Your views needed!

If you are having fertility treatment, or have done recently, you may have been offered some additional extras on top of your IVF or ICSI. These additional treatments include things like time-lapse imaging, embryo glue, endometrial scratching or reproductive immunology. Not all clinics offer every type of additional treatment. Some may not suggest them at all, others include them in the price of IVF or you may be given the option to pay for add ons if you would like them.

Fertility Network UK, the patient charity, and the fertility regulator the Human Fertilisation and Embryology Authority, or HFEA, is interested in finding out more about what you think about these add ons, how they should be offered and what you need in order to make decisions about whether to pay for them. Most of these add ons are not fully proven to increase your chance of getting pregnant.

If you have had treatment recently or are going through treatment currently, do take a minute to answer the short questionnaire to help them find out more about what your views are on this subject. You can find the link by clicking here

 

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

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.

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,

Should I have an endometrial scratch?

800px-Woman-typing-on-laptopIf you are having IVF treatment, you’ve probably read online about endometrial scratch – a procedure which involves “injuring” the lining of the womb and which apparently can increase the chances of an embryo implanting.

The procedure has been in the news this week after a new review of the trials of endometrial scratch was released which suggests it may be beneficial for couples who are either trying to conceive naturally or using IUI where it seemed to increase the chances of success considerably.  This has been widely reported as suggesting that everyone should go off and have a scratch but it is important to note that the review concludes that  “the quality of the available evidence is low”.

You can read more about the review presented at the European Society of Human Reproduction and Embryology here. There are currently trials being carried out looking at the success of endometrial scratch which should give some more good quality evidence to show whether or not the procedure is worth paying for.

Have you paid for extras when having NHS fertility treatment?

images-6Access to NHS-funded fertility treatment in the UK is still a postcode lottery, and what you get depends entirely on where you live. What’s also becoming more apparent is that in some areas people are paying for additional tests and treatment when they are having NHS-funded IVF or ICSI, but this doesn’t happen everywhere.

Some fertility patients are paying for time-lapse imaging, for endometrial scratch or for embryo glue for example – and others are reporting being asked to cough up for tests before treatment such as AMH tests or even sperm freezing and storage.

Your experience of extras for NHS-funded IVF 

The patient support charity Infertility Network UK is trying to build up a picture of what people are currently experiencing, so if you’ve paid for any additional tests or treatments on top of your NHS-funded IVF or ICSI, it would be really useful if you could let them know. All responses will be totally confidential, and you can email katebrian@infertilitynetworkuk.com.  If you have paid and are able to give a rough idea of how much you have paid this would be helpful, and they would also like to hear from you if you would have liked to pay for some extras but this was not permitted.

Want to know more about endometrial scratch?

I’ve noticed a lot of people have been asking about endometrial scratch recently and whether they should have it at their clinic alongside their IVF. It is a procedure which is sometimes offered alongside IVF and carried out before treatment starts. There have been suggestions that it may improve outcomes but it is clear that people aren’t really sure whether it is really worthwhile – and the costs of the procedure can vary hugely from one clinic to another.

Endometrial scratch – evidence and experience

If you want to find out more about other people’s experience of having a scratch, about the science behind it or about what leading specialists in the field would advise, you may be interested in this article I wrote on the subject for Fertility Road magazine. It will certainly help as a starting point if you aren’t quite sure whether to go ahead and pay for a scratch.

Have you tried endometrial scratch?

I’m really interested to know more about people’s experiences of endometrial scratch? If your clinic suggested it for you, or if you chose to have it done as part of your treatment and you might be willing to talk about it, can you get in touch via the contact page, leave a comment below or talk to me on twitter @katebrian?