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

Frozen embryo success

If you’re having fertility treatment, you may worry that using frozen embryos might reduce your chances of a successful pregnancy. Now, new research from Australia and Vietnam has found that your chances of getting pregnant are similar whether you use fresh or frozen embryos.

The researchers explained that previous studies have shown that for women who have PCOS, frozen embryo transfer leads to an increased chance of success so this research was focused on women who don’t have PCOS, and it found no difference in outcomes. The bottom line is that frozen embryo transfer can lead to the same success rates, and that putting back one embryo at a time is not only the safest way to have IVF, but will not reduce your chances of having a baby either.

The research is published in The New England Journal of Medicine, and you can read more details here and there’s an article on the subject with quotes from the researchers Dr Lan Vuong, from the University of Medicine and Pharmacy at Ho Chi Minh City, and Professor Ben Mol, from the University of Adelaide, here

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/