Single women and IVF

I went to Sky News this afternoon to do an interview about the increase in the number of single women having IVF treatment – it seems it has doubled since the change in the legislation requiring clinics to take account of the “need for a father”, replacing it with the need to take into account the need for “supportive parenting”.

I don’t know why this is such an issue – is it really surprising that single women are taking matters into their own hands if they know they want children, aren’t with a partner and are mindful of their biological clocks?  We’re forever telling women not to leave it too late, and this is advice this group of women have clearly taken to heart.

What’s more, the “huge” increase we are hearing about is tiny in real numbers – in the last year for which there are figures, there are likely to be no more than 150 IVF babies born to single women, and they make up just 2% of those having IVF.

I interviewed a number of single women who’d had fertility treatment when I wrote The Complete Guide to Female Fertility, and the one thing that struck me was how carefully they had thought through their decision. Any single woman having IVF would be expected to see the clinic counsellor and staff would take into consideration the welfare of any future children before agreeing to go ahead with treatment. None of this is something anyone would enter into lightly.

It’s also important to keep this in perspective – our society has changed hugely in recent years and a quarter of all families are now headed by a single parent.  The number of IVF single parents is a teeny drop in this ocean. This didn’t stop Josephine Quintavalle of the group Comment on Reproductive Ethics describing the fact single women were having IVF as “disgusting” in the report which preceded the interview I did.  If the best those against IVF for single women can come up with is the suggestion that the the birth of a long awaited, very wanted and loved baby is “disgusting”, I think they’re doing a pretty good job of alienating the vast majority of the population.

 

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.

 

Another new technique to increase IVF success

I was on Sky News with Allan Pacey of the British Fertility Society this morning discussing endometrial scratching. It’s a technique that has been used in some UK fertility clinics for a while now, and involves scratching the lining of the womb before embryos are put back during an IVF or ICSI cycle. At the moment, it is most often used when women have good quality embryos but treatment hasn’t worked, and it seems to improve implantation,

Today’s story was based on a paper being delivered at a conference called the World Conference on Ultrasound in Obstetrics and Gynaecology by researchers from Nottingham and Brazil which found a large increase in IVF and ICSI success using the technique. It is a promising study, but what we don’t yet know is whether this could be replicated on a larger scale with a wider group of patients.  The average age of the patients in the study appears to be 32, which is an age at which IVF/ICSI  is more likely to be successful – and at which egg quality is likely to be better.

Of course, any steps to further increase IVF success should be welcomed, but being invited to discuss the study on Sky News today, all I could think about was how difficult it is to be a patient facing endless headlines about new research or new techniques which are about to revolutionise the world of assisted conception.  As I’ve said here before, there’s often a big gap between research and reality.  In this case, that’s not quite the case as endometrial scratching is already being offered in the UK – but it’s how and when it is offered that is so crucial.

I did a completely unscientific trawl of clinic websites this morning, and discovered that most were offering it when treatment had been unsuccessful – but the price ranges were fascinating.  We’re being told that this is an inexpensive procedure and one clinic was performing it at no extra charge at all (during an IVF/ICSI/FET cycle where the embryos were good quality but two previous cycles had been unsuccessful), most were charging around the £100 rate and I found one billing patients just shy of £400.

It’s embryo quality which is the other sticking point here. It seems that this technique has a lot to recommend it where there are good embryos, but in women whose fertility is affected by their egg quality (which is predominantly older women) this process may not make the same sort of difference.

So, in conclusion – yes, do ask your consultant about endometrial scratching but do be guided by his or her views on this. It’s a technique which may help many women, but which may have less to offer to others.  And, as always, more research is needed…