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.

‘When you lose a child you lose your future’

A repost from last year:

Interesting article about miscarriage in the Irish Independent newspaper. Fiona McPhilips, who has experienced miscarriage and is the author of Trying To Conceive: The Irish Couple’s Guide has this to say:

“No couple expects to be in for the long haul when they start trying for a baby. It is supposed to be a time of great hope and anticipation, when you plan excitedly for your new lives together. It is true that having a baby changes your life, but not having one changes it so much more.”

“I had known how common miscarriage was (approximately one in four pregnancies), but I wasn’t prepared for the onslaught of emotions it would bring. I felt angry, cheated, desolate and so, so sad. Everyone said I could try again, but I wanted that baby, the one that would be born on that due date.

When you lose a child, you lose your future. It doesn’t matter how long your baby has been with you, you feel the gap that their death has left behind. From the moment you know about your baby, you plan their future — your future, together. You work out the due date, pick names, imagine who they will look like. When these hopes and dreams are taken away, it often seems like you are expected to forget you ever had them. I couldn’t forget for one second and I knew that, for me, the only cure for miscarriage was another pregnancy.”

Fiona started a blog originally calling it The Two-Week Wait. “The two-week wait is the time between ovulation and when you can test for pregnancy — that’s how long I expected to be writing the blog for. Well, two weeks came and went, and another, and another and, before I knew it, I had unwittingly documented the slow descent into infertility.” 

I identify with the way in which Fiona dealt with her (dis)stress by writing as it is working for me too. Like Fiona, I wrote on internet message boards after the miscarriage and am writing this blog, and again like Fiona ” I met some wonderful women who listened to my rants and kept me sane..the greatest piece of advice I can give to those battling infertility or recurrent miscarriage is to talk to others in the same boat. ”

“I didn’t know anyone who was infertile, so I could only guess at how hard it might be.  I didn’t have a clue. My guess only extended to the long-term pain a couple might feel about not having a child in their lives. Thanks to television, many people assume that there is a once-off diagnosis that a couple has to deal with, and that they are then free to return to their lives and reshape their future without their much-wanted child. If only it was that easy.”

Much heartache followed Fiona’s miscarriage ” an IUI (intrauterine insemination) yielded success but the baby died at three months gestation. Further IUIs were fruitless, so we moved on to IVF (in-vitro fertilisation). Two IVFs and two further miscarriages later, we were running out of options physically, emotionally and financially. We were lucky enough to conceive naturally twice more, but lost both babies. ” Finally, Fiona conceived a daughter and carried her to term and is overjoyed at this happy ending.

Fiona speaks eloquently of “the cumulative effect of month after month, and year after year, of hope and disappointment….after a while, everything hurts — other people’s bumps and babies, anniversaries of failed cycles and lost babies, and every new birthday, Christmas and Mother’s Day you face with empty arms.”, something I understand and feel only too well.

“There is a huge lack of understanding of infertility in the outside world. It is just not viewed as one of the very bad things in life. A common reaction is, “Why can’t you just be happy with what you’ve got? Focus on all the good things in your life”. When you can’t have a baby, nothing else matters. It is not possible to forget about it, channel your energy elsewhere, take up a hobby. The desire for a child goes beyond the desire for the joy that a child brings — it is a primal, uncontainable urge that overpowers all reason. ”

I will leave the final word to Fiona, words of hope for all you brave women reading this who are experiencing the pain of pregnancy loss and infertility:

“My doctor once said to me, “Brave women are generally rewarded”. There are no guarantees, but it can and does happen — even against the greatest of odds.”

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.

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

Should women do a fertility MoT at 30?

I was reading an article in the Observer on Sunday, which reported on one fertility expert in the UK who recommends that  30-year-old women take a “fertility MoT” test to reveal their prospects of bearing children. “Women do not realise the importance of age when it comes to fertility,” said Professor Bill Ledger, of Sheffield University. “They think, ‘It won’t happen to me, I’m 37, I go to the gym twice a week, I don’t drink, I don’t smoke, I’m fit – everything about me is young’. Well it is, except your ovaries.” He said the solution was for women to take a blood test that could highlight problems in those who wanted children, but had not started trying.

If necessary, women could then opt for a £200-300 ultrasound scan to look for other problems, as well as discussing their medical histories with doctors. Such a “fertility MoT” could act as a reality check for couples who were unaware they were running out of time, said Ledger, who is also a member of the Human Fertilisation and Embryology Authority (HFEA). Testing at 30 would give doctors time to treat any problems.

The call by Ledger – professor of obstetrics and gynaecology at Sheffield – followed a week in which fertility dominated the news, with stories about postcode lotteries for those seeking IVF treatment, and a study revealing that one in eight couples undergoing treatment had their bill subsidised by an average of £5,413 by would-be grandparents.

Experts also claimed that the public’s knowledge about fertility was so limited that an education programme should be introduced in secondary and primary schools.

“Sexual health messages focus entirely on avoidance of sex, but this should be coupled with promotion of fertility awareness,” said Dr Mark Hamilton, the leading consultant obstetrician and gynaecologist at Aberdeen Maternity Hospital. “We should be teaching everyone, from childhood up, about all the factors linked to fertility potential, and how the huge range of things from lifestyle choices to genetic inheritance can have harmful effects on that potential.” Hamilton – a former chairman of the British Fertility Society – said it was crucial to tackle a “widespread misapprehension” about the success rate of fertility treatments. The chances dip sharply with age: from 31% for women aged under 35, to below 5% among women over 41.

However, the average age at which women have their first child has been rising for decades. For married women, it has breached 30, while increasing numbers are waiting until their 40s. However, fertility halves by the age of 35 and declines dramatically after that.

Tony Rutherford, chair of the British Fertility Society, said: “If a woman leaves it late, by which I mean 36, she is taking a gamble. There’s a public health duty for us to ensure that men and women are informed about their fertility potential. At the moment, that’s not the case.”

But Rutherford said it would be risky if women based their decisions on a blood test: “None of the tests give an accurate answer. They are not reliable. You can be fertile at that moment, but you can’t tell what you’ll be like two years on.”

Other critics agreed. Dr Gillian Lockwood, medical director of Midland Fertility Services and vice president of the Royal College of Obstetricians and Gynaecologists’ ethics committee, said: “Someone could be falsely reassured that they have time to wait, when they have an underlying problem that will stop them getting pregnant however good their ovarian reserve is.”

Ledger argued that it would be about more than a blood test. “Maybe doing the test is less important than making them sit down as a couple and talk it through – the test is just a hook to hang it on.”

 

 

Drugs payment scheme and IVF

I am not on IVF but I have been very grateful in the past to have been able to avail of  the Drugs Payment Scheme,under which no individual or family pays more than €100 per month for prescription medication.   I have been following the latest developments with pharmacists withdrawing from the scheme and what implication that will have especially in rural areas. A few weeks ago, in discussion with my husband on his favourite topic of the recession (most certainly not my favourite topic!), I said that the days of the drugs payment scheme  are numbered.  Fiona McPhilips at the Waiting Game, highlights a change in the scheme which will take IVF meds off the list of approved drugs. This will deal a terrible blow to the hopes and dreams of those couples on IVF or planning to go on IVF in Ireland.  It may put those dreams out of reach of the ordinary Irish couples, who are already struggling financially, as we all are, with the effects of the recession.

You can read Fiona’s post here, which also links to a petititon against these cuts.

The world’s oldest mothers

So I watched the Channel 4 documentary on the world’s oldest mothers shown here last Thursday night. If I ever felt like trying to get pregnant at 40 was old, well this made me look like a spring chicken.

It certainly proves one thing, that innate desire and longing for a child never goes away. The documentary was made all the more poignant by the recent death of Maria del Carmen Bousada, the Spanish 69 year old who died of ovarian cancer after giving birth to twins at the age of 67 with the help of IVF. It also raised for me, with my history of breast cancer,  my own concerns over IVF.

Most heartening for me was Mary, in America, who gave birth at the age of 54 to twin girls. Those girls are now 16 and Mary at 60 is so fit that she seems decades younger, water-skiing and pumping iron. The girls adore their mother and they have a wonderful relationship with her.

Most remarkably of all, was the story of Rajo from India, who, after giving birth at the age of 70, became the oldest mother in the world. India appears to be THE place for IVF for these older mothers. 

Rajo’s sister who is a few years younger, and her husband’s other wife (he married the sister when Rajo proved unable to have children but unfortunately for him, the sister was unable to produce the desired heir for him either), is now hoping to undergo IVF. The baby that Rajo gave birth to, is a girl and of course it is the male heir that is the sought after prize in the baby stakes of India…so, the husband must sell some more cattle, and head back to the IVF clinic with his two wives in tow.