Low ovarian reserve

If you’re trying to conceive, you will be aware of your ovarian reserve but when you are starting out on your fertility journey, this isn’t something you will have come across before. Our potential to produce eggs declines as we get older, but the rate at which this happens is different for everyone – so some women may be diagnosed with a low ovarian reserve in their thirties or even twenties, which often comes as a real surprise as there may be no other signs of any decline in fertility at all.

If you want to know about your ovarian reserve, I was interviewed about the emotional impact by Allie Anderson for an article for NetDoctor the other day which you can read online here.  It is important that we talk about this issue more often and more openly. Fertility specialists may suggest using donor eggs if they feel the ovarian reserve is so low that IVF is unlikely to be successful, but for women this may seem a huge and unexpected step and is certainly one which needs thought and counselling.

Anyone who is using donor eggs or sperm will find it useful to contact the Donor Conception Network who can provide information, help and support.

New fertility support groups

The patient support charity Fertility Network UK has announced two new support groups which have been set up recently in Lancashire/Cumbria and in Hull.

I know many people don’t like to think that they might need a “support group” but what is so invaluable about the groups is being able to meet up with other people who are going through similar things and to share experiences. It really can be such a huge relief just to know that there are other people out there finding it hard to be happy when a close friend announces a pregnancy, or who take long detours to avoid the local nursery at pick up and drop off times. Going along to a group is a sign of strength rather than suggesting that you need more support than other people and if you see it that way, it can be a useful – and free – way of helping yourself through treatment.

For more information about the Lancashire/Cumbria group, please email lancashirecumbriagroup314@gmail.com and for the Hull group, you can email fertilitygrouphull@gmail.com.

You can find a list of all the other Fertility Network UK groups on their website here. There really is nothing to lose by going along once and seeing what you think – you may find it helps far more than you expected!

On egg freezing

There have been a couple of interesting items on egg freezing in the last few days. The first is a piece from the Telegraph, based around a BBC Radio 4 documentary about egg freezing presented by Fi Glover which looks at the reality of egg freezing. It’s definitely worth a read – and a listen – as it looks at why people consider egg freezing and asks whether the promises it offers are a reality.

At the same time, the Guardian’s Mariella Frostrup was answering a dilemma in a letter from someone who felt angry and let down by a friend who had suggested that she shouldn’t bother freezing her eggs at 35 as she was now 40, wanting a baby and had been told she had possibly left it too late. What was most interesting about this was the completely misplaced certainty that she would have been able to have children had she frozen her eggs, when in fact as Fi Glover’s programme and the Telegraph article explain, this may be very far from the case.

There is a huge media interest in egg freezing, and this is an interesting discussion whatever your point of view…

Celebrating International Women’s Day

It’s International Women’s Day and a good opportunity to celebrate some of the things that women do for one another in fertility. I was thinking of some of the women who have done and continue to do so much to change things in this field, and wanted to thank a few of them.

The first is Clare Lewis-Jones, the former Chief Executive of the charity Fertility Network UK. Clare led the charity as it grew in size and influence and was a presence at every fertility conference and event, reminding professionals of the need to think about the patient perspective. She championed the cause and helped to change the way people think about fertility, removing some of the stigma and encouraging us to talk, in part by being open about her own fertility story. Clare was awarded a much-deserved MBE for her work and was a real inspiration to me.

The second is Jessica Hepburn, who wrote a book about her own experiences of fertility problems and treatment and who went on to set up Fertility Fest. Jessica is an amazingly inspiring person who has swum the Channel and is now running the marathon to raise funds to help to support other people going through fertility problems. She has spoken widely and openly about how it feels to have unsuccessful treatment and has enabled many other people to talk about this.

My third is someone you may not know. She is called Diane and she runs the support line at Fertility Network UK. Diane is a nurse and has been answering calls and responding to emails from fertility patients for as long as I can remember. Every time I’ve suggested that anyone might benefit from giving her a call, they’ve been really touched by her kindness and helped so much by the support and advice she has offered. Diane has been at hand for hundreds of fertility patients on their journeys and is a real inspiration with her positivity and generosity of spirit.

These are just three women – there are so many more I can think of out there who are doing remarkable work to support and encourage, to inspire and inform. There are also all those women who support one another every day just by being there for each other, by showing their understanding and offering words of encouragement to their fellow fertility patients. The importance of that support should never be underestimated. Happy International Women’s Day to you all!

What do the abbreviations mean?

If you’ve been looking at fertility websites or forums (I think it should be “fora” but that sounds too weird), you may have been confused by the abbreviations…

They crop up throughout posts, and at first it can seem as if people are speaking an entirely different language when they talk about TTC (trying to conceive) and being on their 2ww (two week wait) hoping for a BFP (big fat positive – a positive pregnancy test).

Here is a brief guide to some common abbreviations for anyone who may a little help with translation…
A/F = Aunt Flo (period)
AH = Assisted hatching
AI = Artificial insemination
AIH = Artificial insemination by husband
AMH = Anti mullerian hormone
ART = Assisted reproductive technique
BBT = Basal body temperature
BFN = Big fat negative
BFP = Big fat positive
BICA = British Infertility Counselling Association
CD = Cycle day
DE = Donor eggs
DHEA = Dehydroepiandrosterone (a hormone which some believe can be beneficial for women with a low ovarian reserve)
DI = Donor insemination
DH = Darling husband
DPO = Days post ovulation
DPR = Days post retrieval
DP = Darling partner
DPT = Days post transfer
DS = Donor sperm
EC = Egg collection
ENDO = Endometriosis
ET = Embryo transfer
FER = Frozen embryo replacement
FET = Frozen embryo transfer
FP = Follicular phase
FSH = Follicle stimulating hormone
HCG = Human chorionic gonadotropin
HFEA = Human Fertilisation & Embryology Authority
HPT = Home pregnancy test
HRT = Hormone replacement therapy
HSC = Hysteroscopy
HSG = Hysterosalpingogram
ICSI = Intra-cytoplasmic sperm injection
IMHO = In my humble opinion
IMO = In my opinion
IUI = Intra-uterine insemination
IVF = In vitro fertilisation
IYKWIM = If you know what I mean
LAP = Laparoscopy
LH = Luteinising hormone
LMP = Last menstrual period
LP = Luteal phase
LPD = Luteal phase defect
M/C = Miscarriage
OI = Ovulation induction
OHSS = Ovarian hyperstimulation syndrome
OPK = Ovulation predictor kit
PCOS = Polycystic ovary syndrome
PESA Percutaneous epididymal sperm aspiration
PG = Pregnant
PI = Primary infertility
PID = Pelvic inflammatory disease
PMS = Pre-menstrual syndrome
POF = Premature ovarian failure
SI = Secondary infertility
TESA = Testicular sperm aspiration

And finally HTH (hope that helps)!

Clean eating and your fertility

I know from running support groups that there’s a lot of interest in the idea of ‘clean eating’ and fertility – and the recent Fertility Network UK patient survey showed that 75% of respondents had changed their diets because of their fertility problems.

Of course, it makes sense to eat healthily if you are having difficulty getting pregnant or going through treatment – it is good for you, it makes you feel better about yourself and you really wouldn’t want to be living on beer and chips. However, so many fertility patients I see are on diets that can start to feel incredibly restrictive, and that may not be a good thing.

I always remember interviewing someone who’d been following a strict diet for her fertility who said she suddenly realised it was making her really miserable and dominating her life. She concluded that actually being happy was probably more important than not ever eating a biscuit or drinking a cup of tea (builders as opposed to herbal of course).

I think she was absolutely right. There is nothing worse than feeling constantly guilty. I have seen people who end up blaming themselves for their fertility problems because they like ice cream or having a glass of wine when they are out with friends. These things in moderation are really not going to stop you getting pregnant. This article from The Spectator may be of interest!

Finding clinic success rates

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

You can find the full report from Manchester University which was published in the British Medical Journal here.

 

E-cigarettes and your fertility

They are often thought to be the safer version of smoking – but new research has found that the flavourings used in e-cigarettes may contain toxic chemicals which can damage men’s sperm.

A team from University College London found that two of the most popular flavours put into e-cigarettes were particularly damaging to sperm – bubblegum and cinnamon were both found to affect male fertility.  You can read more details about their research, which was presented at the Fertility 2017 Conference earlier this month, here 

Why one embryo may be better than two

Embryo,_8_cellsWhen 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.

Don’t bother with that detox

images-4Most people think about their lifestyle when they are going through fertility tests and treatment – there is so much information out there now about how diet and lifestyle can impact on fertility that it’s not surprising that people often feel a need to take measures to improve what they eat. It’s never a bad thing to eat healthily, but it’s also true that there’s little scientific evidence about so-called fertility “superfoods” or that supplements are going to make a real difference to the outcome of treatment.

At the start of a new year, many of us feel we want to use the opportunity to improve ourselves in some way and the idea of a detox to start the year is often very popular. However, doctors have issued a warning after one woman who did this last year became seriously ill as a result of taking herbal remedies and drinking too much water. She collapsed and suffered a seizure before being admitted to hospital.

Please don’t worry that eating your five a day and cutting back on alcohol is going to make you unwell – this was a full-on detox diet which is a very different thing. In fact, the British Dietetic Association told the BBC that the whole idea of detoxing is nonsense – so whilst eating well and cooking fresh wholesome food is always going to be good for you, this makes it clear that there is not only no need to follow extreme diets, it can also be very dangerous. You can read more about this here and here