Brain Overload

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So much has been going on. Gahhhhh. Our embryo was transferred on Saturday. It was an uncomfortable but bearable procedure. But now my mind is swirling with possibilities, daydreams, hopes, fears… the works!

The good news was that the embryo was really good quality and received a high grading. It was already starting to hatch and the embryologist was very pleased with it. However that doesn’t mean it will work so isn’t particularly reassuring. The bad news is that none of the other embryos were worth freezing which means this is our only shot from this cycle. I’m really disappointed about this as I had hoped we would have a few to freeze so that we had a few chances. Now the pressure is really on. It had all been so promising when we collected 18 eggs but turns out this cycle wasn’t wasn’t very successful.

I keep having to stop myself from thinking about the outcome. Could I be pregnant? After the previous two embryo transfers I remember being certain that I wasn’t pregnant. I felt totally normal. I don’t know what will happen and I will have to wait another week until we return to the clinic to find out the outcome. All I know is that if this doesn’t work I will be gutted. I would absolutely love to have another little one. But at least I am fortunate to have a beautiful baby already. His lovely face will cheer me up and make me feel incredibly blessed if things don’t go how I hope.

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Egg Collection

a follicle.jpgToday was my egg collection and suddenly the whole thing felt very real. To my surprise the nurse, anesthetist and embryologist remembered us and greeted us warmly. The procedure was a fairly unremarkable experience since I was under general anesthetic. One minute I was having a chat with the doctor, the next I woke up in the recovery room and it was all done!

The egg collection was a success and they retrieved 18 eggs. Now we must wait to hear how many fertilised. It is hard not to compare everything to last time. But since our eggs and sperm are 2 years older I don’t suppose the outcome is comparable. However last time I had 16 eggs so already we are in a better position. However it’s all to play for now as there are a multitude of variables which will dictate the outcome.

Tomorrow, and for the next 5 days, I will receive a phone call with updates on the progress of the embryos. All being well we will have a few that make it to blastocyst stage, one of which we can transfer in 5 days time. The waiting begins.

Mothers Over 40

Portrait of a beautiful middle aged pregnant female smiling on the couch

The debate surrounding the fertility of older mothers has raged on in recent weeks. Enough now, we get it! Yes, delaying motherhood can be catastrophic as fertility plummets after 39. However as Robert Winston, the IVF pioneer and broadcaster, pointed out at The European Society of Human Reproduction and Embryology’s annual conference in Lisbon, there are also benefits of delaying having a baby. Lord Winston said older mothers, who have had time to gain skills and education, as well as build strong relationships, can provide children with a more stable upbringing. So concerned are we to point out the negatives that we fail to notice that there are also positives to being a more mature mother. Women of 40 and upwards have a plethora of reasons for delaying motherhood. Whether it is due to demanding careers, further education, financial circumstances or relationship stability, some women have been in the position to have children earlier. Berating them is not constructive. The press has ensured women are aware of the facts so instead of fear-mongering maybe it is now time to support and learn from women who have left motherhood till later in life.

Right Place, Right Time

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For the first time a new test has been developed that tailors the timing of IVF treatment to a woman’s individual cycle. The scientists behind the technique believe that IVF frequently fails because the embryo is transferred at the wrong time, missing a crucial fertility window. The new test pinpoints a woman’s optimum time for treatment and in pilot studies the approach significantly boosted success rates.

There are more than 60,000 IVF cycles in Britain each year, but just 24% of these treatments lead to live births. Clinics currently check the visual appearance of the womb lining using ultrasound, giving a general indication of health. In the pilot study, the test was given to 85 women who had each experienced on average five rounds of IVF that had failed at the implantation stage. When the gene analysis was used as a guide, 33% of those treated had a successful implantation simply by just changing the day.

Nick Macklon, professor of obstetrics and gynaecology at the University of Southampton, believes that issues linked to the womb lining explain around two-thirds of cases of recurrent implantation failure, with around one-third of cases being due to embryo abnormalities. He asserts that these tests could significantly improve success rates.

The Real Cost of Infertility

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This week, at the fourth and final session of the Progress Educational Trust’s annual conference Professor Lord Robert Winston did not shy away from controversial infertility topics. His talk looked at infertility’s true costs – to society, to families and to women.

He talked about the infertility experience – how it affects individuals and couples, not only medically and physically, but emotionally and in terms of relationships.

Infertility, he said, is misunderstood by the health service – it is seen as a disease that needs treatment. Doctors in other specialties view the infertility procedure as bizarre – no-one reaches straight for coronary surgery when there’s a pain in the chest, he said, as that can be caused by many things. However, when someone can’t have children, the treatment is IVF. Most of the time, he says, there is no serious attempt to make a clear diagnosis of the problem – and this can leave patients ’empty-handed’, both in terms of their finances and their chance of having a child. In what he called a ‘chronic problem’, one of the worst aspects of the health service, which he views as ‘incredibly badly run, for a long time’ is the ‘maternity market’.

He also estimated that IVF cycles could be provided for less than £1,000: ‘IVF should not cost the kind of money that is currently being spent’. Where are the regulators in all this, he asked? He went on to describe it as a ‘bleak picture of poor diagnosis, misdiagnosis and selling of uncharted treatment’.

When asked about clinics in the UK who have partnerships with clinics overseas Lord Winston said it can’t be regulated and neither can other treatments which patients go overseas to get because they are not legal here. He mentioned the Fertility Show, held in November in London, where stands advertised things such as sex selection, not available here. He also pointed out that overseas clinics can advertise on the London Underground things that if they were UK practitioners would be illegal and have them struck off the medical register. These ‘loopholes’ are dangerous, he said, and he believes the Human Fertilisation & Embryology Authority should intervene.

None of this is new but it shows that the world of infertility is not well regulated and the true cost on patients is immeasurable. What do you think?

I Hate To Sound Smug

Pregnancy-Massage

I really I don’t want to be smug and offensive to all you ladies who are desperate to be pregnant. I have been you. I know how shit it feels. I also know how it feels to lose a pregnancy you have worked so hard for. So please don’t begrudge me mentioning the milestone that is reaching my 3rd trimester. I am so thrilled to be at this stage and now I am feeling increasingly, yet cautiously optimistic, about actually having this baby.

We had a scan this week. It was wonderful to see the baby looking bigger and we had some amazing 3D images of the baby. We have now been discharged from Fetal Medicine. The doctor said goodbye with the words ‘see you during your next pregnancy’! Woah.

Here’s too a quick and uneventful 12 weeks.

Fertility MoT

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According to yesterday’s press busy city workers are to be offered £200 fertility ‘MoTs’ during their lunch breaks. The one-hour test will assess women using 3D ultrasounds and blood tests, while men will be offered a detailed analysis of their semen for £90. Up to 4,000 IVF cycles will also be offered each year by the Create Fertility centre, which opens in London later this month. Professor Geeta Nargund, who founded the Create Fertility centre said: ‘A woman’s fertility potential can be assessed in an hour.’

Interestingly, Professor Nargund claims that they will not offer conventional IVF where drugs are used to stimulate the ovaries. Instead they will offer natural-cycle IVF, in which a woman’s egg is collected following her natural cycle and replaced in the uterus after fertilisation. The clinic will also offer mild-stimulation IVF, in which a lower dosage of drugs is used.  She said the treatment is safer, less expensive and is able to be repeated over subsequent cycles. Her business offers three cycles of natural-cycle IVF for £5,900, while three cycles of mild-stimulation IVF costs £6,950.

However Gedis Grudzinskas, an independent consultant gynaecologist, warned that results are much lower in natural cycles than when drugs are used.

A Mini Sigh Of Relief

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So the scan on Monday was, as predicted, an emotional affair! I was anxious beforehand but I was not expecting the surge of tears that came as I lay down on the bed for the scan. I suppose it was a painful reminder of the last awful scan which took place in that same Fetal Medicine Unit. When I apologised to the doctor for being a crazy person he said very kindly, and perhaps dishonestly, that he’d seen worse.

Once I had overcome the initial shock and sobbing I just waited and watched intently for the doctors reaction. Having decided not to look at the monitor, all I could do was grip my husbands hand and hope things looked normal. My husband, braver than I, did look. I glanced over occasionally.

We knew that at 12 weeks the baby would be too small for a conclusive assessment of the babies health and that that was not likely until 16 weeks. However our excellent doctor is a specialist in the early detection of birth defects and he told us that based on the early examinations he feels confident that things seem well. The doctor stressed that he needs to scan me again next week and until he can look at things more closely he won’t know with enough certainty.

Next week we should know more. It’s a good first step. And we feel very confident in the care of an Israeli-educated specialist (probably the world’s finest) and a kind and compassionate midwife. For now we can take a mini sigh of relief.

Ask The Expert

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Professor Robert Winston is Britain’s best-known reproductive health expert and, on a personal note, the doctor who made it possible for my mother to have my little sister. Now 73, he runs a pioneering research programme and an online Q&A for fertility patients confused by the conflicting information available. Winston has been a thorn in the side of the fertility industry in recent years, critical of the high costs and unproven treatments.

“Each week, I get dozens of emails from people who feel that they are not getting proper advice from the clinics they are attending and don’t have a clear understanding of what has been happening to them, why their treatment has failed or why they need to have a specific treatment,” he says.

Consequently he has set up an online advice service run through the Genesis Research Trust, where he offers a reliable source of information to fertility patients, who often find themselves bewildered by the mass of conflicting advice they face, particularly on the internet. Anyone can email Winston their fertility question. He wants to counter what he describes as a paucity of information about infertility and treatment. He says that with clinics keen to claim high success rates, women don’t always understand that the chance of getting pregnant from an individual IVF cycle still only stands at about 25% and that “you aren’t beating the odds until you’ve had three cycles”.

He understands the distress that infertility causes, the way it can affect every area of life, and he is concerned about some new developments where patients pay for treatments that are unproven. He gives the example of egg freezing, used by some women who are worried about their future fertility in an attempt to beat the biological clock.

“We still don’t know how many pregnancies we are likely to get from freezing eggs, and women who are storing their eggs with total confidence, believing that they are going to get pregnant in 10 years’ time, may be getting very unrealistic advice.”

Other techniques he questions include the immune treatments used in some British fertility clinics, which he says are based on poor science. He’s also concerned about pre-implantation genetic screening (PGS), in which one or two embryo cells are taken to test for abnormalities.

The idea of a source of free, trustworthy information from a leading expert in the field is bound to be attractive to patients. Winston keeps in touch with current medical practice, from research and writing papers to giving lectures and attending meetings so it is apparent that, though he may not be seeing patients in a clinic, his interest in the subject of fertility has not diminished. For patients, he remains in high regard as the best known specialist in the field so his inbox must be overflowing!

Email your queries to at: www.genesisresearchtrust.com/page/askrobertwinston