Monday, 27 April 2015

The changing fertility landscape: What should women know in 2015?

It is close to 40 years since Louise Brown, the world’s first IVF baby, was born. A pioneering development, it paved the way for those facing heart-breaking struggles to conceive. Since this initial breakthrough the IVF industry has seen many more, and continues to grow apace both in scale and sophistication. The latest figures from the HFEA show that, in the UK, more women than ever are undergoing IVF procedures – with almost 50,000 women undergoing 64,000 cycles in 2013. From the moment of Louise’s birth, medical experts have driven a constant development of fertility treatments and procedures, seeking to ensure that no one must needlessly face the tragedy of infertility.

Yet sometimes the sheer scale of opportunity and choice in the IVF arena can be overwhelming to comprehend. The past 5 years in particular have seen some revolutionary changes in the fertility landscape – both scientific and social. Landmark medical developments have been made in areas such as egg-freezing, fertility MOTs, low-drug IVF and womb transplants. Socially IVF is rapidly widening in its accessibility, and has seen a significant rise in uptake amongst single women and same-sex couples. 

Further, the transfer of this information to the public is often still very much lacking, and outdated information will ultimately only limit the opportunity for IVF to become a safer and more reliable process for those who need it. In this new landscape it is therefore important to know what opportunities and options now exist, and how we can be sure to make the most of these advancements. 

Socially, arguably one of the most pertinent developments has been the rise in single women seeking IVF treatment. Since 2007 the number of women embarking on IVF alone has more than doubled, rising from 259 to 632 in 2012, and when the next set of figures are released it is expected we will once again see a significant rise. At our regular clinic open days, it is not uncommon for around a quarter of the attendees to be single women. This has been supported by a rise in sperm banks and the availability of donor sperm, and even a growing role for parents and grandparents in both financing and supporting their offspring to start a family without a partner. We are becoming much more accepting of alternative family models, and this is especially important for women who may be facing an imminently declining fertility but not have a partner to seek children with.

In aiding the prevention of infertility, Fertility MOTs are undoubtedly one of the most crucial new medical developments, as they rapidly provide women with indispensable knowledge on their fertility timeline. One of the most difficult parts of being an IVF doctor is treating women who simply had no idea their fertility was declining, and are now facing difficult hurdles that could have been prevented. Relatively simple and straightforward, a Fertility MOT can now be carried out in one visit and results are available within the hour. If the results should highlight a cause for concern, women are then empowered to take proactive steps to either pursue pregnancy or take preventative measures to protect their future fertility chances.

This brings us to egg-freezing, a procedure that has seen significant technical advancements over the past few years, and has really become a key step in ensuring no woman need gamble her ability to have children over pursuing her career. The key benefit of egg-freezing is that, because egg quality deteriorates with age, it preserves better quality eggs for use at a later time. Thanks to the pioneering development of a new method of preservation called ‘Vitrification’ (or fast freezing) by Professor RC Chian, it is now an incredibly effective way of preserving eggs for use in assisted IVF conception. In the past, the only available method of egg freezing involved a slow freezing process, which was less successful as it allowed ice crystals to form within the egg, potentially destroying the cell’s structure. To overcome this Vitrification first dehydrates the eggs and, using a specialised freezing technique, freezes them so quickly that ice crystals are prevented from forming. This has led to a new generation of women essentially futureproofing their fertility by holding their eggs on ice.

For those undergoing IVF treatment, we have also seen IVF become a gentler and safer process. Over recent years there has been growing awareness that what has become ‘conventional’ IVF, is not the safest or most effective. Conventional IVF involves the use of strong, potentially dangerous, stimulatory drugs. Intended to boost the number of eggs collected, these drugs are both incredibly expensive and can lead to complications such as Ovarian Hyper Stimulation syndrome (OHSS) in mothers and low birth weights in babies. It has now been shown that harvesting a smaller number of quality, naturally produced eggs offer just as high a success rate as a high number of stimulated eggs. This has given rise to a growing number of women choosing to undergo Natural and Mild IVF treatments, which work within a woman’s natural cycle and use little to no drugs. While Conventional IVF involves around 4-5 weeks of daily injections, Mild IVF involves only 5-9 days, and Natural IVF absolutely zero. It is important that women have the knowledge, and thus the power, to challenge clinics who may automatically place them on high dosage treatment cycles without considering individual needs – resulting in unnecessary risks.

Both in the UK and internationally, IVF and fertility treatments are widening in both accessibility and scope. 2015 has the potential to see more women than ever seek IVF treatment that is safer, or take the time to ensure their future fertility is protected. One of the most important considerations for women navigating the fertility industry is to ensuring that you are informed, empowered, and have the confidence to seek what is right for you, your body and your future. 

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