Leap In by Alexandra Heminsley

This is a book about swimming, about how Alexandra Heminsley overcame her fear of water and learnt not only to swim, but to enjoy swimming outdoors in choppy seas, cold rivers and dark tarns. Heminsley’s earlier book, Running Like a Girl, is about running when you don’t think you’re a runner and Leap In is the swimming version. It’s her honesty, the detail and her beautiful writing which make this such an engaging book; I could completely envisage the sweaty attempts to squeeze her body into a wetsuit, the feelings of panic in deep water, the anxiety about her bare feet when she does her first river swim.

Leap In is about pushing yourself, about facing up to difficulties – and we learn more than half-way through the book that Heminsley is going through fertility problems and IVF as she continues her swimming journey.  At that point, her battles to overcome her fears have an undercurrent of a more fundamental challenge.

Heminsley doesn’t tell us much about her fertility problems or the experiences of tests and treatment, but what she does say is rich with meaning for anyone who has been there. “When I think about never having a child, a sort of breathlessness, almost a vertigo, comes over me,” she writes, explaining in just one sentence the overwhelming hollow bleakness of infertility. She has a positive pregnancy test after her second IVF cycle, but miscarries – something she deals with in two poignant paragraphs in which she describes the sense of crushing grief and how this transforms her relationship with her body which she feels has betrayed her and which she now rejects.

I really love this book – it manages to be funny, sad, inspiring and thought-provoking. The last chapter of the first part ends with Heminsley pondering what lessons swimming has taught her and where her future lies. She says she doesn’t know if she will ever have a child, or even the strength to try IVF again, but her attitude to life is that we must Leap In, living life as a participant rather than a spectator, that we must not give into our fear of the unknown and must be courageous when we need to adapt or amend our plans and discover our inner strength and resilience. These are certainly thoughts to ponder for anyone who is in the midst of fertility problems.

Leap In is published by Hutchinson.

 

 

Finding clinic success rates

New research suggests that if you want to find out about outcomes from fertility treatment at a particular clinic, the best place to go is not the clinic’s own website. Researchers from Manchester University discovered that fertility clinics use a variety of different ways to present their data which makes it very difficult for anyone trying to compare one clinic with another.  They found that clinic websites often use league tables which they construct themselves using their own parameters to compare clinics in their area and that these are “invariably constructed so that the comparison was favourable to the reporting clinic.”

If you do want to look at outcomes, it is worth bearing in mind that most clinics have broadly similar success rates and that relatively small percentage differences can be pretty meaningless and may have more to do with the patients being treated at any given time than anything else. The HFEA publishes outcomes broken down by age and this is by far the best place to go for information if you want to look at treatment outcomes as the figures are collected and collated the same way for all clinics across the UK

You can find the full report from Manchester University which was published in the British Medical Journal here.

 

How old is too old to be a parent?

Do you think there should be a cut-off age after which people shouldn’t have children? Or is it fine at any age at which it is remotely feasible? And is it right that we ponder this subject so much when it comes to women having children later in life, and yet barely raise an eyebrow when Mick Jagger has a baby at the ripe old age of 73?

The subject has been back in the news again after Dame Julia Peyton-Jones, former director of the Serpentine Galleries, became a mother at 64. It isn’t clear how she had her daughter, although we can be sure she didn’t use her eggs and that she may well have paid for a surrogate to carry the baby too.  I know we all feel and act younger than our grandparents may have done at the same age, but she will be 80 by the time her daughter is 16 – and I can’t help wondering what it would be like for a 16 year old to have an 80 year old mother? Or what it would be like to be responsible for a teenager when you were 80?

Of course, the other problem with news stories like this is that they muddy the waters when it comes to NHS funding for fertility treatment, as many people seem to assume that it is the NHS which is footing the bill for older women to try to have babies. In fact, in most areas there is limited funding for women up to the age of 39, and often nothing at all beyond that. At most women of 40-42 will get one cycle, but if you are older, there is no likelihood of funded treatment.

Leap In

If you haven’t already seen this fabulous article from The Guardian by Alexandra Heminsley, it is worth a read.

You may have come across Alexandra Heminsley before as she wrote a previous book, Running Like a Girl,, about her experiences of running (which I found really inspiring as someone who is not remotely sporty but who has discovered an unexpected love of running – albeit very slowly…).

This article is about her new book Leap In, which deals with swimming and fertility treatment. We learn that she has been through two rounds of treatment, one of which resulted in a positive pregnancy test followed by a miscarriage. There is always a feeling of connection when you read about someone going through fertility treatment – we all understand something that others never really can – and I found her article incredibly moving. She talks about her changing feelings as she goes through the unsuccessful treatment and miscarriage, about how she feels betrayed by her body and rejects it. Describing all this through a focus on swimming somehow makes it an even more powerful read. When she talks about the “sort of breathlessness, almost a vertigo” that comes over her when she thinks about never having a child, she captures in just a few words the vast hollow emptiness and fear which are so familiar to many of us.

I’ll be posting a book review soon, but in the meantime, do read the article.

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 

Other people’s fertility treatment

laptop-computers-1446068-mThe Internet can be a fantastic resource when it comes to finding out more about fertility and treatment, and many people gain important insights by reading other people’s fertility stories online. This can, however, have a less helpful side. Although it may be useful to get practical tips, to read about what happens during a cycle and to feel that you are more prepared for what is about to happen, it is also vital to remember that everyone’s treatment is different. The tests carried out, the protocols used, the drugs prescribed can all vary depending on your own individual situation.

Recently I’ve been contacted by a few people asking about their treatment who have become worried that something might not be right because they’ve come across other people who have had different tests or treatments – or who have been prescribed different drugs at different doses. Just because your treatment is not exactly the same as someone else’s, that doesn’t mean it is wrong or less likely to work. If you have concerns, you should never worry about asking at your clinic, but remember that fertility treatment is always tailored to an individual to some degree and that clinics may not all do everything exactly the same way.

Fertility funding schemes

unknown-6I’ve come across quite a few mentions of fertility funding schemes recently where you pay a lump sum and are then offered your money back if you don’t get pregnant. Of course, the usual criticism of these schemes is that they are only available for younger women who are most likely to get pregnant. So I was interested to read of one recently which was apparently open to women of all ages with no age cut off. However, reading further down the article, it was apparent that actually although there wasn’t an official age cut off, women did have to pass a “screening” – and it is highly likely that by their mid forties, very few women would pass such a test.

These schemes can seem a great option – but it is important to understand their limitations as they are not open to everyone.

Can you ever stop plans to cut IVF

images-10If there are plans afoot in your local area to reduce the number of IVF cycles offered to those who need treatment, or even to cut treatment altogether, you may be left wondering whether there is anything you can do to make a difference. Although there are sometimes public consultations when funding is due to be cut or reduced, it can be tough to have the confidence to put forward your point of view – and sometimes it may start to seem as if there is very little point anyway as people wonder whether those who commission treatment are really listening.

This excellent piece from Bionews written by Richard Clothier tells how he fought back against planned cuts to fertility treatment in his local area. It’s a great read – and you may be surprised by the outcome.

Expert opinion on treatment add-ons

If you’ve been unsure who to believe about fertility proline_level_measurement_in_eurasian_national_universitytreatment add-ons, you may be interested in some impartial and expert advice in two new scientific opinion papers published by the Royal College of Obstetricians and Gynaecologists (RCOG). They call for more high quality research into the role of natural killer cells in fertility and the effect of endometrial scratching on pregnancy outcomes.

Scientific Impact Papers (SIP), are up-to-date reviews of emerging or controversial scientific issues. The first paper looks at the role of uterine natural killer (uNK) cells, how they are measured, the role of testing and the evidence behind any links to improving implantation rates and early placental development. The paper clarifies that uNK cells are completely different from peripheral blood natural killer cells (which you would be testing in the blood tests some fertility clinics currently offer).

The paper makes it clear that there is no evidence to offer routine tests for NK cells as part of fertility treatment or testing, and that there is uncertainty about how NK cells are measured and reported. The paper says that treatment for raised levels with intravenous immunoglobulin (IVIg)  is not supported by the current evidence and, since it may have serious adverse effects, should not be used..

The second opinion paper explores the effect of endometrial scratch on pregnancy outcomes in women who have experienced recurrent miscarriage and recurrent implantation failure.

Endometrial scratch is a procedure which is hypothesised to help embryos implant more successfully after IVF/ICSI and involves scratching the lining of the womb.

Several studies have examined the impact of endometrial scratch in the cycle preceding an IVF treatment cycle in women with recurrent implantation failure, which appear to provide convincing evidence of benefit of superficial endometrial scratch in improving the implantation rate in this group of women. However, the effect of this treatment on pregnancy outcomes in women who have experienced recurrent miscarriage or those undergoing their first IVF cycle is uncertain.

Professor Adam Balen, Chair of the British Fertility Society (BFS) and spokesperson for the RCOG, said: “These two papers look at the current available evidence which exists and give much-needed guidance to both healthcare professionals and the public on these two topics. It is important that patients receive full information about treatments, the current evidence for benefit and whether there are any side effects or risks associated with it.”

Mr Mostafa Metwally, Vice Chair of the RCOG’s Scientific Advisory Committee added: “There is currently no convincing evidence that uterine natural killer cells are the cause of reproductive failure. Despite this, a number of women are requesting and being offered analysis of either peripheral blood or uterine killer cells and the value of these measurements remains controversial. Current evidence suggests that endometrial scratch may benefit women with recurrent implantation failure and therefore defining the optimal number of previously failed embryo transfer cycles needs to be evaluated in large cohort randomised prospective clinical trials.We still do not understand the mechanism by which endometrial trauma may lead to improvements in IVF outcomes in women and further studies are needed looking specifically at its success among women undergoing their first IVF cycle.”

The papers are available here:

The Role of Natural Killer Cells in Human Fertility

Local Endometrial Trauma (Endometrial Scratch): A Treatment Strategy to Improve Implantation Rates

How to handle Christmas when you’re trying to conceive

juletraeetIt’s that time of year again and it can seem as if you can’t escape images of cheery happy families whatever you do and wherever you go.  Christmas is always a difficult time for anyone trying to conceive when it can feel as if everything conspires to remind you of what you don’t have – and of course, the festival itself is all about celebrating a very special birth.

I know lots of people offer lots of different advice about how best to get through the next few weeks, but I think the bottom line is that you need to try to find a way to make the Christmas break an enjoyable or rewarding time for yourself. It isn’t easy if you end up with dozens of invitations to family parties or child-focused events, but don’t forget that this is your holiday too and your top priority should be looking after yourself.

Christmas is meant to be a time of giving, and sometimes we assume that means that we need to put what others want and need ahead of what we might want and need ourselves – but actually sometimes that’s not the best thing to do. If you know you are going to spend a miserable afternoon at your friend’s Christmas party surrounded by the friends she’s made at her daughter’s nursery school who all want to discuss how to get children to eat broccoli and which is the best local primary – and who will all ask whether you have children yourself – it’s really quite acceptable to make an excuse not to go and just arrange to see your friend at another time over the Christmas period.

This is true of any events over the holiday period. Try not to feel guilty about making an excuse if you need to. Sometimes other people may not seem to understand, but there’s nothing wrong with being honest and saying that actually you would just find it too painful if you feel able to do that. Otherwise, you can always make an excuse – at this time of year, there are often so many things on that it’s very common to be double-booked. Don’t feel you have to do things that you know will make you feel upset and unhappy just because it’s Christmas.

If Christmas makes you feel lonely, never forget that there are 3.5 million people across the UK having difficulty getting pregnant – and it may be that your neighbour or colleague is experiencing exactly the same feelings.

Think carefully about the things you would like to do – an adults drinks party, a trip to the theatre or cinema and maybe you’d like to celebrate in your own way and do something completely different whether that’s a Christmas trip somewhere completely different (IVF-diminished funds permitting), a long seaside walk, tapas for two at home for Christmas lunch or a Christmas Day film marathon. You could consider doing something completely different, perhaps volunteering with an organisation like Crisis which provides Christmas for homeless people or Community Christmas which provides celebrations for isolated elderly people – in London, another option is Whitechapel Mission but there are similar schemes across the UK.  It really is up to you what you want to do, and you don’t need approval from anyone else. Do something that will make you feel good and that you will enjoy – and most importantly, try to have fun.