Every so often there’s an article like this one in today’s Guardian, about “twins” born years apart… The writer of this piece has a son and daughter born as a result of one fresh IVF cycle and a further frozen embryo transfer from the same batch of embryos.
It is a fortunate, yet far from uncommon, experience after fertility treatment, but it doesn’t make the children “twins”. Twins are two babies who are carried together and born at the same time, which these children were not. They are siblings rather than twins.
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.
I owe Diane Chandler a huge apology as I’ve been meaning to review her book Moondance for months – and it’s a novel that will resonate with many fertility patients. We should always welcome novels about fertility problems and IVF because they really do help to normalise what can seem a very lonely experience, and also educate other people about the realities of what it’s like not to be able to get pregnant.
In Moondance we follow Cat and Dom through their attempts to conceive, fertility tests and the crashing ups and downs of treatment. There is much that will be familiar to anyone who has been through this themselves, especially in the way that treatment takes centre stage and comes to dominate everything else in life. Cat is not a sympathetic or likeable character – almost unbelievably self-centred, arrogant and selfish – which makes it hard to feel much in the way of empathy at the start of the novel. And yet seeing how someone so obsessed with controlling everything in their life is completely thwarted by their inability to conceive adds strength to the portrayal of the nature of infertility.
This is the sort of book that you sit down with and find yourself speeding through – despite being a thick book it’s a fairly quick read. There are a couple of niggling inaccuracies, for example, a type of post-coital sperm test which is medically impossible, but these don’t detract from what is otherwise a detailed account of the realities of treatment.
Thanks to Carole Bonner, Chair of Croydon Council’s health and social care scrutiny sub-committee, and her fellow members who have called on the government to stop cuts to all funding for IVF in the area. They sent a letter to the Secretary of State for Health, Jeremy Hunt, asking him to look at the decision to cut all funding made by the local Clinical Commissioning Group.
It is the first time that a decision has been challenged in this way and the Committee was concerned that the impact of the decision to remove access to fertility treatment would mean that those in the most deprived, low-income areas will be unable to afford to have IVF. A consultation carried out locally by the Clinical Commissioning Group showed that 77% of almost 800 respondents thought the funding should be retained.
Councillor Carole Bonner said “We’re making this referral because of the potential long-term adverse health effects the removal of IVF will have on Croydon residents. Not only can infertility result in family breakdown and the ending of relationships, it often has an impact on the mental health of those affected. A comprehensive study was carried out by Middlesex University and the Fertility Network that showed a clear correlation between infertility and depression, with 90% experiencing depression. The committee is acutely aware of, and has sympathy for, the CCG’s underfunding and the inconsistencies of the funding formula when compared to similar authorities. However, we feel that the effects of the withdrawal of IVF funding in Croydon are not in the best interests of the borough’s residents.”
Whatever the outcome, it is heartening to see a local Council appreciating the huge impact that cutting fertility services can have for a relatively small saving – so thanks to Croydon and let’s hope that others are inspired to follow their example.
For most people, it’s probably the worst part of an IVF cycle – the notorious 2ww when you get to spend a fortnight (which seems to last about ten years) on tenterhooks, worried about everything you do and don’t do in case it affects the chances of a positive outcome. One of the most frequently asked questions is what you should and shouldn’t do during this time.
You will find all kinds of advice from all kinds of experts about activities, diet and supplements during the two week wait. There are those who advise that you should take the time off work and do as little as possible, spending the first day or two lying on the sofa. Others may advise going back to work right away to try to keep your mind occupied and suggest that it’s best for your mind and body to keep active and busy. I’ve heard of people drinking pints of milk and others avoiding dairy products. There are women who don’t take baths because they might overheat, and others who are lying around with hot water bottles on their stomachs.
If you visit any fertility forum, you will find it awash with questions and suggestions about the two week wait. Some are quite bizarre – a quick trawl produced all the usual stuff about eating pineapple core and brazil nuts, but the idea that you shouldn’t eat anything uncooked and that you need to wear socks 24 hours a day were both new ones to me!
I will always remember the nurse who cared for us during our first IVF cycle telling me that any rules about what not to do during the two week wait weren’t really set because they would cause an embryo not to implant or induce a miscarriage but rather because they were things that fertility patients often worried about. So, having a glass of wine during the two week wait is not going to stop you getting pregnant, but if your treatment doesn’t work and you’ve had a glass of wine, you are likely to question whether it was to blame.
I think the bottom line with all of this is that if you are sufficiently worried to be asking whether it is OK to do something, it’s probably a good idea not to do it. Two weeks seems a lifetime during the 2ww, but in reality it isn’t a long period to have to give anything up. There are no hard and fast rules, but following your own instincts and doing what feels right for you rather than allowing yourself to be driven to distraction by conflicting suggestions is probably the best advice anyone can give you about what to do and not to do.
NHS Commissioners in yet another area are considering cutting fertility services. This time, it’s Richmond Clinical Commissioning Group which is consulting on whether to continue to offer one fresh and one frozen cycle of treatment or to cut the service entirely. You can give your views by completing their survey – https://www.surveymonkey.co.uk/r/IVFandICSIconsultation
The consultation closes on Tuesday 4 April 2017, so please do let your views be heard especially if you live in or near Richmond.
Did you know that the Fertility Show will be in Manchester next month? The event which has taken place at London’s Olympia for many years is spreading its wings and will be held at Manchester’s Central Convention Complex in Windmill St on March 25 and 26.
Tickets are now on sale here so do come along if you are nearby – I will be there too speaking about how to choose a fertility clinic and will be on the Fertility Network UK stand so come and say hello!
All too often, there’s an assumption that secondary infertility is somehow less of a problem because you aren’t childless – and yet in fact the pain it causes may be different, but it is still a deeply distressing problem. Parents can feel guilty about not being able to provide a sibling for their child, and it can be very difficult to escape pregnant women and babies when you have a young child.
People sometimes put off seeking medical advice if they are experiencing secondary infertility having conceived without a problem in the past. In fact, there are no guarantees when it comes to fertility and it is actually more common to have a problem second time around than it is not to be able to have a child in the first place. Sometimes the difficulties you are experiencing are just down to the fact that you are older than you were when you got pregnant before, but there can be other medical problems which may have occurred in the interim. If it is taking you longer than you would have liked to get pregnant again, you should visit your GP in just the same way that you would do for primary infertility – so usually after a year of trying unsuccessfully or after 6 months if you are over 35.
A really interesting new study has found that women who worked night shifts or who had jobs involving heavy lifting produced fewer eggs when having fertility treatment than those who worked normal day shifts. The research team from the United States investigated around 500 women who filled in detailed questionnaires about their work shift patterns and any heavy lifting involved in their jobs. The researchers found that there were clear differences in the number of eggs produced by women who worked at night and those who did heavy lifting at work.
I found this study particularly fascinating as I worked night shifts before I started trying to conceive, and was very aware of the negative impact it had on my overall health – but often wondered whether it could affect fertility too. This was an observational study – which means the researchers were not linking cause and effect but just seeing what happened with the different groups of women and fertility experts have urged caution in interpreting the results. However, if you are doing a job which involves working nights or a lot of heavy lifting and are having difficulty getting, the study would suggest it may be worth investigating if there is anything you can do to change your shift pattern or lifting at work.
New research from the States suggests that women who are depressed are less likely to carry on with fertility treatment. The researchers from the University of North Carolina (UNC) screened 416 women with fertility problems, and 41% scored positive for depression although apparently more than half said that they felt depressed most or all of the time.
The research team found that the women whose screening test showed that they were depressed were less likely to carry on with treatment, and therefore less likely to end up with a pregnancy. You can see more about the research, which was published in the journal Human Reproduction, here
It isn’t really surprising that so many people who are having difficulty getting pregnant experience depression, but it is sad that some may end up avoiding or delaying accessing treatment that could help because of depression and anxiety.