Could endless IVF cycles be a thing of the past?

A pioneering new chromosome counting technique could put paid to endless IVF cycles.

Microarray CGH (comparative genomic hybridisation) is used to check for any significant abnormalities present in the chromosomes of the embryo before implantation in IVF treatment.

A small number of cells are removed from the growing embryo five days after fertilisation and the DNA in them is scanned for any clear problems.

The results are available within 24 hours, which allows the maximum information to be obtained from the embryo before it is used.

Armed with this knowledge, doctors can then ensure that only embryos with the correct number of chromosomes are transferred in IVF, thereby improving the chances of a successful pregnancy and reducing the likelihood of miscarriage or Down’s syndrome.

Read more on this story here

New hope for women at risk of miscarriage

Great to read this latest piece of news in today’s Irish Times:

WOMEN AT risk of miscarriage are becoming pregnant following treatment with an inexpensive intravenous infusion, a major fertility conference in Dublin has heard.

A new study carried out by Care Fertility in the UK has shown that use of the special infusion resulted in 50 per cent positive pregnancy tests in a group of women with recurrent embryo implantation failure following IVF.

Dr George Ndukwe, medical director of Care Fertility, told the Fertility 2011 conference in Dublin that 20-25 per cent of women trying to have a baby could have faulty immune systems.

“Every day in my clinic, I see women who have endured numerous IVF cycles, all with the same negative outcome,” said Dr Ndukwe. “I also regularly see couples who have suffered the misery of repeated miscarriage.

“We are devoting our attention to finding answers when nature goes wrong. This infusion is inexpensive, well tolerated and easy to administer.”

The average age of the 50 women in the study was 37 and the mean number of failed cycles was six. A matched cohort of 46 women who had no therapy had a clinical pregnancy rate of just 8.7 per cent compared with 50 per cent.

“Previous studies had treated the condition with Humira, a drug used in the management of rheumatoid arthritis. Humira is expensive [a prescription costs up to £2,000], it has risks and is unsuccessful in about 20 per cent of patients, ” Dr Ndukwe said.

He found that intravenous Intralipid was more effective, and cheaper at £200. Intralipid is a fat emulsion containing egg extract and soya oil, used for patients requiring intravenous feeding

Fertility method raises pregnancy rates

From today’s Irish Times comes a report about a new assisted reproductive technique which analyses embryonic chromosomes is significantly increasing pregnancy rates in couples struggling with infertility, particularly older mothers.

The Fish technique, developed at the Institut Marquès in Barcelona, is now being applied to Preimplantational Genetic Diagnosis (PGD) to analyse all embryo chromosomes in a single cell and to identify which embryos derived from invitro fertilisation are healthy enough for transfer to the uterus of the woman.

Click to read more

How can you judge me?

If I’m learning one thing through this journey, I am learning how judgemental and self-righteous people can be about our decisions to undergo fertility treatment.

I have just returned from a trip to the US and while checking e-mails and reading some online newspapers in the airport while waiting for our homebound flight, I came across some of the most upsetting comments online I have heard to date. All the way home across the Atlantic, the words burned in my brain and the level of vitriol tore at my heart.

The article I read concerned American E! News host, Giuliana Rancic and her decision to undergo IVF treatment. The 36-year-old television presenter speaks about the realities of the arduous process, undergoing up to 63 injections a month as part of the fertility treatment, and a miscarriage that she suffered.

Now I wouldn’t be the biggest fan of her or her reality TV show Guiliana and Bill, but as always my sympathies lie with anyone going through this heartache. What shocked and dismayed me were the comments online afterwards – almost to a man/woman the comments all said how she deserved this pain as it was self-inflicted and representative of  a self-centered desire to ‘spread her genes’  and that she needs to face up to the fact that her genes weren’t just meant to replicate. This judgement of course they also apply to anyone undergoing the same process.

While I absolutely respect the right to everyone to hold their own opinion, I am dismayed by the level of self-righteous judgment and the nastiness of some of the comments. I wonder how many of these commentators are childless? And was their desire to have children not self-centered too? Isn’t that the nature of having children –  an innate biological desire to replicate their own genes?

I wonder how many of these commentators have gone month after painful month wishing, hoping and praying for a positive pregnancy test? How many have experienced a miscarriage? How many know what it feels like to long to hold yours and your partner’s child in your arms? To marvel as you gaze on that little bit of you, and that little bit of me in their face, their gestures, their look? To nurture that baby, watch and guide it as it grows? And how many of these people can honestly say hand on heart, that if they were faced with childlessness, they wouldn’t make the same very same decisions in the end?

So please people, some compassion here. We all walk a hard life at times, with or without children – there is pain along the way. Let’s not judge each other, for unless we’ve walked in each other’s shoes, we have no idea what we would have done in similar circumstances.

A new direction for fertility in Ireland

I am so excited about today’s post for several reasons. Firstly, I haven’t blogged in quite some time and I wanted to wait until I had something positive to write about before I did again. Secondly, I am excited to introduce you to two professionals who I sincerely believe will make a difference to fertility in Ireland.

Aisling Killoran of Accomplish Change Clinic is a certified Hypnotherapist and Psychotherapist specialising in helping mums and dads conceive.  She follows the unique HypnoFertility™ programme which is a multi-faceted hypnotherapy programme used to help and support and facilitate natural conception and the medical process for women undergoing IVF, IUI, ICSI, and other medical procedures. This is a powerful, precise programme that supports the entire fertility process and is tailored for each individual for optimal health and wellbeing.

While Aisling can’t promise you will get pregnant, I can personally testify that what she can do is help you to achieve the best state of mind/body connection conducive to pregnancy.  I wouldn’t hesitate to recommend Aisling to anyone who is looking for a holistic approach to fertility.

And speaking of holistic approaches, Aisling has written a post this week on her blog about ReproMed Consultancy Services, a Fertility Clinic in Sandyford, Dublin that is worth blogging about. This service is run by Mr Declan Keane, Consultant Embryologist, with 18 years clinical experience and who is licensed/accredited by the Irish Medicines Board, UK Health Professions Council and European Society of Human Reproduction and Embryology as a Senior Clinical Scientist.

Aisling met with Declan, earlier this week and on her blog she writes that she found him to be “a genuine sincere man full of integrity and passion in helping couples to conceive.” I confess to knowing a little about the man myself, as three years ago, he helped me produce a patient information booklet on breast cancer and fertility and he was wonderfully helpful then. Anyway, I got my own chance to speak with Declan yesterday and I share Aisling’s views. I too am impressed with his patient-centred approach and believe he is going to make a real difference to couples looking to conceive in Ireland.

If you are interested in learning more, check out Aisling’s blog, which incidentally is updated regularly with some great posts on trying to conceive.

Egg screening boosts IVF success

Doctors at an annual US fertility meeting heard for the second year running of the merits of a test that screens embryos for genetic faults. So far more than 20 babies have been born using the technique. The UK researchers say they are now able to back the method with “great confidence”. They hope it will eventually be available to all. Currently, it is offered in a few private UK clinics. Doctors believe the £2,000 test, called comparative genomic hybridisation or CGH, will be particularly useful to older women, whose embryos have a greater risk of carrying genetic errors that cause conditions like Down’s syndrome. 

 The screening checks chromosomes in the developing embryo when it is a few days old, meaning only those embryos with the best chance of success are used in fertility treatment. Dr Dagan Wells from Oxford University, who led the study, described the latest results on 115 women – six times as many as last year – as “astonishing”. The results are particularly impressive as many of the women were on their “last chance” at IVF – they were typically aged 39 with two failed IVF cycles behind them.

In total, 66% of the women fell pregnant after screening – more than double the number (28%) who typically fall pregnant without it. Dr Wells told the American Society of Reproductive Medicine’s annual conference: “We were taken aback by the impact it had on the success rates. “I think it’s at the point now that we can say with great confidence that we are seeing a positive effect of this.” Around 37,00 women undergo IVF every year in the UK and less than one in four of these procedures is successful.

Allan Pacey of the British Fertility Society said: “Embryology is really crying out for something like this. “We really haven’t moved on from the science of just looking down the microscope and seeing if an embryo looks good on the basis of some rather loose criteria.”

Susan Seenan, from Infertility Network UK, said: “We welcome all new research which may ultimately improve the success rates of IVF for patients. “Although this is still in very early stages, it could be of great benefit to older women whose chances of success with IVF treatment is lower and it is also welcome given the move towards single embryo transfer in the UK and the lack of NHS funding which often, unfairly, means that patients are being denied access to the three cycles which the NICE guidance recommended in 2004. “Improvements in success rates are always important but even more so where patients are receiving only one, or in some cases, no NHS cycles, and we look forward to seeing if further research confirms these results.”

Source: BBC

Infertility: the last great taboo

I was reading the Irish Times today and in the health supplement this headline stood out: “Infertility:the last great taboo”.

Leaving aside the fact that a lot of things are supposedly the last great taboo, there is certainly a lot of truth to the taboo aspect. We just don’t talk about it  freely in society. Because it is such an emotive subject, many couples find it difficult to discuss what one writer has called ‘the baby-shaped hole in their lives’.

Without a doubt it is the last great taboo, says Prof Robert Harrison. “No one speaks of it. Maybe a woman will talk to a close friend if she’s worried. But it is such a private issue. It’s one even close friends won’t ask about. It goes right to the heart, I suppose, of who we are as adults and why we get together.”

To be infertile gives rise to feelings of failure, of sexual dysfunction. Author Martina Devlin, who has written of her own experiences of infertility and unsuccessful attempts at treatment, said on the issue last week: “It leaves you with a big R’ stamped on you, for rejection.”

Speaking at the publication of two reports by the Women’s Health Council (WHC) on issues surrounding infertility, Devlin spoke of the mourning couples did “behind a wall of silence”.

“There is so much grief and exclusion and disenfranchisement.”

Since she wrote about her infertility some years ago she is still regularly approached “mainly by women”, she said. “They look happy and glossy and as if they have everything they want in life, and they just want to talk to someone about the baby-shaped hole in their lives.”

It was a testament to how hidden and unspoken an issue infertility was that people were willing to talk to a stranger about such a personal issue, she said.

“Society in general fails to comprehend what it’s like to be childless. People feel it’s tactless to say anything to people they suspect may be struggling with infertility. People stay silent.”

It’s not surprising then that a couple, worried they can’t get pregnant, feel utterly ill-equipped to know where to start, what treatment to seek, how long it will take, the financial and emotional toll it will exact and, indeed whether they even should seek treatment at all.

Infertility affects one in six Irish couples. It was defined by the World Health Organisation in 2001 as “failure to conceive after at least one year of unprotected intercourse”.

Studies indicate 80 per cent of couples having regular intercourse will conceive within a year and 70 per cent will have a baby.

Factors such as age and health will play a role and older couples should probably not wait as long as a year before seeking help.

Harrison, obstetrician, gynaecologist and founder of the Human Assisted Reproduction unit Ireland (Hari) at the Rotunda Hospital, Dublin, has written a book The Smart Guide to Infertility , to help couples.

Now retired from Hari, he says there is a particular pressure in a Catholic, family-oriented culture such as Ireland’s, to have children.

“There is pressure here and in Arab cultures. Children are seen as the natural next step after a couple have got together and stayed together for a number of years.”

The only published survey of couples affected by infertility in this country, a 2005 study of 129 such couples by the National Infertility Support and Information Group (NSIG), found 87 per cent of them felt under pressure to have children.

It also found 63 per cent felt unable to discuss their infertility with family and 58 per cent were unable to discuss it with any friend, pointing to the isolation many couples feel.

Such findings underline, says Harrison, how important both counselling and accurate information are for any couple considering fertility treatment, given the lack of any in general circulation.

“Any couple’s first port of call should be their GP and they should let the GP know in advance what the consultation is about. These consultations take time.”

In the Hari unit, he says, there is great emphasis on counselling at the beginning and throughout the whole process. The fact that couples feel under social pressure to have children is an important issue, he says.

“The counsellor will work out whether the couple is ready or suitable for treatment, and indeed for children.

“Infertility is a couple’s problem. My book stresses that. It is so important. It is not a woman’s issue or a man’s issue, and both in the couple must be dedicated to wanting to have a child.”

He says the journey of treatment can be so long and stressful that couples can only hope to get through it if they are well prepared for – and prepared to – go through it.

Though many will associate fertility treatment with in vitro fertilisation (IVF), the book is an encyclopedic testament to the fact there is much more to it.

Harrison says IVF is likely to be the last course embarked on. There will be investigations of both the man and woman and the answer may lie in simply taking medications to stimulate ovulation in the woman, or sperm production in the man. Tubes may simply need to be unblocked.

“However, answers are not always clear cut and responses to therapy may be unpredictable and disappointing. No guarantees may be given,” he says.

A fact many couples seeking help must face is that infertility is not always “fixable”.

“It is a sad fact that even with today’s advances one in 20 will be consigned to a meaningless non-diagnosis of unexplained infertility.”

Just one in three couples who embark on IVF will be successful, he points out, and the odds decrease as the woman in particular gets older.

An area often forgotten is how difficult it can be for some couples to decide not to continue with treatment.

“You go in with such high hopes and if after three cycles of IVF and still there’s no baby, some couples might want to try another clinic or another treatment. It must be so difficult. I almost feel it’s like cancer treatment at that point.

“You have to weigh up the costs in terms of money, time and psychological toll, as against the quality of life issue.

“There is a quality of life to be had out there without children. I know that is easy for me to say who has children, but to find you are continually banging your head off a brick wall, without success, it must be soul-destroying.

“I think help is so important for couples in that position. It can become a millstone around your neck and people can isolate themselves, avoiding friends who have children.

“If treatment is unsuccessful you have to learn to accept and live with it. Losing the hope of a baby is like losing a loved one.

“The pain never fully goes away, but you take it on as part of who you are.”

Successful couples also need counselling. Pregnancies as a result of fertility treatment tend to be much more stressful he says, as the couple are more nervous about such issues as miscarriage and other problems.

Asked about the absence of legislation regulating the 10 fertility clinics in the State, he says it is “appalling” that the 40 recommendations made in 2005 by the Commission on Assisted Reproduction have not been acted upon.

Ireland is one of three EU states with no regulation of infertility services. The others are Poland and Romania. The only guidance available to clinicians are the Medical Council’s ethical guidelines, published in 2004.

He understands the Department of Health is drawing up guidelines but not legislation. The obstacle holding things up, he believes, is an awaited Supreme Court judgment on the fate of frozen embryos. “I think they really need to grasp the nettle and make a decision.”

Devlin, in her remarks during the week, spoke of her frustration at delays in legislation.

“It’s too important to leave it to individual clinics to self-regulate. There is a lot of talk about the protection of embryos. Well, the adult human beings need protection too.

“Infertile people already feel second-rate, feel substandard. Don’t let society institutionalise this. Don’t let’s continue to look the other way, in silence.”

IVF: three misses and you’re out!

So screamed the headline on the front page of today’s Sunday Times. Not having any personal experience of IVF I cannot comment on this article, so I would love to get your opinions on it.

The  basic tenet of the article is that the Women’s Health Council (WHC) of Ireland has said that infertile Irish couples should not be allowed an unlimited number of attempts at in-vitro fertilisation (IVF) because it is rarely effective after the third cycle and takes a huge toll on their mental and physical health.

Geraldine Luddy, the WHC director, said: “It’s a sad situation. Some people who are infertile would go to any lengths. Therefore it’s important that they have a way out of these treatments and that there is support and counselling for them. After a couple of attempts it might be time to let the reproductive technology end of it go.”

Last week the WHC launched two reports on infertility saying it is “a medical and social condition that often causes significant pain and distress to couples and which many people go to great lengths to overcome”.

It said that it was as stressful as divorce and death in the family, yet because of the stigma and shame attached to infertility it is the “last taboo” in Irish society.

At present fertility clinics are unregulated in Ireland, despite a report five years ago recommending that an authority be set up. As a result there is no limit to the number of times a couple can undergo IVF. Clinics do not have to report success rates, making it difficult for couples to choose where their best chances lie.

So what do you think? Is it time we regulated fertility clinics here in Ireland? Should couples themselves determine how many attempts at IVF they wish to try or are they just been offered  false hope and a drained bank account after the third attempt? I would love to hear your views.

Criticism over delay in licensing infertility clinics

A STATE agency promoting women’s health has criticised the delay in licensing infertility clinics that have been providing services in Ireland for over 20 years.

The Women’s Health Council (WHC) said Ireland, Romania and Poland were the only countries in Europe not to have legislation for clinics offering assisted reproductive technologies.

Infertility affects one in six couples in Ireland and the WHC said demand for infertility treatments was likely to increase with couples delaying parenthood to pursue career and financial security and as obesity and sexually transmitted infection rates increase.

Latest figures show that the number of babies born as a result of in vitro fertilisation (IVF) has more than doubled from 135 to 301 in 2005.

The WHC, who launched two reports on infertility and treatments yesterday, warned that the cost of one IVF cycle was €7,000, with fertility drugs costing up to €3,000.

Director Geraldine Luddy said the Department of Health was drafting guidelines for regulations and the expected judgment in the R v R frozen embryo case would also be taken into account when drafting legislation.

Ms Luddy said it was presently impossible for couples to compare the success of clinics as data was collected in different ways. “They will tell you the successful pregnancies they have, but not the births,” she said.

Less than a quarter of couples who undergo treatment will have a baby, with success depending on patient age, weight, pregnancy history and IVF procedures.

The WHC believes that regulation would curb any commercialisation of Ireland’s 10 privately run infertility clinics and enable the implementation of best practice guidelines.

Regulating the clinics would also support the gathering and publication of statistics in terms of services provided and outcomes.

It also pointed out that the unresolved legal question of the embryo had practical repercussions for service providers and might also negatively affect patients’ emotional and psychological wellbeing.

The WHC said there was no legislation to cover egg and sperm donations that was being dealt with on a case by case basis in the courts.

Director of the Merrion Fertility Clinic in Dublin, Dr Mary Wingfield, said recent figures put the number of babies born every year in Ireland as a result of IVF at around 3,000.

She pointed out that there was no upper age limit on infertility treatments and said that was a huge problem. “It is very difficult to discuss because we do not want to feel we are blaming women,” she said.

Dr Wingfield said a woman’s fertility began to decline at age 35 and fell dramatically after the age of 38.

 Source: This story appeared in the printed version of the Irish Examiner Thursday, September 24, 2009

Is this Fertility Plan an alternative to IVF?

Tidying out a drawer today, I came across an article I had cut out from a Sunday supplement in July. I was interested to read it at the time, but not ready to learn more as I was still in the throes of dealing with my recent miscarriage. Returning to it again today, I intend to follow up the article and see if there might be anything in it. I am particularly keen as I am desperately hoping I may still be able to conceive again naturally.  Because of my cancer history, I would not feel confident hyper-stimulating my hormones with fertility drugs. I think it’s wonderful for women who do conceive with IVF but for me, it is not an option I feel is safe for me to explore.  Have a read of this article and let me know what your thoughts are.

Dr Sami David, a doctor involved with the first-ever successful IVF procedure in New York 30 years ago now believes that half the women who undergo IVF do not need but could get pregnant naturally.

David has turned his back on what has become a multimillion-pound industry with a vested interest in rushing women into assisted conception. “Infertility is a symptom, not a disease,” he says, “yet most fertility doctors are only interested in giving a woman drugs and getting her on a course of expensive, and stressful, IVF as soon as possible. I’m not against IVF — far from it,” he continues. “But it shouldn’t be the first thing we turn to as doctors. Putting a woman on aggressive drugs to stimulate egg production is a waste of time if, in fact, she is failing to get pregnant because her partner has a low sperm count, or she has an infection.”

David claims that most specialists have little interest in doing the necessary detective work to establish why a couple aren’t conceiving. Together with Jill Blakeway, an alternative-health practitioner who moved from the UK to America 20 years ago, he has written The Fertility Plan, a three-month scheme that helps women overcome common blocks to pregnancy. The book offers targeted advice according to five different “types” of people. “The types are loosely based on Chinese medicine, combined with Dr David’s clinical experience,” says Blakeway, who has such a high success rate that The New York Times dubbed her “the fertility goddess”. “I didn’t want to bog people down with the more esoteric aspects of eastern philosophy,” she adds, “so I’ve kept it simple.” The five types are: stuck, pale, waterlogged, dry and tired; there are quizzes and guidelines to help identify your type and what to do in each case. It’s all refreshingly simple.

“IVF is part of our quick-fix society, particularly in New York,” says Blakeway. “We are used to life being convenient, to having stuff delivered on demand, so a woman might think: ‘When the time comes, I can always go for IVF.’ Making babies is a much more mysterious thing — you can’t think like that.” She is also keen to remind women that IVF still has a relatively poor success rate. “At one of the most renowned New York clinics, figures indicate that among women under 35, the success rate is still only 47%.”

In the book, the duo present a range of common factors that can inhibit fertility, but which doctors don’t always raise. “There are issues from hormones being thrown out of balance by yo-yo dieting, to women who exercise too much, which could lower levels of oestrogen and progesterone,” David says. “Or infertility can arise from a diminished flow of blood to the uterus, which can be dramatically helped by acupuncture.”

Another common cause of infertility is bacterial infection, which has prompted David to remark that antibiotics are his favourite fertility drug. “A lot of doctors specialise in scaring the patient,” he says. “They’ll tell a woman of 37 she’s left it too late and her only option is IVF. But they’re measuring everyone by the same yardstick. Every woman has time to take a three- or four-month evaluation of what’s going on with her body.” Blakeway agrees that the emotional rollercoaster of trying to become pregnant can extract a heavy toll on would-be mothers. “The last thing we wanted to do was make women feel stressed out about not getting pregnant. If it’s not happening for you yet, it’s comforting to bear in mind that there is an enormous amount you can do for yourself”. 

Source: Sunday Times