationship breakdown and social isolation; removing the recommended clinical help or making it harder to access is cruel and economically short-sighted. Access to NHS treatment should be according to medical need and not your postcode. We urge anyone affected to join Fertility Network’s #Scream4IVF campaign calling for fair access to NHS IVF in the UK; with your help we can reach 100,000 signatures and hold a debate on the issue at Westminster. Sign the petition at www.scream4IVF.org and share your #Scream4IVF during Fertility Week.’

The Fertility Show goes to Manchester

Did you know that the Fertility Show will be in Manchester next month? The event which has taken place at London’s Olympia for many years is spreading its wings and will be held at Manchester’s Central Convention Complex in Windmill St on March 25 and 26.

There will be a wide range of speakers including Allan Pacey,  Geeta Nargund, British Fertility Society Chair Adam BalenCharles KingslandSimon Fishel, John Parsons, Rachel Cutting, Jane Stewart, Raj Mathur, Tony Rutherford and Zita West. The HFEA’s Juliet Tizzard will also be speaking as well as specialist lawyer Natalie Gamble and Fertility Fest Director Jessica Hepburn. The sessions will cover a wide range of topics suitable to those just starting out and wanting to know more about their fertility through to more detailed sessions on specific fertility problems and treatment options. There will also be a separate platform for Q and A sessions and a wide range of exhibitors.

Tickets are now on sale here so do come along if you are nearby – I will be there too speaking about how to choose a fertility clinic and will be on the Fertility Network UK stand so come and say hello!

Expert opinion on treatment add-ons

If you’ve been unsure who to believe about fertility proline_level_measurement_in_eurasian_national_universitytreatment add-ons, you may be interested in some impartial and expert advice in two new scientific opinion papers published by the Royal College of Obstetricians and Gynaecologists (RCOG). They call for more high quality research into the role of natural killer cells in fertility and the effect of endometrial scratching on pregnancy outcomes.

Scientific Impact Papers (SIP), are up-to-date reviews of emerging or controversial scientific issues. The first paper looks at the role of uterine natural killer (uNK) cells, how they are measured, the role of testing and the evidence behind any links to improving implantation rates and early placental development. The paper clarifies that uNK cells are completely different from peripheral blood natural killer cells (which you would be testing in the blood tests some fertility clinics currently offer).

The paper makes it clear that there is no evidence to offer routine tests for NK cells as part of fertility treatment or testing, and that there is uncertainty about how NK cells are measured and reported. The paper says that treatment for raised levels with intravenous immunoglobulin (IVIg)  is not supported by the current evidence and, since it may have serious adverse effects, should not be used..

The second opinion paper explores the effect of endometrial scratch on pregnancy outcomes in women who have experienced recurrent miscarriage and recurrent implantation failure.

Endometrial scratch is a procedure which is hypothesised to help embryos implant more successfully after IVF/ICSI and involves scratching the lining of the womb.

Several studies have examined the impact of endometrial scratch in the cycle preceding an IVF treatment cycle in women with recurrent implantation failure, which appear to provide convincing evidence of benefit of superficial endometrial scratch in improving the implantation rate in this group of women. However, the effect of this treatment on pregnancy outcomes in women who have experienced recurrent miscarriage or those undergoing their first IVF cycle is uncertain.

Professor Adam Balen, Chair of the British Fertility Society (BFS) and spokesperson for the RCOG, said: “These two papers look at the current available evidence which exists and give much-needed guidance to both healthcare professionals and the public on these two topics. It is important that patients receive full information about treatments, the current evidence for benefit and whether there are any side effects or risks associated with it.”

Mr Mostafa Metwally, Vice Chair of the RCOG’s Scientific Advisory Committee added: “There is currently no convincing evidence that uterine natural killer cells are the cause of reproductive failure. Despite this, a number of women are requesting and being offered analysis of either peripheral blood or uterine killer cells and the value of these measurements remains controversial. Current evidence suggests that endometrial scratch may benefit women with recurrent implantation failure and therefore defining the optimal number of previously failed embryo transfer cycles needs to be evaluated in large cohort randomised prospective clinical trials.We still do not understand the mechanism by which endometrial trauma may lead to improvements in IVF outcomes in women and further studies are needed looking specifically at its success among women undergoing their first IVF cycle.”

The papers are available here:

The Role of Natural Killer Cells in Human Fertility

Local Endometrial Trauma (Endometrial Scratch): A Treatment Strategy to Improve Implantation Rates

Left confused about intralipids?

lipidemulsionIf you watched Panorama yesterday and were left worried or confused about intralipids, there are sources of accurate and sensible information.

Looking at some of the comments from fertility patients after the programme, it seems that many people were actually surprisingly unconcerned by the lack of evidence for many of the treatments discussed because they felt if there was any chance at all of something making a difference, they would still be happy to try it.

What the programme didn’t make clear was that there are some potential health risks from using intralipids. These are clearly explained on the current HFEA website which has excellent information on reproductive immunology and covers intralipids. There is also a basic information sheet on add-ons from the British Fertility Society.

Not too late to watch the BBC fertility programme

images-6If you missed it last night, the BBC TV programme on fertility presented by The One Show’s Alex Jones (and yes, it was on quite late!) is available to watch here and the BBC also has a good information page about getting pregnant at 35 plus which has links to some great factsheets on a variety of fertility-related issues from the British Fertility Society and the patient charity Fertility Network UK.

The programme is definitely worth watching – all too often media coverage of fertility is inaccurate or looks at extreme cases, but this managed to be balanced and interesting, covering the subject in a sensitive and empathetic way with lots of sensible advice.

A “potent” new treatment

images-21Another week, another Daily Mail story about IVF. You may have read this one about a “potent” new fertility treatment that is cheaper and less invasive than IVF and leads to a “50% increase in embryos”.  As usual with these stories about marvellous new advances, it all sounded wonderful and there was little to suggest that it might not be available at a clinic near you tomorrow.

I always read to the bottom of these stories. You usually find a sensible quote from a British expert, often Professor Adam Balen of the British Fertility Society or Professor Allan Pacey of Sheffield University if it’s a story about male fertility. In this case, there was no British expert, just a paragraph from the HFEA about in vitro maturation which wasn’t quite the same thing as the whole point of this “potent” treatment is that it is apparently an addition to in vitro maturation where substances are added to the egg cells to try to improve egg quality.

At the end of this article, a final paragraph explained that researchers are now starting to carry out some safety studies to ensure that adding these substances to the egg cells has no impact on the long-term health of babies – so probably not coming to a clinic near you just yet…

Fertility education – what do you think?

120px-Classe-merikanjakaShould we be educating pupils in school about fertility? Or would it just be worrying and confusing for young people? That was the subject up for discussion at last night’s Progress Educational Trust debate at the Royal College of Obstetricians and Gynaecologists.

The evening began with short talks from each of the speakers. Fertility specialist Dr Melanie Davies began with a neat summary of the biological facts, illustrating how fertility declines with age, how the rate of miscarriage increases and how IVF success rates follow that pattern. Infertility Network UK‘s Chief Executive Susan Seenan followed, talking about the charity’s Scottish education project which is funded by the government there. The project has exposed a lack of knowledge among students about basic fertility facts, and has shown how learning more can influence their choices going forwards. Helen Fraser, Chief Executive of the Girls’ Day School Trust sounded a note of caution about the realities for young women today, and discussed how going to University, having a career, finding the right person to have children with and a suitable home can all lead women to delay childbearing. Finally sex and relationships educator Justin Hancock who writes at bishuk.com spoke about what is wrong with today’s sex and relationships education and why all too often it doesn’t give young people the information they need.

The discussion which followed, chaired by Professor Adam Balen of the British Fertility Society was fascinating with many varied views – is it essential that everyone is properly informed about fertility or would fertility education just be placing adult problems on children? Does fertility education imply that lifestyle choices might be to blame for infertility? Is it time for a complete overhaul of the way we talk to young people about sex and relationships? The audience included a good number of young people who actively engaged in the discussion making interesting points and asking questions.

So would fertility education be a good thing? Should it be an essential part of every young person’s education to ensure they are properly informed? Or do we risk giving them yet another thing to worry about at a time when they have so much to deal with already? My own view is that we miss the point if we focus on teaching about “infertility” as what really matters here is fertility awareness – and I do believe young people should be taught about their own fertility in a way that my generation wasn’t. But what do you think? Would knowing more about your own fertility have made a difference to you?

Who will you find at this year’s Fertility Show?

logoIt’s here at last – the seminar details for this year’s Fertility Show are now available online for you to browse! Once again, there are a really great array of speakers covering pretty much everything you might want to find out about fertility problems, tests and treatments.

Starting with the basics, there are talks from Zita West, nutritionist Marilyn Glenville and IVF Hammersmith’s Stuart Lavery. There are talks on ovarian reserve (from  James Nicopoullos, Consultant Gynaecologist at the Lister Fertility Clinic) and on the causes of infertility, and Infertility Network UK trustee Jessica Hepburn will be talking about the patient experience. Leading consultant Yacoub Khalaf will explain how to improve your chances of success, Professor Geeta Nargund, Medical Director of CREATE Fertility,will be looking at natural cycle and mild IVF, the HFEA’s Juliet Tizzard will discuss making sense of success rates and I will be talking about choosing a clinic.

There are some interesting debates on new techniques in IVF and on dealing with particular problems. Professor Lesley Regan will be covering recurrent miscarriage, Dimitrios Nikolaou, lead clinician at Chelsea and Westminster NHS Hospital, will talk about treatment for over 40s while Dr Melanie Davies, consultant in the Reproductive Medicine Unit at London’s NHS University College Hospital will talk about how to deal with the diagnosis of unexplained infertility. Sam Abdalla, Director of the Lister Fertility Clinic, will ask whether anyone is too difficult to treat with a low ovarian reserve, Professor Adam Balen, Chair of the British Fertility Society, will talk about PCOS (polycystic ovary syndrome) and Tarek El-Toukhy will discuss treatment for older women.

There will also be some interesting discussions on donor treatment with Laura Witjens of the National Gamete Donation Trust and Kamal Ahuja of the London Women’s Clinic as well as a variety of talks on different aspects of fertility treatment overseas.  Complementary therapies such as acupuncture, hypnosis and massage will be covered in  a number of seminars. There will be four sessions for single women and lesbian couples and separate sessions on surrogacy. Male fertility issues will be covered by Professor Allan Pacey of Sheffield University, who will be talking on both the Saturday and Sunday so that no one needs to miss his sessions.

Fertility counsellors Jennie Hunt and Tracey Sainsbury will look at emotional issues and coping with treatment, along with Anya Sizer who is the support co-ordinator at London Women’s Clinic. The difficult issue of whether to try again after unsuccessful treatment will be covered by Tim Child who is Associate Professor and Subspecialist in Reproductive Medicine at the University of Oxford and and Honorary Consultant Gynaecologist at John Radcliffe Hospital. Finally, there will also be three sessions over the weekend looking at different aspects of adoption.

This year’s Fertility Show will be on November 7 and 8 and London’s Olympia and you can find the full seminar list here 

 

 

How late you can leave it – again…

So, the debate about when women should get pregnant goes on… When fertility specialist Geeta Nargund called for fertility education, it soon turned into a heated discussion about whether doctors should be telling people when to get pregnant (which, if you read what she actually said, Geeta Nargund hadn’t).

Not long afterwards, Lord Winston, still one of the country’s best-known fertility experts, said that he thought that delaying motherhood was a good thing, and that there were many advantages to waiting to start a family. Now the Chair of the British Fertility Society, Adam Balen, has added his voice to the debate, pointing out that it is important that women are aware of the risks of trying to get pregnant later – you can read his remarks, and a reply from Lord Winston here. The “row” may be largely manufactured by the Daily Mail, but it continues to raise important points about the biological clock and women’s awareness of their fertility.

Whatever your views on the subject, it doesn’t alter the fact that proper fertility education can only ever be a good thing. There are all kinds of reasons why women delay having children – often more to do with circumstance than choice – but being well-informed about the lifestyle factors that can influence your fertility can be hugely beneficial whatever age you may be,

Tripadvisor for fertility clinics?

If you missed the debate organised by Progress Educational Trust on the HFEA’s plans to include some patient feedback on clinics on the website, you can catch up with the podcast here.

You can hear the HFEA’s Juliet Tizzard, Infertility Network UK’s Susan Seenan, Yacoub Khalaf director of the fertility clinic at Guy’s and St Thomas and Antonia Foster, a media litigation specialist discuss the issue in a debate chaired by Adam Balen, the chair of the British Fertility Society.  It was an interesting and lively evening – and that link is at –http://www.progress.org.uk/tripadvisor