Could your ethnicity affect your chances of IVF success?

120px-Pregnancy_test_resultNew research suggests that ethnicity may affect the chances of ending up with a baby after fertility treatment. A team from The University of Nottingham and the fertility unit at Royal Derby Hospital analysed data from the Human Fertilisation and Embryology Authority to see whether ethnicity had an impact on treatment outcomes, and found that there were some significant differences. According to the data, White British women are more likely to get pregnant with IVF or ICSI than women from a number of other ethnic groups.

This is the biggest study to look at the outcomes for individual ethnic groups in this way, and it considered the number of eggs collected and fertilised and the number of embryos produced as well as the pregnancy and live birth rate. The researchers also considered potential reasons for the differences in outcomes for the different ethnic groups and discuss factors such as genetic background, environment, diet, socio-economic and cultural factors and attitudes to medical care and accessing fertility treatment. They also discuss the fact that South Asian women are at higher risk of polycystic ovary syndrome (PCOS) which can affect egg quality and success rates.

You can find out more about this 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.

Fertility research – can you help?

Would you be able to spend a couple of minutes completing a quick questionnaire to help a research team?

They are keen to find out people’s views about time lapse imaging which some clinics are now offering with IVF/ICSI treatment. They want to assess whether fertility patients think a research trial to see how effective this is would be useful. You don’t need to have any personal experience of it but you do need to have had or be going to have IVF/ICSI.

If you have a spare couple of minutes, you can find their questions here –

When ICSI may not be best…

images-6ICSI (intracytoplasmic sperm injection) is a form of IVF that was developed to help overcome male fertility problems by injecting sperm directly into eggs, but in recent years is often used far more widely and sometimes in cases where there isn’t a male factor problem at all. Patients are often told that ICSI improves the chances of success, but a new study from the States has found that this is not the case unless there is a male fertility problem.  In fact, in cases where there is no male factor problem, ICSI is associated with lower rates of implantation and live birth than conventional IVF.

The research was a big retrospective study looking at more than 1 300, 000 IVF and ICSI cycles from 1996 to 2012.  The use of ICSI in the US in this period had gone up from 36% of cycles to 76%, but it was not associated with improved outcomes.

The research is published by the Journal of the American Medical Association, and you can read the full findings on their website –



Should you be buying your IVF drugs at ASDA?

You may have heard about the baby born after his parents bought their fertility drugs cheaply from the supermarket chain ASDA. ASDA say they are selling to patients at cost, and hugely reducing the prices patients normally pay for their fertility drugs.  If your clinic gives you a prescription and suggests you buy your drugs from a pharmacy, it’s always a good idea to shop around and ASDA’s prices do appear to be well below those of their rivals.

Many hospital pharmacies buy their drugs in bulk direct from the suppliers, and so they may also be able to offer a good price for the drugs. It’s worth checking how much your clinic or hospital pharmacy will be charging and comparing this with the cheapest high street price. If you find that it is cheaper to shop at ASDA, then you don’t have to purchase your drugs from the clinic.

With most IVF cycles taking place in the private sector, the bill for drugs can be huge – ASDA say that what is needed for a typical cycle will cost £1,346.34 from them which they suggest is about £800 cheaper than the usual pharmacy price. Of course, every cycle is different and tailored to the individual, so you will need to get a costing on your prescription – but it’s always worth shopping around when it comes to fertility drugs and making sure that you aren’t paying more than you need to.

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…




Anyone going through fertility treatment wants to maximise their chances of success, and you may have heard that opting for ICSI will mean you are more likely to end up with a baby whatever the nature of your fertility problems.  In fact, ICSI is a treatment for male fertility problems which is also used when IVF hasn’t worked in the past because eggs haven’t fertilised.  When it is used in these circumstances, it can increase the chances of success.  There is, however, no benefit from using ICSI for those who don’t actually need it.

 I’ve just been reading a really interesting paper on this in the journal Human Fertility which looked how fertility clinics in the UK approach ICSI and found wide discrepancies with some clinics using it for around 20% of their IVF cycles and others using it in more than 80% of IVF cycles.  The criteria they used to decide when to use ICSI also varied, with many offering it for sperm that would be considered perfectly normal and letting patients to choose whether they wanted IVF or ICSI regardless of the nature of their fertility problems.

 You may feel that it’s up to you to have that choice, but patients aren’t always presented with clear evidence about what ICSI can and cannot do.  Research shows that using ICSI when you have normal sperm doesn’t increase success rates, and in fact there is even some suggestion that it could lead to a reduced chance of success.  ICSI is more expensive and there have been questions raised about the potential risks of the technique.

 For men with fertility problems, ICSI has been a hugely important development allowing many couples to have the children they long for – but it’s not something that should be undertaken as some kind of optional add-on,  If you don’t need ICSI, why pay more money for something which could carry more risk and which will not increase your chances of a successful outcome?  It’s time fertility clinics started spelling this out more clearly to their patients…