Could you ask strangers for money to pay for IVF?

It may sound incredible, but apparently people are having to come up with ever more inventive ways to fund their fertility treatment in the current economic situation.  With many couples already living on overdrafts, cutting back on holidays or other luxuries will not free up the ready cash needed, and getting loans or using already overloaded credit cards is becoming increasingly difficult. So, in the States at least, some couples have apparently turned to the internet using websites or Facebook to ask strangers for money to fund their treatment – see this article.  Could you consider this? Should you have to?

Here in the UK, the postcode lottery for treatment continues to cause distress to many couples who find they can’t access IVF despite being eligible according to the national guidelines because in their local area the primary care trust has decided not to fund treatment – or to ration it.  It can be very difficult to find the money for private treatment which will cost more than the NHS would pay.  Lord Winston campaigned on this some time ago – saying that many clinics were hugely overcharging for fertility treatment and that it could be far cheaper.

Asking strangers for money may seem extreme, but does perhaps illustrate how difficult it can be to live with involuntary childlessness…

Is it ever right to raffle fertility treatment?

When plans for an IVF lottery were announced here in the UK, the overall response was far from positive with questions raised about the ethics and the finances, but in the US it appears that running lotteries for fertility treatment has become more common.  One clinic even asked people to enter a competition to win treatment by writing or making a video about their fertility problems and why they deserved treatment…

It’s true that our current access to funded fertility treatment is problematic to say the least, and that many couples simply can’t afford to go privately – but does that make running lotteries for treatment right? Those in favour argue that it offers hope, but if your chance of winning is one in a million, it’s probably more about raising unrealistic expectations.  Lotteries may be a good way for clinics to gain publicity, they may be a good way for individuals to make money – but I don’t see how a lottery can ever be a satisfactory way to offer healthcare.

If you’re interested, you can read more about the US lotteries here 

After embryo transfer...

One of the most alarming moments in an IVF cycle - for me at least - was standing up for the first time after embryo transfer.  I could never quite get over the idea that an embryo could just fall straight out when you get up after the transfer. Speaking to other people since, I've learnt that I'm not the only one to feel that way. It's quite common to worry that you might somehow jeopardise your chances of success if you stand up too quickly - or if you do too much in the days after embryo transfer.

Some complementary therapists advise a couple of days bed rest after embryo transfer, but research shows that this makes absolutely no difference to outcomes at all - and you can bet your bottom dollar that fertility specialists would all be encouraging their patients to stay in bed if there was any chance that this could possibly increase success rates.

When fertility treatment doesn't work, we want to know why and start looking for reasons.  Most often, there is no clear reason but you can rest assured that the one thing that really won't make a difference is how long you spend lying down in the first couple of days after embryo transfer.

Celebrity sperm donors

So, did you hear about the celebrity sperm donor service earlier this week, set up by a company allegedly offering "celebrity sperm" to anyone who needed to use a donor?  A number of journalists from reputable newspapers and other outlets around the world were taken in and ran features on the company whose website featured alleged donors such as an Oscar-winning actor, a former Premiership footballer and an aristocrat with a seat in the House of Lords. The ITV show This Morning even ran a studio interview with an actor claiming to be the man behind the company.

The company's website claimed the celebrities had decided to donate sperm because they had friends or family who had experienced fertility problems and that potential clients would be able to choose to have a child with the inherited character traits of a Formula One racing driver, a leading entrepreneur or scientist.

It has now, unsurprisingly, been revealed to be a hoax, set up by a TV production company for an entertainment programme.  The company claimed that the hoax aimed to highlight the sometimes detrimental impact of social media on the news culture. It is difficult to see why they decided to create a hoax sperm donor service in order to do this or what the allegedly "serious" side of this might be.

I'm still getting sent links to pieces about this new 'service' written by people who have yet to learn about the hoax.  The TV company in question clearly thought this hoax was a great joke and are doubtless congratulating themselves on a jolly jape. I'm afraid to me it just shows the total lack of sympathy and respect many people have for those who experience fertility problems - can you imagine the outcry if this hoax had featured a treatment for any other kind of medical condition?

A new website...

I've started work on a new version of this blog that I hope will look better, will contain more information and will allow you to find the information that you want more easily.  People are often surprised at how much STUFF there is here about so many different aspects of fertility - but looking for what you want can involve long trawls through lots of things that you aren't so interested in.

My new blog/website will include real-life stories and downloadable factsheets as well as details of events and the normal news updates.  If you have any thoughts about things you'd really like to know more or read more about, do leave me a message. I'll let you have the details of the new site as soon as it is up and running.

IVF or ICSI?

Anyone going through fertility treatment wants to maximise their chances of success, and you may have heard that opting for ICSI will mean you are more likely to end up with a baby whatever the nature of your fertility problems.  In fact, ICSI is a treatment for male fertility problems which is also used when IVF hasn’t worked in the past because eggs haven’t fertilised.  When it is used in these circumstances, it can increase the chances of success.  There is, however, no benefit from using ICSI for those who don’t actually need it.

I’ve just been reading a really interesting paper on this in the journal Human Fertility which looked how fertility clinics in the UK approach ICSI and found wide discrepancies with some clinics using it for around 20% of their IVF cycles and others using it in more than 80% of IVF cycles.  The criteria they used to decide when to use ICSI also varied, with many offering it for sperm that would be considered perfectly normal and letting patients to choose whether they wanted IVF or ICSI regardless of the nature of their fertility problems. 

You may feel that it’s up to you to have that choice, but patients aren’t always presented with clear evidence about what ICSI can and cannot do.  Research shows that using ICSI when you have normal sperm doesn’t increase success rates, and in fact there is even some suggestion that it could lead to a reduced chance of success.  ICSI is more expensive and there have been questions raised about the potential risks of the technique.

For men with fertility problems, ICSI has been a hugely important development allowing many couples to have the children they long for - but it’s not something that should be undertaken as some kind of optional add-on,  If you don’t need ICSI, why pay more money for something which could carry more risk and which will not increase your chances of a successful outcome?  It’s time fertility clinics started spelling this out more clearly to their patients...

Eggs for sale

When the levels of compensation for egg donors were increased, it was generally welcomed as a good move.  £750 was seen to be an acceptable rate to repay altruistic donors who faced considerable disruption and discomfort for their kindness.  The HFEA was careful to point out that the fixed rate payment had been set at a level which would not attract "those who are merely financially motivated".

Having overheard a conversation between two shop assistants earlier this week, I am not sure this has turned out to be the case.  My ears prick up automatically at any mention of fertility treatments, and when I heard one explaining to the other that she would have to go through a full IVF cycle, I assumed she was talking about her own fertility problems.  Then, to my surprise, she went on to say that it was quite a lot to go through with the operation to collect the eggs and everything, but that she had concluded it was worth doing because it would be an awful lot of shifts in the shop to get the same amount of cash - and I realised she was talking about becoming an egg donor.

Admittedly, it was only a short conversation, but at no point at all was the thought of a child, of helping someone else or of the future consequences mentioned. Whether it was worth donating eggs or not focused entirely on how many shifts you'd have to work in a shop to get the same amount of money.

It made me feel terribly sad.  I know we need more egg donors and I was in favour of the changes to compensation, but I really hope that young women like this are getting the advice and counselling that they need before making decisions about donating eggs. Although £750 probably doesn't seem much to the professionals running the HFEA, it's enough money to make a huge difference to many women in the UK.  Of course, we want to compensate people properly, but we do have to be very wary of creating a situation where for young girls in need of cash, donating their eggs is a purely financial decision.

Eggs from skin cells

It's hard not to get excited about stories like today's news of Japanese scientists successfully creating embryos from skin cells which led to the birth of fertile offspring.  The reality is that this is a technique still in the very early stages which is not going to be available in your local fertility clinic in the foreseeable future, but it's still an amazing development.

The Japanese team had already managed to create sperm from stem cells, and this is their latest advance. They performed a very complex experiment, creating eggs from skin cells, building an ovary-like structure to support the eggs when they transplanted them into the mice, and then using IVF techniques to fertilise the eggs.  Not only did the embryos implant and lead to pregnancies, but the babies themselves have been shown to be fertile and able to reproduce.

There is still a very long way to go to find out whether this could work with human skin cells and eggs, but it does offer hope for the future.  Fertility treatments have become more successful in recent years, but cannot reverse the effects of the biological clock on female eggs - and women who don't have viable eggs of their own currently need to use donor eggs.  Today's news raises the possibility that perhaps one day in the future, there will be other options available.

Scottish funding - not good news for smokers or overweight women

Well, yes it's still great that Scotland is investing in fertility services, but the announcement was swiftly followed by the news that in Fife anyone who was overweight or who smoked would not qualify for treatment.  The weight rule applies solely to women who have a BMI, or body mass index, of 30 or above but the smoking ban applies to both partners.

This kind of rationing is often presented as being only sensible because we know that smoking affects IVF outcomes and that being obese can affect fertility - why not restrict treatment to those for whom it is most likely to work? The problem is that all kinds of medical treatments are more likely to be successful for average-sized non-smokers, and yet rationing in many other areas would be seen to be out of the question.

It's yet another example of the way that couples with fertility problems are judged - and divided into those who are deemed to be deserving of treatment and those who are not.