When IVF doesn’t work…

You may have heard in the news recently about the latest statistics on IVF success for women in their forties, and seen that Sally Cheshire, Chair of the fertility regulator the Human Fertilisation and Embryology Authority (HFEA), has spoken out about the need for fertility clinics to be more honest and open with patients about their chances of IVF success.

The latest figures show that the number of women in their forties having IVF has doubled since 2004, but only 75 women aged 42 and 43 will get pregnant using their own eggs, and once you reach the age of 44, just two women a year are successful. To put that into context, approaching 11,000 women who were over 40 had IVF in 2017.

Some clinicians say that women are entering into IVF with their eyes open, well aware of the chances of a successful outcome, but you don’t have to talk to many women who have had IVF to know that is often far from the case. When you are longing for a baby, you tend to hear the positives rather than the negatives, and when there’s a 5% chance of success, it’s the 5% you focus on rather than the 95% chance of your treatment not working.

It is difficult as sometimes women feel that although they may be 44 or 45 and know it is unlikely that treatment will work, they still want some kind of closure and need to know they’ve done everything they possibly could.

Sally Cheshire talks in her interview about being approached by clinics at the Fertility Show in Manchester and being given unrealistic suggestions of her chances of having successful IVF treatment. It is vital for clinics to be honest about this – and it doesn’t take much searching to find clinics publishing clinical pregnancy rates for women in their mid-forties which many will see as their chance of having a baby – when in fact, miscarriage rates are high for women of this age and these clinics know only too well that the live birth rate is very different from the clinical pregnancy rate.

You can read more about Sally Cheshire’s interview with the Telegraph here

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 

 

 

New advice to women of 44 and over doing IVF

eggFor women who are going into IVF in their mid-forties, the chances of success are not good and now new research from  Dr Marta Devesa from Barcelona has led her to suggest that women who are 44 and over should be advised against trying IVF with their own eggs.

What does the research conclude when it comes to IVF  for older women ?

Her study, which has taken 12 years to complete, looks at birth rates following IVF at her clinic and shows that the cumulative rate for women aged 44 and over using their own eggs is just 1.3%. The success rates for women using donor eggs do not decline with age in the same way – leading to the conclusion that it is the age and quality of the egg which is the key factor rather than the age of the woman herself.

Dr Devesa explained that the most likely biological reason for a decline in live birth with female age was chromosomal abnormalities in the embryo.

You can read more about her research and her findings here 

Fertility, age and egg freezing

There’s an interesting piece on the Guardian’s Comment is Free written by Barbara Ellen about a paper in the Lancet suggesting young women might freeze their eggs or ovarian tissue for future use.  She is quite right to be concerned about the uncertainties around freezing as a solution – it is relatively new, expensive and comes with no guarantees – and yet having come across many women who are still unaware of the realities of their fertility I don’t think all women are aware of the way that fertility declines.

There may be endless screeching about this through the “media megaphone” as she describes it, and yet I regularly meet women in their forties who think that being fit and healthy and still having periods must also mean being fertile. I’m not sure where the disconnect is here, and whilst it is quite true that there are many women who may be unnecessarily anxious about their fertility in their early thirties, the realities of fertility in your forties still comes as a surprise to many others.

I’m not sure why this is – is it that women who are now in their forties didn’t get this message when they were younger? Is it that they are putting too much faith in fertility treatments to solve any problems? The realities of IVF success rates of less than 2% at the age of 45 combined with miscarriage rates rising to 93% at that age are still something too few women really appreciate.

IVF as a “lifestyle choice”?

TV presenter Kirstie Allsopp has made headlines again with her views on women and fertility – this time claiming that women shouldn’t see IVF as a “lifestyle choice”. Last time she spoke out about age and fertility, I agreed with her – but this time I’m not sure I do.

I honestly don’t think people do see IVF as a “lifestyle choice” – no one wants to go through IVF, no one “chooses” it. I think perhaps sometimes people assume it can help if they’ve left it later to try to have children – and that can be terribly sad if it’s only then that they discover how low IVF success rates drop once you are into your forties.

She also talks about women having to “run the risk” of pumping drugs into their bodies during IVF. Again, although no one would choose to stimulate their ovaries in this way and ovarian hyperstimulation is a potentially dangerous side-effect if not managed properly, I don’t think it’s very helpful to talk about it as running a risk.  To read many newspapers today, you would believe that anyone who has had IVF is likely to develop all kinds of ghastly long-term conditions as a result of the drugs, when in fact there is no evidence of this kind of health risk.

I’m glad she’s speaking out about this and I think she’s right to encourage women to have children sooner rather than leaving it later if that’s a possibility – but I’m not sure talking about IVF as being risky, or as a lifestyle choice, is terribly helpful.