Can environment make a different to IVF outcomes?

When it comes to factors that could possibly have an impact on IVF success, the things that often spring to mind are often those we can influence ourselves – a healthy diet, not smoking or drinking too much – or the kind of add-ons that have become increasingly popular in many clinics such as embryo glue or time-lapse.

For most fertility patients, the type of liquid embryos are placed in at the clinic would not be the first thing to consider when it comes to treatment outcomes – in fact, it’s not something most of us think about at all. However, new research carried out at Boston Place Clinic by Dr Stuart Lavery of IVF Hammersmith, suggests that the culture medium used by the clinic can make a difference to the way that embryos grow. You can read more about the 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.

Does your job make a difference to treatment outcomes?

120px-Classe-merikanjakaThere’s a rather intriguing survey carried out in the US for their National Infertility Awareness Week by a fertility website which suggests that teachers are six times more likely to have a successful outcome from IVF treatment than those working in other areas. If you work in sales, marketing or public relations, you’ll also be pleased with the outcome which claims you are twice as likely to be successful as some others. Apparently the bad news is for those in investment banking and engineering who are less likely to have a baby after IVF.

It all sounds rather odd to me but the results were apparently collected from more than a thousand fertility patients. What wasn’t entirely surprising was that wealthier women were more likely to be successful as they can afford to pay for more treatment – but then teachers earn considerably less than investment bankers… The study’s authors suggest that the results may have something to do with the fact that teachers said they were more open about their fertility problems and that they used their school summer holidays to have treatment – and that engineering and investment banking are traditionally male-dominated and more stressful and demanding with longer hours.

I’m not convinced that many teachers here in the UK would claim that their jobs are less stressful – or that they don’t work long hours – and it would be interesting to find if the results were similar elsewhere in the world. Purely coincidental or something more? What do you think? You can find more about the research here 

 

 

Why you need to look at IVF as a course of treatment

Embryo,_8_cellsAll too often, IVF is criticised as being “unsuccessful” when people look at the chances of getting pregnant from an individual cycle of treatment – but now a new study shows that the majority of couples are successful if they are able to have more than one cycle.  The research, published in the Journal of The American Medical Association, has found that 65% of patients will have a baby if they have six or more cycles.

The recommendation here in the UK is for three funded cycles, and in many parts of the country fertility patients can’t even access that, but this research suggests that more people could be successful with more treatment.  The researchers found that in all women, the cumulative percentage of live births across all cycles continued to increase up to the ninth cycle.

You can read more about the study, whose main authors were Professor Debbie Lawlor of  the University of Bristol and Professor Scott Nelson from the University of Glasgow’s School of Medicine, on the Bristol University website here

This is really welcome research as all too often when NHS funding is cut, local commissioners claim that IVF has very little chance of success after one or two cycles, but this research suggests there could be benefits to extending the number of IVF cycles beyond three or four.

The study included 156,947 U.K. women who received 257,398 IVF cycles between 2003 and 2010 and were followed up until June 2012. It was funded by the Wellcome Trust and the Medical Research Council.

Are you lacking in vitamin D?

Some interesting new research from Italy suggests that women who are lacking in Vitamin D are only half as likely to get pregnant using IVF as those who have sufficient Vitamin D levels. The researchers looked at just over 300 women who had IVF treatment and there were significant differences in success rates between those who were deficient in Vitamin D and those who were not.

Vitamin D is found in oily fish (such as salmon, sardines and mackerel), eggs, fortified spreads and breakfast cereals – but is also manufactured in our bodies when skin is exposed to summer sunlight.  So a good excuse to make sure you get outside and enjoy some sunshine when you can (with all the normal caveats about protecting your skin from too much sun of course…)

You can read more about the research here 

Could a urine test hold the key to IVF failure?

A team of researchers in the Netherlands say they may be able to identify the IVF treatment cycles which are unlikely to work by carrying out tests to measure bacteria in urine or in the vagina. The team from Erasmus MC in Rotterdam say that their work has enabled them to predict, with an accuracy of 96%, when a woman is not going to get pregnant using IVF.

As with many of these things, the research is still at an early stage and far more investigation in a wider group of women will be needed before this would be ready to be used in a clinical setting so you are not likely to be able to access this kind of testing at a clinic near you in the near future.

Further trials are likely, and there may also be work to determine whether lifestyle changes could alter the levels of bacteria. You can read more about it on the website http://www.erasmusmc.nl

Are people rushing into IVF?

According to a report out today, we are using IVF too quickly and too often, particularly for those with unexplained infertility.  I was due to go and discuss this on Sky News this morning, but due to hideous traffic ended up missing the slot. I was disappointed, as I did want to raise some important issues from the patient perspective on this.

The report says that 25 – 30% of those who come for IVF currently have unexplained infertility, and that some of them will actually get pregnant naturally. The report talks about natural conception occurring even in couples who have been through two to three years of unexplained infertility.  This is true – we all know it can happen – but that doesn’t mean it will happen for every patient with unexplained infertility.  According to HFEA data, the average fertility patient in the UK has spent four years trying before they have IVF.  I am not sure how much longer the authors of the report would expect them to carry on before fertility treatment would become appropriate.

We also have to remember that there is always a cause for unexplained infertility – the diagnosis just means that doctors haven’t managed to find it.  Our infertility was unexplained, and we have never conceived naturally. Had we waited five or six years before trying IVF (and I assume this is how long we are meant to carry on as four years is seemingly not enough), our treatment would have been far less likely to work as my fertility would have been declining.

I appreciate that clinicians need to debate these issues, but it can be very difficult for patients who are forever facing conflicting information about what they should do and when.  I’d say the best thing is always to take advice from a fertility specialist, and to take newspaper headlines with a pinch of salt.

 

Age and IVF success

images-5There has been a lot of discussion recently about age and infertility, with some claims that it’s not as relevant as we’ve been led to believe.  I was interested to see some new research from the University of Aberdeen which makes it very clear just how closely IVF success is linked to age.  Interestingly, the research found that although the amount of time that a couple had been trying to get pregnant before treatment is relevant to the outcome, it doesn’t have nearly as much impact as age.

The researchers looked at data for more than 120,000 women, and found that women’s chances of success with IVF start to decline once they reach their mid 30s, but are then sharply reduced from the age of 37.  For those who did get pregnant, the changes of having a miscarriage were also considerably higher in women of 38 and above.

You can read more about the research from the team headed by Professor Siladitya Bhattacharya here at www.abdn.ac.uk/news/

Can I have a glass of wine?

I can’t quite remember when it became accepted wisdom that anyone trying to conceive should be cutting out alcohol entirely, or giving up all caffeine, or taking loads of vitamin supplements… When I did my first IVF cycle, the consultant did mention that smoking wasn’t a terribly good idea – but that was about it.  Of course, IVF success rates have gone up since then, but I suspect that’s more to do with advanced techniques than the fact that so many of the patients are teetotal, caffeine-free and rattling with vitamin pills.

It goes without saying that you shouldn’t drink excessive quantities of alcohol when you’re trying to conceive – or excessive amounts of caffeine – but is an occasional glass of wine really going to stop you getting pregnant? I’ve never seen any convincing evidence to show that’s the case.

I was thinking about this at a fertility support group I facilitate last night and realised that I’d only ever been to one support group where wine was offered to all the members as they arrived.  Interestingly, it was in a fertility clinic and run by a consultant who clearly didn’t think a glass of wine was going to ruin the members’ chances of getting pregnant…

If giving up alcohol and caffeine entirely makes you feel better, if you happen to prefer herbal tea and you find the vitamin pills are boosting your energy – then so much the better. But if it’s making you miserable, I’d be a bit kinder to yourself.

 

Does IVF work?

There has been a lot of discussion in the last week or so about how successful IVF really is after the Chair of the HFEA Professor Lisa Jardine talked about the “discouragingly low” success rates in an industry which “trades in hope”, pointing out that for each cycle of IVF, fewer than a third of women over the age of 35 would emerge with a baby.  In the wider discussion of the issue, it has since been repeated that IVF is only successful for this relatively small percentage of women with none of the necessary caveats.

In reality, most women who have a baby after IVF don’t get pregnant after their first cycle.  The reason the NICE fertility guideline recommends three cycles of treatment is because that has been shown to be clinically effective. Cumulative success rates for IVF are often hard to come by, but a recent study at Bourn Hall Clinic in Cambridge has shown a success rate of more than 70% over three cycles of treatment  – and cumulative success rates are key if you are considering IVF success.

The chances of getting pregnant with IVF depend very much on who is having the treatment. The likelihood of a positive outcome may be high for a woman of 28, but a 43 year old having fertility treatment is far less likely to succeed – and this is the balance that needs to be taken into account when considering IVF success rates as they are so dependent on the patient.

Of course, Professor Jardine is right that we need to think more about what happens when IVF doesn’t work and whether we are preparing people for this possibility – but we also need to acknowledge that one of the main problems we see today is women who are still assuming that IVF will be able to help if they leave it until their late thirties or early forties to start trying to have a child.