Will my IVF work?

ivf_science-300x168You may have heard about the new predictor tool for IVF/ICSI which has been developed recently which is available through the University of Aberdeen website.

It uses data from the Human Fertilisation and Embryology Authority which keeps records of all cycles of treatment carried out in the UK, to aim to give a picture of your individual chances of having a baby after IVF/ICSI treatment,

The reporting of this has been analysed by NHS Choices which points out that there are some gaps in the data which the researchers themselves have acknowledged as it doesn’t account for the woman’s body mass index (BMI), whether she smokes and how much alcohol she drinks.

Despite these limitations, it is certainly a very useful tool and one which may help many couples get some kind of realistic idea of the chances of an IVF cycle working. Of course, the experience of each individual couple is always different and this doesn’t allow you to include any detailed medical data either, but it does give a broad picture view which may prove very helpful.

Choosing a fertility clinic

800px-Woman-typing-on-laptopThose of you who came to my talk at the Fertility Show will know that I promised to put up some notes from my talk on the blog this week – here they are at last!

The HFEA website

We begin with the HFEA website which is the best place to start. You can search for your local clinic using the Choose a Clinic tool – just type in your postcode or local region and you will get a shortlist of local clinics.

You can see more about the treatments they are licensed to carry out, services, facilities and staff. It will tell you whether they take NHS patients, the opening hours, whether there is a female doctor and links to a map.

Of course, the one thing you really want to know is how likely am I to get pregnant there? Which is the one thing no one can honestly tell you. The HFEA publishes success rates for all licensed clinics, but they may not be as clear cut as you imagine. Most clinics have broadly similar success rates and the majority of clinics in UK have success rates which are consistent with national average. Don’t forget, the patients treated affect the success rates.

You may want to look at the success rate for someone of your age, and make sure you are comparing like with like. The HFEA also gives the multiple birth rate, but a high rate doesn’t suggest a good clinic which has your best interests at heart. Naturally multiple births occur in 1 in 80 of all pregnancies, it’s around one in six after IVF. That may sound positive, but in fact multiple birth is the single biggest risk after fertility treatment. 1 in 12 multiple pregnancies ends in death or disability for one or more babies, and it is also more risky for mothers. Good clinics should not have very high twin rates. A really good clinic will have good success rates and low multiple rates.

When it comes to success rates, don’t get bogged down in fairly small percentage differences – in general they’re probably not that meaningful.

NHS Funding 

You will also want to know if you qualify for NHS funding. The guideline from NICE recommends 3 full cycles (fresh and transfer of any frozen embryos) for women of 39 and under and one full cycle for women of 40-42 who have had no previous treatment, who have a good ovarian reserve and who have spent 2 years trying)

In England funding comes from your local CCG (Clinical Commissioning Group) not your clinic so you need to find out their rules – and unfortunately they all make their own up as the NICE guideline is only a guideline. You can find out what your CCG is offering by visiting the Fertility Fairness website. The CCG will also set eligibility criteria – and each will have their own

Location 

Think about how close the clinic is to your home or workplace. Be realistic as a long journey is fine as a one-off, but think about doing it three or four times a week. Ask the clinic how often you will have to visit as some will want you in every day of the cycle, but others just a few times a week.

Think about how you will get there and how long the journey will take? Are you going to use public transport or drive? Will you be travelling in the rush hour? Can the clinic offer early morning appointments or will you need to take time off work? Will it fit around your job?

Cost 

Fertility treatment prices are not regulated and can vary hugely. Clinics that charge more are not necessarily better so do look into prices. The headline figure on clinic websites is rarely the total cost of treatment  – ask instead what the average person actually pays

The HFEA does require clinics to offer you a personalised costed treatment plan, but check what is included – drugs, counselling, scans and bloods, freezing and storing spare embryos, follow-up consultations etc.

Unproven treatments 

Many clinics offer unproven additional treatments. Many are not scientifically proven. The HFEA has advice on some of these . Additional treatments can be very expensive, and you may risk paying a lot for something that may not make a difference – and may even bring additional risks.

Support

Will there be someone you can call with any problems/concerns? You should be given a contact to call if you are concerned about anything at any time. And is counselling included in the cost of treatment? You may think you don’t want or need it, you may may find it helpful once you have started treatment. So check if you are going to have to pay for counselling, and if it is included, ask how many sessions.

Is there a counsellor based at the clinic? Some counsellors also offer telephone counselling and you can find a list of fertility counsellors on the British Infertility Counselling Association website. Is there a patient support group?

Waiting 

How soon could you get an appointment and when could you start treatment if it is recommended ? How long are waiting times for donor eggs or sperm? At some clinics,
there are still waiting lists for donor eggs and sperm but others have plenty of donors, so do check.k

Do you like the clinic?

I think this is far more important than you might initially think.

Talk to anyone else you know who has been there, look online for views – but remember that everyone is different. Go to any open days or meetings for prospective patients and think if the clinic feels right for you. It may sound ridiculous, but it matters.

Trust your instincts, and don’t hink they don’t matter. Make sure that you have chosen a clinic that you will be happy with.

Treatment isn’t always easy, but it is certainly much easier if you are being looked after by people you like and trust.

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!

ICSI and the fertility of future children

DownloadedFile-17You may have heard about recent research suggesting that boys born after ICSI were likely to have lower sperm counts – and you may have been concerned about it. If you were, you may find this commentary from Bionews by Professor Allan Pacey of Sheffield University, who is one of the country’s leading sperm experts, reassuring.

There has always been a question about the future fertility of males born using ICSI, and it had been suggested that they might inherit their fathers’ fertility problems. The latest research has found that the sperm of ICSI-conceived men is of lower quality than average, but when fathers have particularly poor sperm quality this doesn’t seem to be passed on to their sons. You can read Professor Pacey’s interesting commentary on the subject here.

The brilliant NHS Choices also has a commentary on the research behind the headlines, and you can find that here.

Have you had fertility treatment overseas?

Cmhc-LqWYAAWk88Fertility Network UK have a media request for anyone who either has had IVF or ICSI overseas or anyone who is actively considering it?

If you are happy to talk to a Radio 4 journalist about this – and it can be done anonymously if you prefer – please email Catherine Hill at media@fertilitynetworkuk.org

Could your ethnicity affect your chances of IVF success?

120px-Pregnancy_test_resultNew research suggests that ethnicity may affect the chances of ending up with a baby after fertility treatment. A team from The University of Nottingham and the fertility unit at Royal Derby Hospital analysed data from the Human Fertilisation and Embryology Authority to see whether ethnicity had an impact on treatment outcomes, and found that there were some significant differences. According to the data, White British women are more likely to get pregnant with IVF or ICSI than women from a number of other ethnic groups.

This is the biggest study to look at the outcomes for individual ethnic groups in this way, and it considered the number of eggs collected and fertilised and the number of embryos produced as well as the pregnancy and live birth rate. The researchers also considered potential reasons for the differences in outcomes for the different ethnic groups and discuss factors such as genetic background, environment, diet, socio-economic and cultural factors and attitudes to medical care and accessing fertility treatment. They also discuss the fact that South Asian women are at higher risk of polycystic ovary syndrome (PCOS) which can affect egg quality and success rates.

You can find out more about this research here 

Do you really need ICSI?

images-6If you’d seen the Daily Mail headline earlier this week suggesting that the “Most popular form of IVF given to thousands of couples is ‘ineffective’“, you may well have been worried. In fact, the headline was referring to ICSI which is far from ineffective as a treatment for male fertility problems, and has allowed many men who would otherwise have had to use a donor to have their own genetic child.

The story in the Mail concerned the fact that ICSI isn’t an effective treatment in other cases, and it said that the editor-in-chief of the Human Reproduction journal, Professor Hans Evers, had criticised IVF clinics for offering ICSI to couples who will not benefit from it.

The fact that ICSI isn’t for everyone is not news. The NICE guidance in 2013 made it clear that ICSI should only be used where there were male fertility problems although it could also be considered where previous fertility treatment had resulted in failed or very poor fertilisation. ICSI is sometimes offered more widely, but there is no evidence that this would increase the chances of IVF working, and some research has suggested that it could actually reduce the chances of pregnancy where there is no indication that it is needed.

If you have male factor problems, you can ignore this as ICSI may well be the most effective treatment for you. If you are being offered ICSI where there are female issues or unexplained infertility, then you should make sure you talk to the team treating you about this before going ahead.

If you have been successful with IVF…

120px-Pregnancy_test_resultIf you are pregnant after fertility treatment and live in the South East, would you be willing to help with a research project?

Liz Gale, a Senior Lecturer in Midwifery at the University of Greenwich, is interested in the experiences of parents to be who are expecting their first child through IVF. This study is open to prospective parents who live in London or the South East and are expecting their first child, conceived using IVF or ICSI, genetically belonging to both parents. Full ethical approval for the study has been granted from the University of Greenwich research ethics committee.

Involvement in the study will entail 3 interviews, one antenatally at 34 weeks, the second when the baby is six weeks old and another 3 months following the birth. Interviews will take place in participant’s own home or somewhere convenient to you. You will also be asked to keep a diary to complete at your own convenience; this will not be onerous but will allow you to record your early experiences of parenthood; the diary will be reviewed by the researcher but will be yours to keep as a record of your early days with your baby. Anonymity is guaranteed and if you choose to participate you would have the right to withdraw at any point.

The study is undertaken as part of Liz’s PhD and once completed, the findings will be used to improve the care and support for parents with an IVF baby. If you are interested in taking part or wish to find out more information, please contact Liz at e.a.gale@greenwich.ac.uk

Fertility research request

Another research request, this one from a team at Oxford University. They are keen to interview people who have had IVF/ICSI in the UK in the last five years. They want to talk to people about their views on allowing their personal data to be used in fertility research – if you had treatment in this time frame, you would have been asked if you were willing to allow information to be used for research purposes.

If you have had fertility treatment at a clinic in the UK in the last five years and live in England, you can contact Dr Claire Carson if you would like to know more about this research project or are interested in taking part. You can call her on 01865 289755 or email claire.carson@npeu.ox.ac.uk