THE MAGAZINE FROM FERTILITY NETWORK UK
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
FREE
ISSUE #58 WINTER 2020
AFFINITY THE MAGAZINE FROM FERTILITY NETWORK UK
fertilitynetworkuk.org @fertilityNUK fertilitynetworkuk fertilitynetworkUK
Hello and welcome to the Winter edition of Affinity, Fertility Network’s magazine.
This issue coincides with the charity’s annual National Fertility Week, this year 2nd November –
5th November. The aims of the week are threefold: it’s about changing perceptions and raising
awareness of fertility issues; it’s also about providing vital support and finally it’s about raising much
needed funds to continue the charity’s work.
#YouAreNotAlone is our core message. Here’s what we did during Fertility Week:
Monday 2nd November #FertilityInequalities
To kick-start this important week, we spotlighted inequalities to fair access to fertility treatment for
all. We want to see fair and equitable access to NHS fertility treatment regardless of where you live,
your race or your sexuality. We highlighted the unacceptable rationing of treatment throughout
the UK, the difference in provision between each of the four nations and the postcode lottery in
England. We also raised awareness of inequalities in access based on ethnicity and sexuality, of the
differences in outcomes for some ethnic groups, and called for fairness for everyone who needs
treatment.
Tuesday 3rd November #MentalHealthMatters
Infertility is not only about physical health, but can take a toll on mental health too. The impact of
COVID-19 with clinic closures and reduced capacity on reopening has increased distress for many
patients, making our #MentalHealthMatters day more important than ever. We shared testimonials
from our community as well as tips from mental health experts about how best to look after
yourself. This day was about raising awareness of fertility and mental health and offered solutions to
help fertility patients navigate this challenging journey.
Wednesday 4th November #MenMatter
Men are half the fertility equation but their voices are not always heard. Men can find it harder
to express their feelings, and during the early stages of the COVID-19 pandemic, men reported
feeling forgotten and overlooked. During our #MenMatter day, we spotlighted men’s voices with
testimonials from our male community and experts in the field. We highlighted the need for
more tailored support and advice for men, and publicised some of Fertility Network UK’s new
initiatives aimed specifically at our male community.
Thursday 5th November #FertilityEducation #FertilityInTheWorkplace
Our Fertility Education day looked at why our society needs to be more informed and educated
about fertility. We asked why young people are still not aware of the lifestyle factors that could affect
their fertility. We also shared the results from our own Fertility Education project #FutureFertility,
which is funded by the Scottish Government, and launched our new project in Wales.
We highlighted the need for more education for all, including
healthcare professionals and employers, and raised awareness of the
importance of our #FertilityInTheWorkplace initiative.
Although Fertility Week 2020 has finished, the campaign has
not: share your stories, experiences, blogs using the hashtag
#YouAreNotAlone. Host a Fertilit-Tea and help raise funds even
virtually. We hope that 2020 will be one of our biggest years ever.
Very best wishes, Gwenda
1
1
Craig Mcallister
marathon runner
Myself and my wife Kat tried
for four years to become
pregnant, however, as Kat
suffers from PCOS we knew
it could be more difficult to
conceive. Eventually, in 2017 we
were referred for IVF treatment at
Oxford Fertility.
Like so many others, we entered The next year, in April 2018, more anxious and scared to get
our fertility journey with raised we once again attended excited.
expectations, nerves for what the clinic and, after what
might be, and the hope that we seemed like the longest In September 2018 we had an
might become the parents we so two-week wait, we were over early scan and were overjoyed
wanted to be. Sadly, on our first the moon to find out that we to discover we were expecting
attempt we only managed two were expecting. We were so twins. We were in complete
embryos and unfortunately this led excited that finally Kat was disbelief that finally, after
to a failed cycle. pregnant and at long last such a difficult and traumatic
we would become parents. journey, we could now
We gathered our strength and But I cannot put into words look forward. Our beautiful
decided to have another attempt. the grief we felt when we daughters Mikeala and Lille
However, unlike our first time our were told that our precious arrived on April 7th 2019 and
expectations were raised when pregnancy was ectopic. This our life has been transformed.
we were told that Kat had 25 pregnancy was not to be, and Although a difficult journey,
follicles. Great, we thought – we we were absolutely devasted; full of worry with so many
may get more quality embryos and one minute so hopeful and competing emotions we are
an increased chance of success. the next so desolate. so thankful for the support we
However, again our hopes were received.
dashed as Kat was suffering After taking the time to
from ovarian hyperstimulation come to terms with the loss, Fertility Network UK are an
syndrome (OHSS). we agreed to have another amazing charity, and with
attempt at a frozen cycle. their support I have been lucky
The consultant explained that enough to secure a place in
the risks to Kat were too great We returned to the clinic the London Marathon in 2021.
to go ahead with a transfer and in Oxford and we had two This will enable me to raise
Kat needed to recover. Although embryos replaced. As with awareness of infertility and
downhearted, we were consoled the last attempt, that two- funds to support the work
in the fact we had 11 embryos all week wait seemed to last the charity does to help more
suitable for freezing and we could forever! We were so happy to people on their fertility journey.
have a frozen cycle when Kat get a positive result however I hope you will follow and
recovered. this time we were much support me on this too.
2
4
CONTENTS
01 Welcome 16-17 Peanut’s TTC Community
02 Craig McAllister marathon 18-19 Gut Microbiome
runner
20 Highlights from Wales
04 A Simple intervention to know
About
21 Highlights from Northern Ireland
05 Fertility Funding: We need a
radical new approauch from our
government 22 Highlights from Scotland
06-07 Our journey: fertility 23 Highlights from England
treatment, adoption and family
24-25 It takes a village
08-10 Putting men centre stage in
thier fertility journey
26-27 Working with our patients
11 Graham’s story
28-29 Fertility treatment add-ons:
an update to the HFEA’s traffic light
12-13 The future of fertility travel system
14-15 Fertility Yoga 30 Fertility Network UK support line
31 The Patient Pledge
Fertility Network UK is a trading Address: Information: Magazine designed by:
name of The Infertility Network (UK) Fertility Network UK info@fertilitynetworkuk.org Marshall Creative
Company Registration The Forum at Greenwich Tel: 01424 732361 www.marshall-creative.co.uk
No. 4822073 Trafalgar Road hope@marshall-creative.co.uk
Charity Registration Greenwich Media Enquiries:
No. 1099960 London media@fertilitynetworkuk.org
Charity Registration in Scotland SE10 9EQ Tel: 07469 660845
No. SC039511 3
A SIMPLE INTERVENTION
TO KNOW ABOUT
BY N E I L J O H N S O N , F R O M O U R PA RT N E R S G U E R B E T
Women experiencing is sent through the canal of impact even when the disease
infertility problems may the cervix. The solution is then itself is not extensive. Indeed,
feel under pressure to start gently instilled into the uterus, we found that those with a
IVF (in vitro fertilisation) through the fallopian tubes history of endometriosis in our
treatment immediately. and bathes the pelvic cavity. trial group experienced around
a four-fold improvement
But there is a quick, “Very occasionally, there may in fertility. We thought it
minimally invasive be some discomfort, but it is was amazing and have
intervention they could not usually painful, and the vast been offering it as a routine
explore first, potentially majority of patients tolerate it treatment for infertility since
increasing their chance extremely well. Appointments 2004.”
of becoming pregnant take around half an hour, but
without the need for IVF. the main part of the procedure Patients who are unsuitable
The procedure involves usually takes just 10 minutes.” for treatment
using iodised poppy seed
oil and appears to have a Particular success for women Nevertheless, there are women
positive immuno-biological with endometriosis who are unsuitable for the
impact on fertility, possibly intervention. “For example, if
by flushing fertility- An HSG was once a purely a patient’s fallopian tubes are
hindering debris from the diagnostic intervention, where blocked or damaged, then the
fallopian tubes. dye is injected into the cervical treatment is not going to work,
canal in order to investigate and they should proceed to
However, many patients the shape of the womb and IVF,” says Professor Johnson.
are unaware this treatment fallopian tubes.
exists — and that’s wrong, “Other patients who won’t find
says Professor Neil Johnson, However, between 1999 and it beneficial include women
a fertility specialist based 2004, Professor Johnson who don’t release an egg
in Auckland, New Zealand, and his team recognised its — they will need ovulation
and President of the World remarkable therapeutic effects induction instead — and those
Endometriosis Society. when iodised poppy seed whose partners have a low
oil doubled fertility within a sperm count. However, it is
“IVF is involved, expensive trial group with unexplained absolutely appropriate for the
and carries the possibility infertility. majority of women who have
of complications,” he notes. relatively mild endometriosis-
“This intervention, however, The procedure was particularly related infertility that hasn’t
is low-invasive, cost- beneficial for women with a damaged their fallopian tubes.
effective, carries a very low history of endometriosis, an In fact, it’s probably their best
chance of complications inflammatory disease where first-line treatment because it’s
and is very effective.” tissue that normally lines the so effective.”
inside of the uterus is also
What to expect during the found outside of the uterus. There’s now growing interest
procedure? in the procedure around the
“Endometriosis is a benign world. “That’s very exciting,”
The iodised poppy seed oil condition that can cause says Professor Johnson. “I
can be administered in a abdominal pain, pelvic pain think every woman visiting a
hysterosalpingogram ram and infertility,” he says. “In New fertility service should have
(HSG). “The patient lies on Zealand, we’ve discovered that the opportunity to explore this
an X-ray bed,” Professor this procedure has increased treatment as a first option,
Johnson explains. “A the fertility of women with instead of moving straight to
speculum is then inserted endometriosis, which can have IVF.”
into the vagina and tubing a substantial negative fertility
4
Fertility funding: We need a radical new
approach from our government
Prof Dr Geeta Nargund, Medical IVF Tariff to increase the number The savings could be diverted to
Director, CREATE Fertility of cycles that can be funded funding more IVF cycles.
within the existing budget.
At present, there exists a deep Currently, the price paid per However, with pressures on NHS
inequality in access to fertility IVF cycle differs dramatically budgets only increasing in the wake
treatment in the UK. A woman’s between regions, ranging from of COVID-19, it is unfair to place
age, egg reserve, whether she is £2500 to over £6000 for the same responsibility for IVF funding solely
single or in a same-sex relationship treatment. This cost per cycle has at the NHS’ door. I believe that the
and whether herself or her partner a direct impact on the number Treasury, and the departments
have had a child from a previous of couples who can access IVF. of Work and Pensions, Health
relationship, all determine whether By introducing an upper limit and Social Care, and Women and
she is granted IVF treatment. Just for the price any CCG pays for Equality should also meet the cost
this month, it was revealed that IVF treatment, the NHS could of funding IVF treatment for those
women in 24 NHS regions are save money whilst giving more who need it. This is because crucially,
required to prove that they are in a couples around the country by improving access to fertility
“stable” relationship before funding access to treatment within the treatment, we are also supporting
is considered. existing budget. The NHS already the future social and economic
employs this standardised prosperity of the UK. Research
Further, with an increasing national approach for other shows that, through tax and pension
number of Clinical Commissioning medical treatments, so why not contributions, the economic value
Groups (CCGs) deciding to IVF? of a child born in the UK is over
cut fertility treatment funding £700,000 over their lifetime, and
altogether, thousands of women Currently, our NHS bears the current birth rates will fail to meet
and couples are being denied burden of treating women the country’s future economic
the chance to become parents, hospitalised following Ovarian requirements.
simply by virtue of where they Hyperstimulation Syndrome
live. Therefore, although NICE (OHSS) and caring for premature It is therefore in our government’s
guidelines recommend that and low birth weight babies interest to tackle the current
women under 40 should be born as a result of multiple inequality and invest in IVF funding,
offered at least three cycles of IVF, births from IVF treatment. We not only to give more women and
currently only 12% of regions meet could potentially save millions of couples the precious chance to start
this recommendation. pounds to the NHS if we reduce a family, but also to support the long-
these complications by adopting term economic prosperity of the UK.
One way we could look to tackle modern treatment protocols and We need a collective action from our
this is by introducing a National single embryo transfer policies. government.
5
Our Journey: Fertility
Treatment, Adoption
and Family
By Anya Sizer
6
For many of us, as we grow up there felt like just scraping by. often not the most helpful route. A new
is an expectation of a “natural order” therapeutic model of parenting will be
of events. We find a job, meet a part- Our son was diagnosed early on almost certainly needed.
ner, settle into a career and then start with Foetal alcohol syndrome, a
a family. It is such a presumed course lifelong debilitating condition which As such, we really do need to be realistic
of events, that it makes infertility diffi- means he will always require extra and sensible about who investigates
cult to navigate. support and care. It was a gradual adoptive parenting, and we certainly
process of coming to terms with this, need to challenge the concept of “just”
So how do we proceed when famil- and has involved battles on many adopting. There is no just in adoption.
iar terrain disappears? fronts, which it still does and always
will. There is some fantastic training about
As a couple, we experienced first- this and some useful books, but the
hand the grief of infertility and the Parenting a child with additional reality is that you can only prepare so far
demands of IVF. We were hugely needs has challenged us far beyond without meeting your child. Looking into
lucky after six years, five rounds of IVF, what we thought was possible. At the realities of adoption, working out
two miscarriages and huge amounts times it has stretched us to breaking how you will best support yourself going
of investment (on every level) to point. Adoptive parenting is certainly forward and putting structure in place is
have our two children - and yet we equal in terms of value but not in essential.
had also always wanted to explore terms of demand.
adoption. The second key learning point is the
However, after some time we fundamental need for support when
For us, the actual process of being discovered a new normal. A new adopting a child. Another phrase I used
matched with a child was relatively way of being a family. We found the to happily throw out before we met our
easy. It took far longer than it should support that we all needed in terms son was that it “takes a village to raise a
have done, three years in total from of educational care, medication and child”.
start to finish, when these days it a new tribe of people who would
takes under a year. carry us through. We have learned Since becoming an adoptive parent, I
to persevere, to lower expectations know now this is not just true but vital in
However, the process felt positive and and to love unconditionally in a way making such a family work and holding
hopeful, the absolute antithesis of fer- we had previously never had to. onto hope during the almost inevitable
tility treatment. There were certainly turbulence. As with infertility, we have
huge numbers of forms, home visits Adoption has completed our family sadly found that some people will just
and hurdles to go through, but there and we have a lively, funny affection- not understand or be able to empathise
was an end goal in sight. For a cou- ate bundle of craziness to call our with your experience.
ple who had spent so long navigat- son, a brother who we love equally
ing uncertainty, this was a huge relief. to our birth children. We would not However, there will be others who do,
change it for the world, even though who stand in the gap for you when life
However, I would now challenge the process has been more costly just seems too difficult to navigate. We
our initial assumptions that it was than we could ever have imagined will always be grateful that we found our
basically all the same and just an- when we started. tribe and for the amazing support we
other route to parenthood. Adoptive have found along the way.
parenting is so much more demand- What, then, have we learned in all
ing than that, and as Krish Kandiah this? Ultimately, adoption can be a wonderful
CEO of the Home for Good adoption option for becoming parents but per-
charity so rightly puts it: The first thing I would argue is that haps even more importantly can be an
adoption is an incredible option, but incredible option for the child. It is not for
“Ultimately adoption is not about not one for everyone, and certainly everyone, nor is it a second-best prize.
family completion, but the flourishing not one that should be continually
of vulnerable children.” the domain of the infertility com- Finally, then to return to my original
munity. To do so demeans both the question: how do we proceed when
Our son came to us aged 15 months, child and prospective parent. familiar terrain disappears?
a tiny bundle of energy, wonderful
but scared and angry about the The average age of a child up for With fertility treatment and adoption,
change in his environment. We faced adoption in the UK is just under four the answer is that we build a new terrain.
months of barely any sleep and days years old. They will almost certainly Slowly, and at times with uncertainty, but
when we were all exhausted and have a history of neglect and abuse, we build and we make something new.
overwhelmed. It was a lonely time and may have special needs. The We make our own definition of family.
when we felt we really should be realities of parenting such a child
coping well but in reality, each day mean that “normal” parenting is
7
improves sperm quality, and this can be stress levels. You can ask your fertility
performed through a minor out- team for these tests.
patient procedure.
Sperm DNA quality
Next, we should do a more
detailed examination Your sperm DNA is your baby’s blueprint.
PUTTING MEN CENTRE STAGE of the man’s semen. DNA is what makes you who you are.
Infections in semen are Your sperm DNA carries a copy of the
IN THEIR FERTILITY JOURNEY also a very common cause genes that you pass on to your baby.
of infertility. They can Not only do your genes pass on your
be easily detected by a characteristics, like eye colour or height,
Sheena E. M. Lewis BSc PhD CBiol FRSB ‘semen culture’ and easily but they also build your children’s brains,
Honorary Professor, Queen’s cured with antibiotics. determine their behaviour and their
University Belfast CEO Examen Third, we need to find out future health. Sperm DNA damage is
www.examenlab.com about the man’s medical another leading cause of male infertility,
conditions and medications. but it is not tested routinely in most
He may be diabetic or taking clinics. Even though you can have a
antidepressants, and these can affect normal semen analysis, your sperm
his sperm. DNA damage could be high. That
makes it less likely that you will get your
He may be taking seemingly innocuous partner pregnant naturally, or even
This article is written by Professor Sheena Lewis products for hair loss or protein shakes in with treatment. Men with high levels of
who is the CEO of Examen, a company offering the gym but some of these can lower his damaged sperm DNA also have double
the tests mentioned in the piece, and represents sperm count. By not investigating the man the risk of miscarriage. Sperm DNA can be
her views. Patients should always seek advice fully, we are in danger of making men feeling damaged when sperm are being made,
about any tests from their specialist. ignored and emasculated by their fertility snapping some of the DNA strands. We
journey and also of reducing the couple’s can’t do much about that, but more
Couples often find their fertility journey chances of having their own family. often DNA damage is caused by lifestyle
is female focused. The woman is given hazards like smoking, poor diets or being
numerous examinations, investigations and Let’s return to the semen analysis and what overweight and we can change that.
offered new tests. The man is not. He is it tells us. A conventional semen analysis
seldom examined; he is rarely asked about his measures the number of sperm a man is You can ask your fertility team about
current health or past illnesses and the only producing (sperm count or concentration), testing your sperm DNA. Some fertility
test his sperm will have is a semen analysis that how well his sperm can swim (motility) clinics will send your sample directly to
hasn’t changed much for the past 60 years. and what shape they are on the outside a sperm DNA testing lab for you. Other
(morphology). A semen analysis has two clinics can arrange for you to attend a lab
This is surprising because in 2018, the HFEA weaknesses: in many men, it can’t diagnose like TDL in London, produce your semen
reported that male problems were actually their problem nor can it predict their sample there and TDL will send your
the most common reason for couples having chances of success with fertility treatment. sample for DNA testing. Your results will
fertility treatment. You might think that would That said, it’s the still the first test every man be back in 10 days.
have brought more focus to the man and his should have. It just shouldn’t be the only
needs. Sadly, this is not the case. one. It needs to be followed up with other Knowing the quality of your sperm
investigations to provide a better diagnosis, DNA will help fertility experts predict
Checking out the man to guide men to the best treatment for the fertility treatment with the highest
them. likelihood of success for you. This means
The first thing we need to do is check out the you could improve your chances of
man. Just as we treat women, the man needs Sperm Stress getting pregnant with fewer treatment
an examination. cycles and every couple wants that;
You may not know this, but sperm can get especially with the longer waits for
Have you heard of ‘varicoceles’? They are stressed! It’s a special kind of stress called treatment caused by COVID-19.
varicose veins on the scrotum, and they ‘oxidative stress’ and it is caused by reactive
are really common in men with fertility oxygen species or ROS for short. Improving your sperm health
issues. Up to 40% of men who aren’t able to
have children have varicoceles. This figure This can be produced by environmental There is one big difference between men
increases to a staggering 80% of men who pollution, or poor lifestyle choices. ROS can and women – apart from the obvious!
already have children but are unable to have also be produced by diseases that cause
more. Despite this, clinical examinations are inflammation like diabetes or arthritis. Men produce new sperm every three
seldom performed on men attending for Weight and age also play a factor. The good months whereas women have all their
fertility investigations. Yet there is strong news is that there are a number of ROS tests eggs in place before they are even born.
scientific evidence that varicocele repair that can be used to check your sperm’s
8That means that men can improve their next conversation for clinics and couples alike. egg has a better chance of repairing the
batch of sperm if they find their sperm aren’t When men have a normal semen analysis, this sperm DNA breaks in ICSI than in IVF.
well. This puts men back in control. also means that they won’t be investigated any For those couples who have had several
further. If there is no diagnosis; there can be no failed ICSI cycles, donor sperm used
With the right advice, men can protect and personalised solution. to be the only route left for them. New
improve their sperm health. The good news solutions are now being explored.
is that lifestyle changes can bring about rapid This can lead to expensive, invasive, prolonged
improvements. Here are some easy ways to and often unsuccessful cycles of treatment. Scientists have found that when
improve your sperm health: Further tests for couples with ‘unexplained men have high DNA damage in their
infertility’ can be really useful. For example, ejaculated sperm, it is possible to take
1. Stop smoking: Preparing for parenthood research has shown that 75% of men with sperm from the testis and use them
can be a great opportunity to quit smoking ‘unexplained’ infertility have high DNA damage in ICSI instead. The success rates with
and improve the health of you and your in their sperm. If men find out they have high this treatment are very good and it is
family. Giving up cigarettes can increase your DNA damage, they can take steps to improve it becoming more popular. It is done as
likelihood of becoming a parent, so why not in the next batch of sperm they make. an out-patient procedure, with plenty of
make the change now? anaesthesia so you won’t feel a thing!
The importance of understanding men’s role in
2. Reduce your stress levels: Not only can stress miscarriage The importance of having healthy sperm
put you off sex, it also produces free radicals,
which can damage sperm DNA. Taking some of We don’t usually think of miscarriage as a Poor semen quality is not just linked
the stress out of your life can go a long way to form of infertility, because the couple did get to a man’s fertility. It is also linked to
improving your sperm quality. pregnant. Yet in broader terms, we might think cardiovascular risk, later onset cancers,
of all couples that can’t have a baby as having and shortened life expectancy. So, it’s
3. Get healthy: Being at a healthy weight gives fertility problems. worth keeping an eye on sperm health as
you the best chance of producing sperm of a check of overall health.
good quality and quantity. Regular exercise When we think of pregnancy loss, we usually
and healthy eating are essential to lose weight think of the mum. We often forget how For your children’s health
and maintain a balanced lifestyle. important the dad is in creating a healthy baby
as well. As discussed earlier, men with high Sperm quality can also impact your
4. Cool off: Your testes are where they are for levels of sperm DNA damage take longer to get children’s health. So, if you find it hard
a reason – sperm production works best at a their partner pregnant and have double the risk making lifestyle changes for yourself, do
lower temperature than inside your body. Try of miscarriage. it for your kids.
to avoid activities that increase your testicular
heat, such as wearing lycra shorts or tight In a new study just published by Professor We hope that all of this new information
underwear, spending all day sitting at a desk or Sheena Lewis, Dr Hassan Shehata and Dr will help more men become dads.
even doing lots of cycling. Stephen Gordon, sperm DNA damage in
men whose partners have miscarried was Living the ‘new’ normal
5. Avoid drugs: Cannabis damages sperm in compared with that of men who had babies
many ways including slowing them down and recently. The Examen test was used to assess As of September 2020, COVID-19
changing the way they act, making it harder the average level of sperm DNA damage, the restrictions have eased enough to let
for them to find the egg and to penetrate it proportion of sperm with low DNA damage clinics open again. However, post-COVID
when they do. Regular cannabis use over a few and the proportion with high DNA damage, to we don’t have time for several ART
years can permanently reduce a man’s ability determine whether these are reliable indicators cycles. We need a better diagnosis and a
to make sperm. Even if you don’t take drugs, in the diagnosis of miscarriage. better understanding of how to optimise
some protein shakes and health supplements our sperm for the next treatment cycle
contain steroids which can also damage Male partners of women who had miscarried to give ourselves the best chance that
sperm. were all found to have much higher sperm that cycle alone will work.
DNA damage than fertile men, and the Examen
6. Don’t use supplements unless you have tests were highly predictive of both sporadic If you’re feeling overwhelmed by delays
been tested and found to have high levels of and recurrent miscarriage. This shows that and isolated as you try to get through
ROS. We are inclined to think ‘over the counter’ sperm DNA tests are a powerful tool for your fertility crisis during the pandemic,
vitamins and antioxidants can’t do us any understanding and predicting pregnancy then know that you’re not alone. Many
harm. That’s not true. Too many vitamins can loss, and lead to new fertility pathways for couples are experiencing the same
cause serious damage to our sperm. Save your couples struggling with miscarriage. Men who feelings as you. We know you are worried
money instead. have experienced miscarriage should visit about when you can get treatment and
a urologist, a specialist doctor trained and if COVID-19 will affect your pregnancy.
Have you been told that fertility experts can’t focused on male reproductive problems. Fertility Network UK is here to support
find anything wrong with you? you.
The latest treatments for male fertility
You are not alone. Believe it or not, more than a fertilitynetworkuk.org/trying-to-conceive/
quarter of couples having fertility investigations For men who have low sperm counts or high fertility-treatment/male-issues/
are told that neither of them have any sperm DNA damage, ICSI is the best treatment
9
detectable problems. This is a disappointing because only one sperm is needed, and theAs if this were not complicated enough, whilst the lap-
aroscopy was taking place, Graham had to produce
a semen sample whilst a nurse waited outside an
upstairs bathroom!
Once the egg was collected, it was suspended in a
special fluid culture medium and the prepared sperm
sample was simply added to it in a petri dish. It was
then incubated for several hours and viewed frequently
under a stereo microscope to see if it had fertilised.
Incubation continued for two or three days until it
reached blastocyst stage, and then it was reintroduced
to the uterus via a catheter. It was a very exacting task
as it had to be introduced into the right area of the uter-
us at the right time and although ultrasound existed, it
was very basic.
The treatment available in Lesley and Graham’s time
was in stark contrast to the standard procedure now,
where an artificial menopause is induced, followed
by super-ovulation via hormone injections and the
Graham’s
By Michèle Wright
Story eggs collected via transvaginal ultrasound. The men's
rooms also tend to be slightly more luxurious and ‘well
equipped’!
A few weeks ago, I was lucky enough to meet Graham
Unfortunately, Graham and Lesley lost their
Hunter. He was one of the first patients through the much-wanted baby at six weeks. This had a further
doors at Bourn Hall, the Cambridgeshire fertility impact on Lesley's mental health and ultimately the
clinic opened in 1980 by Robert Edwards (later Sir) and marriage ended. In an ironic twist of fate, Graham went
on to sell IVF equipment all over the world. He started
Patrick Steptoe, both now sadly deceased. his own company, Hunter Scientific, which specialised
This is Graham’s fascinating story; the treatment options for infer- in microtools for IVF and had a multi-million-pound
tility were very different in the 1970s, but the emotional impact was turnover by the time he retired in 2012.
just as devasting as it is now and the moral dilemmas associated
with treatment remain. By 2010 it had become possible to assess the quality of
an embryo through timelapse photography, enabling
Graham and his wife Lesley married in 1972, when they were a thorough analysis of the cell division that has taken
both 21. Later that year Lesley was very ill, resulting in her losing a place. The fertilised egg is monitored for three days
fallopian tube and being told she would never have children. In to check that division has taken place correctly and
1975, they heard that Robert Winston had pioneered a technique without granulation. During this period, it is now also
to unblock tubes and as they were desperate to have a family, possible to diagnose genetic conditions via pre-implan-
Lesley underwent surgery. Sadly, this was not successful and had tation genetic diagnosis (PGD), to look for suspected
a massive impact on her mental health. diseases such as cystic fibrosis. To do this, a cell is
surgically removed from the embryo at the 4 or 8 cell
In 1978 the first test tube baby, Louise Brown, was born in Oldham. stage and a chromosome map is produced to look for
Graham and Lesley wondered if they might now have a chance of that specific disease. PGD only became possible after
a family and so, in 1980, they wrote to Bourn Hall asking for help. Intracytoplasmic Sperm Injection (ICSI) was perfected,
They were accepted for treatment and began the first phase - tak- and initially only a few diseases could be screened for
ing Lesley’s temperature every morning for three months, to detect as the genome had to be found which coded for them.
a temperature increase that would indicate ovulation.
Techniques and knowledge have advanced a great
The only treatment available at the time, the one that Edwards deal over the last 45 years, but complex moral di-
and Steptoe had been researching, involved fertilising a single lemmas remain surrounding those embryos that are
egg outside of the body. Lesley and Graham stayed at Bourn Hall not ‘good enough’ or surplus to requirements. Some
for the three days before Lesley ovulated. And on the morning of unwanted embryos are donated for implantation and
her temperature increase, Lesley was rushed into theatre for a some for stem cell research. Further complications can
single egg recovery by laparoscopy. Timing was critical as the egg arise as there are limits as to how long frozen eggs,
had to be retrieved as soon as it was released from the ovary but embryos and sperm can be stored. However, the most
before the fimbrial end of the fallopian tube could catch hold of it emotive (and legally challenging) problems arise when
and propel it towards the uterus. a couple separate, and one party, for example, wishes
to use their frozen material with a new partner.
10“My name is Afryea and I had always desired to be a mum.
From a young age l had already naively predicted how
many children I would have. My husband and I decided
we wanted to start a family as soon as possible following
our wedding, however we struggled to conceive due to my
irregular and then absent cycles. After being continually
turned away by the NHS with no real direction, we sought a
second opinion and discovered I had significantly elevated
Prolactin levels, which were causing my body to think my
body was already pregnant. Following multiple scans, inva-
sive tests, holistic womb support - we found a medication
that worked and reinstated my cycles. We were blessed with
the birth of our beloved daughter who was born in March
2019.
The hardest part of my journey was constantly being in the
unknown, and for such a long time having no diagnosis or
understanding of what was blocking my fertility. I had the
fear of not being able to fulfil my dream of motherhood. So
many people around me had been able to fulfil that dream
for themselves and were understandably looking to us for
when we would join what felt like the exclusive parenthood
group. As we chose to keep our challenge quite private,
It Takes a Village
aside from family and a few close friends, it heightened
the feeling of loneliness and anxiety all the time. To remain
optimistic and positive, I turned inward and tried to cultivate
Written by Vanessa Haye
my inner peace. Meditation and seeking holistic ways to
assist my body in the process grounded me and helped to
Contributions by Afryea Henry-Fontaine maintain a positive outlook, even when things were most
challenging. I wish I knew more about the varying ways
and Noni Martins women can be affected by infertility or challenges with con-
ceiving. It’s not one size fits all.” - Afryea Henry-Fontaine
“Have you been to see the doctor yet?” This question will go down in
my history books as one of the most forward questions I’d ever received “For a long time, I felt shame, not because I was being
from a family member during our journey of trying to conceive our first made to feel ashamed externally, but because I was
child, three and a half years into failed fertility treatments. ashamed within myself. My experience forced me to ask
myself where these feelings come from, and when I wrote
Whilst it was extremely out of the blue, at least it wasn’t as bad as the my first blogpost and got responses like “this is a taboo
all familiar question: “When are you going to have children?” This type topic” and “I’m sure your husband still loves you”, it hit me.
of question, which I could never seem to avoid answering in family so- All those years growing up in Zimbabwe, the indoctrination,
cials and friendly catch-ups, seemed much worse because it summed especially as a black girl: the whole idea around servitude
up the epitome of why many couples in some communities will struggle to the man I marry and his legacy, what we are taught
with infertility in silence and shame. It is the presumptuous thinking that about womanhood and the strong focus on motherhood
a couple can successfully start a family with no issues, while setting a as huge part of that.
timeline against that, which is typical of pronatalist attitudes in some
communities, and particularly Black communities. For Southern African women whose spouses pay ‘lobola’
(a bride price) for them, infertility comes with yet another
I was victim to these unwelcome remarks, as gaining a degree, securing dimension where a woman can feel that she has to prove or
a ‘good’ job afterwards, getting married and finally starting a family show her worth by giving the man a child. My husband paid
was the idea of ‘success’. These social and cultural norms are what lobola for me and although I am evolved and his family is
caused me to feel alienated and alone when I had achieved all but equally evolved and incredibly supportive about our situa-
one milestone by the age of 27. I felt that I had failed my husband, my tion, internally in the back of my mind I have thought about
parents and even my siblings. Even though I got through my ‘secret bat- it. Growing up, I used to hear stories of women being sent
tle’ by joining online forums and chat groups, there were some issues back to their families because they couldn’t fall pregnant,
discussed that I never felt could be understood in great detail, due to with the man’s family demanding their money back.
very specific beliefs and behaviours that were held in my culture, and so
it was a very isolating and lonely experience. These might have been just stories but even then, why such
stories? Just imagine the lasting impact – I am 31 now. My
Five years later with our two-year-old son, I often reflect back on those feelings of shame, and the silence I maintained were rooted
difficult times and when speaking with other women and couples from deep in my upbringing, even when my current lifestyle is
my Black community who were experiencing the same issues I faced, that of a liberal surrounded by other liberals. Our ethnicity
I felt a strong urge to hold a safe space for other Black women who and cultures play a big part in who we become and what
require the support network I didn’t have. So Femelanin was created, we subconsciously believe and hold onto.
a community-based organisation that provides a safe and uplifting
space for women to share their intersectional experiences. My infertility journey has taught me to challenge and un-
learn all these belief systems. Finding other black women in
Here are a few inspiring and encouraging stories to read from two this struggle affirms my new perspective.” - Noni Martins
women, who like me found their own ways to cope through infertility
between our community’s ‘walls of silence’.
1112
The Future of
Fertility Travel
donation treatment and 55% said that were expecting
own egg treatment to cost between £2,500 and £5,000. A
range of funding sources were identified to pay for treat-
ment which included loans from family, friends and banks,
savings, credit card payments, re-mortgaging property
and crowdfunding proposals.
A recent online survey, believed to be one of the larg-
est ever to be undertaken on fertility tourism suggests
there remains a substantial number of people who
Potential travellers were attracted to treatment provid-
are prepared to travel, and travel far, for the right
ers for a variety of reasons. Many cited the availability of
treatment.
donors and treatments; smaller waiting lists, success rates,
clinic experience and reputation and positive feedback
The recent 2020 Fertility Travel Survey was undertak-
from former patients. Although donor anonymity was a
en by the International Fertility Company, in part-
reason for some to travel it was not a key driver. Partici-
nership with Fertility Network UK and other fertility
pants were also asked what would negatively affect their
organisations. The work was conducted against the
decision to travel and these responses varied dramatically
backdrop of border closures and COVID-19 travel
by age.
restrictions.
The 18-24 year old group overwhelmingly cited perceived
Co-authors Andrew Coutts, Jakub Dejewski and Alex
language difficulties (48%) and being away from family
Wiecki paint an optimistic view of future patient
and friends (27%) as potential barriers to accessing treat-
travel. 77% of survey participants (over 500) had
ment abroad. Anxiety about communication dropped to
not travelled for treatment previously, but 97% of all
6% in the over-45 group and 10% in the 35-44 group, who
participants said they were actively considering it for
both identified the level of regulation being the crucial
the future.
determinant of travel choice. Interestingly only 4% of re-
spondents said they would be put off travelling by hearing
Those participating in the survey were from Europe,
individual horror stories online.
Canada, Australia, India, the US and across Asia. The
most popular treatments sought after were donor
It is apparent from participants’ feedback that there is a
egg treatment and IVF with own eggs, while 10% of
significant interest in travel, yet 86% of those questioned
participants were seeking surrogacy options.
said that although there was a lot of information on fertil-
Spain remains the most popular fertility destination,
ity travel available, it was not enough. Quite understand-
although countries like Greece, Cyprus and the Czech
ably against the backdrop of the COVID-19 pandemic,
Republic are emerging as favourites for younger
online interaction was preferred at the time of the survey
patients driven by cheaper prices. However, price
with participants highlighting the desire for more digital
is no longer the absolute driver for travel for all age
access to clinics and staff, consultations and telemedicine
groups.
orientated communication.
The UK and US were the preferred locations for 5%
There was a call for more pre-travel testing to become
of participants from all age groups, but significantly,
available in order to reduce the amount of time spent
this rose to over 12% of those aged over 35.
away from home during treatment and there was over-
Interestingly respondents were prepared to not only
whelming support for treatment providers to incorporate
travel, but travel long distances as Andrew Coutts ex-
wellness activities into core treatment packages.
plains: “Prior to travel restrictions being imposed, we
were seeing individuals and couples travelling con-
Andrew Coutts sums up the work:
siderable distances for treatment at specific clinics
“There is a lot of first-hand information in this survey which
or with specific doctors. We saw American patients
can help those thinking about travel. We hope that it will
travelling to the UK, South Africa and India; Australi-
also act as a useful resource for treatment providers, en-
an patients travelling to Spain; and Chinese patients
abling them to consider support services and treatments
travelling into Eastern Europe. Judging by responses
that are responsive to patient needs.”
from the survey we don’t see any reason for this to
stop once we can all travel freely again.”
The full report from the survey is available here:
Internationalfertilitycompany.com/news-blogs/#survey
Participants demonstrated a realistic approach to
the cost of treatments, with 69% saying they were
expecting and prepared to pay over £5,000 for egg
1314
Fertility Yoga
Fertility Network UK responded to the COVID-19 pandemic when clinics
closed, and treatment was cancelled, by reaching out to patients to
support them emotionally. We were overwhelmed by the response to our
Fertility Yoga classes and the feedback has been so positive from patients
that we are continuing to hold weekly webinar classes.
Our teacher Annie Perry, now known by so many fertility patients across
the UK, has taken some time out of her busy schedule to tell us more
about the benefits of Fertility Yoga.
Yoga has an incredibly positive effect on emotional and mental health,
something that is imperative to nourish when going through fertility
treatments and struggles which are physically, emotionally and financial-
ly demanding.
One of the most widely recognised benefits of yoga is its role in stress
reduction. Numerous studies have shown it to be effective in reducing
stress in a broad range of populations. There is no question that ongoing
fertility challenges are stress-producing. A study by Dr Alice Domar at the
Harvard Medical School documented that the anxiety and depression
levels of women facing fertility challenges was on a par with the levels of
people who had been diagnosed with terminal diseases (Domar, 2002).
In turn, stress can negatively impact our ability to become pregnant
when the adrenal glands pump stress hormones such as adrenaline into
the bloodstream and thus rob the uterus and ovaries of the rich blood
blow and oxygen they require to function optimally. Yoga on the other
hand can elicit the ‘relaxation response’, a term coined by cardiologist Dr
Herbert Benson in the late 1960s.
Yoga and meditation are particularly effective in eliciting the relaxation
response. They activate the parasympathetic nervous system, allowing
the body to reverse the physiological effects of the fight-or-flight response,
and instead activating the relaxation response. Interestingly, the hypo-
thalamus gland, which mediates the relaxation response also regulates
all aspects of reproduction. (Domar, 2002)
The aim of Fertility Yoga classes is to elicit the relaxation response in
patients going through fertility struggles, while also tailoring the physical
yoga postures according to the menstrual cycle and/or treatment stage.
Breathing techniques (pranayama) and meditations are also used to
help to balance complex emotions, aid sleep and rest, help to develop
self-compassion, and finally to help the patient feel more empowered
and in control.
Annie Perry
YogaBellies Teacher of the Year 2019!
BA (Hons), MSc, Certified YogaBellies Teacher (300 hours), Birth ROCKS
Mentor, Fertility Yoga Teacher, Pre- & Post-Natal Massage Therapist
15Peanut’s TTC Community
By Sophie Sulehria
16I thought that depression and and I felt like the world was out to was going to connect women like
anxiety wouldn’t “happen” to me. I get me. I would start the day fine, herself, in need of this support
have a great job, wonderful family be out for a walk in the park, only and friendship. She was creating
and friends, a loving husband and to look up and notice a group of a community for mums. And
a lovely little house. We want for women enjoying their babies and perhaps she could help women
very little, what would I have to be exchanging experiences. A group I like me too.
depressed about? believed I would never be a part of.
My heart would start racing and my “You do this,” I said to Michelle.
We’d been trying for a baby for mind would fall down a rabbit hole “You make this app, and you make
only a few months, but I knew of lost dreams. Next thing, I would a success of it. And once you have,
internally that something was be in floods of tears and heading you need to create another app, an
very, very wrong. I had been home, unable to move from the app for women trying to conceive,
bleeding between periods and sofa or bed for the rest of the day. It for women like me. Because
I was in a lot of pain, a lot of was traumatic, heart-breaking and while motherhood can be lonely,
the time. For years doctors had debilitating. For a time, I stopped struggling to become a mum in
diagnosed me with a string of leaving the house unless it was the first place can be even more
incorrect illnesses, from IBS absolutely necessary. I stopped lonely.”
to anxiety to potential Crohn’s shopping in case I accidently went
Disease - no one really considered the wrong way and found myself In 2019, four years after that
it could be gynaecological. down a baby aisle. I stopped walking conversation, Michelle asked me to
The truth was harsh as I was in case I bumped into a bump. I come into her office.
in fact suffering with severe stopped living for anything other
endometriosis, undetected in my than having a baby. “I want you to look at something,”
youth despite copious trips to she said. As she talked me through
the doctors and the long list of Special occasions too become a the yellow slides on her laptop I sat
symptoms. nightmare. Mother’s Day stopped and cried.
being about my own mum and
I went on to have two surgical instead she would spend her day Michelle had created ‘Peanut TTC’
procedures, which led to a worse consoling me. Christmas will only with the most incredible thought
conclusion – a damaged egg ever remind me of children; it never and care. She had produced a
supply. My husband Jonny and I feels like an adult occasion. And don’t platform for women struggling to
were told it would be unlikely for get me started on baby showers! conceive via her Peanut App. At
us to conceive children naturally. My mental health was deteriorating the click of a button, women TTC
We were to join the thousands of and I had become withdrawn and would be able to access support
other couples in a secret club that depressed. Worse still, I didn’t know immediately from other women
no one wanted membership for. anyone else in the same boat as who understood exactly what they
£50,000 worth of IVF treatment me; I had no one in my life who were going through. This meant
later and things looked bad truly understood what I was going we’d have our own community on
for us, round after round of through. Yes, I had friends who I Mother’s Day, or Christmas, or on
disappointment, the prospect could talk to, but I needed to find a random Sunday afternoon while
of becoming pregnant seeming people who got this extremely the world was with their children,
more and more unlikely. complex situation. I wanted to ask whenever we’d need them. Those
questions and find out how other in this safe space could lean on
I’d never experienced depression people coped. I craved hope, and each other, through treatment,
or anxiety before. Sure, I’d been support, and advice. I needed a TTC and miscarriage and negative
low, but this was entirely different. community. pregnancy tests, through it all
Now I was finding everyday life there would be advice and love
hard to navigate, and I could think At around this same time, my best and support. And it’s incredible.
about nothing other than being friend Michelle Kennedy anxiously
pregnant. told me about her new business idea Now, almost two million mothers,
called ‘Peanut’. She wanted to build expectant mothers and women
Worse still, it felt like everyone a social networking app for mums trying to conceive have joined the
else around me was able to to meet, chat and learn from each app, to connect and share their
achieve this goal that I couldn’t other. experiences in a safe space. They
seem to manage. I became hyper all now have community. My only
sensitive to pregnancy, pregnancy “I feel hideous that while you are wish is that it had been around
announcements and other going through all this, I am starting sooner.
people’s children. Every time I an app for mums – it’s the worst
turned on the TV, baby images timing for you.” I didn’t mind. She You can download the Peanut App
haunted me and pregnancy test had her son Finlay at a time when I here: www.peanut-app.io
ads popped up. Every person I couldn’t support her in the same way
met in the street seemed to be I would have liked, and she herself
either pregnant or holding their had felt isolated. She needed support 17
gorgeous newborn. It was torture, as much as I did. Her app, Peanut,GUT MICROBIOME
Can gut microbiome improve fertility in PCOS women?
PCOS is one of the most common causes of infertility around
the world, affecting approximately 20% of women who of a child-
bearing age. Many believe the real number could be significantly
higher.
A key feature of PCOS is insulin resistance - this disorder is present
in around 70% of sufferers.
High insulin levels encourage the ovaries to over-produce
testosterone, which then contributes towards the various
symptoms of PCOS: irregular periods, and irregular or absent
ovulation, which lead to reduced fertility as well as acne and
unwanted hair growth.
Recently we have begun to understand that it is not simply the
food we eat but also our gut bacteria that can affect our blood
glucose and insulin levels.
In fact, the nature of our gut bacteria is a better indicator of these
factors after a meal than the carb content of that meal.
The gut microbiome encompasses the millions of resident
microorganisms inside the human intestinal tract that contribute
to multiple health-related functions, including the absorption of
key nutrients.
Studies have closely linked the gut microbiome with a variety of
diseases.
Endocrine functions (the way the body produces hormones) and
metabolic functions (chemical reactions in the body’s cells) can be
affected by gut flora (normal bacteria).
The expression “leaky gut” is getting a lot of attention in the
medical field. Leaky gut, also known as increased intestinal
permeability, occurs inside our digestive system. We have an
extensive intestinal lining covering more than 4,000 square feet of
surface area. When working properly, it forms a tight barrier that
controls what gets absorbed into the bloodstream.
An unhealthy gut lining and / or changes in the microbiome could
lead to problems within the digestive tract and beyond.
There is a great deal of research currently showing that
modifications in the intestinal bacteria and inflammation may
play a role in the development of several common chronic
diseases, including PCOS.
Studies show women with PCOS have a different balance of gut
bacteria that can reduce the absorption of nutrients, including
myo-inositol.
18Improved absorption of Probiotic treatment could Women with PCOS who are
myo-inositol can help better be an effective way in not ovulating may consider
control insulin levels and treating women with PCOS. myo-inositol, however
hormone balance. In addition to this there are 40% of women with PCOS
several ways these women cannot absorb myo-inositol
Chronic inflammation is can improve their gut health: effectively.
a key contributor to the
development of PCOS. • Eat plenty of fibre Choosing a myo-inositol
A dietary trigger such product with alpha-
as glucose can incite an • Eat a variety of vegetables lactalbumin (a whey milk
inflammatory response in protein) helps reduce the
the body. If you have high • Avoid high protein diets inflammation associated with
inflammation markers, it is such as a paleo diet PCOS and stimulates the
likely that you will have higher intestinal flora growth, thus
testosterone levels and vice- • Eat olive oil – 1tbsp daily increasing intestinal nutrient
versa, thus impacting your absorption of myo-inositol
fertility. • Eat fermented foods/dairy and facilitating the release
products – e.g. sauerkraut of melatonin, which has
Improving the gut been shown to improve egg
microbiota in PCOS • Avoid tap water – chlorine quality.
kills off gut bacteria
Research suggests that For more information
improving levels of gut flora Another key consideration is about fertility, PCOS and
will support an improvement supplementation: balanced supplements that
in PCOS as effectively as the will support men, women
drug metformin. and your future family, visit:
www.fertilityfamily.co.uk.
19You can also read
