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Are Fertility Addons Right For You?

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Are Fertility Addons Right For You?

Time-lapse imaging, embryo glue, endometrial scratch, reproductive immunology… These are just some of the many extras you may be offered alongside your fertility treatment. Of course, you want to do anything you can to increase your chances of success, but are these extras, often known as ‘add ons’, worth paying for? Different clinics and different specialists may give conflicting advice about which add ons can improve the likelihood of pregnancy, and it is not easy to know what to believe when the experts seem to disagree.

Perhaps the best place to start is by understanding what add ons are. It ought to be straightforward, but it is not always clear as fertility clinics may include some of them as part of their standard IVF or ICSI treatment. Other clinics may present you with what looks like a shopping list of extras to consider. Although they may be offered in different ways, add ons are all additions to IVF or ICSI, and most are relatively new so there is little or no clear evidence about how effective they are.

Some clinics may offer every add on available giving you a huge range of extras to choose from, while others provide very few, or none at all. Patients sometimes assume that a clinic offering lots of add ons must be better, but that is not always the case. Clinics that don’t provide them may have looked at the evidence and decided they cannot justify charging patients for a treatment which they do not believe will increase success and may even be risky.

Assessing the evidence is not easy, and the Human Fertilisation and Embryology Authority (HFEA) recently carried out a patient survey to find out what people think about add ons. Some patients were very much in favour and felt that the lack of scientific evidence did not necessarily mean that add ons did not work. They were concerned that patients might miss out if clinics could only provide treatments that have been proven to work. Others were more sceptical, and felt it was too difficult for patients to be faced with an array of extras without clear evidence. Some felt that people could feel pressured into paying for add ons because they would do anything that had any possibility of increasing the chances of success.

So how can you decide whether an add on is right for you? The first thing to look into is whether there is any evidence that the add on works. You may come across research which seems promising, but there are many different types of evidence, and the gold standard is the randomised controlled study. This takes a large group of people who are randomly placed into two separate groups. The people in one group have the add on and those in the other group don’t and the outcomes are then compared. The majority of add ons have not been through this kind of testing.

The HFEA decided to help patients by assessing the evidence about add ons and got together a group of leading scientists and fertility experts to look at all the existing research. They introduced a traffic light system for add ons to help patients when considering possible risks and benefits. When there is more than one good quality study which shows that the procedure is effective and safe, they have given the add on a green light. A yellow light indicates that there is some evidence or some potentially promising results but further research is still required, and a red light indicates that there is no evidence to show that an add on is effective and safe. Once they had made their own assessments, they brought in an expert in the validity of evidence who double checked every traffic light to make sure the ranking was right.

You may be surprised to learn that there are currently no green lights. The majority of add ons fall into amber, with a few red lights. One red-lighted add on is assisted hatching, which involves making a hole in the thick layer of protein which surrounds human eggs and early embryos in order to help an embryo break out of the layer, or “hatch”. Another red light has been given to intrauterine culture, which involves putting fertilised eggs into a device which is inserted into the woman’s womb and left there for several hours. This treatment is rarely offered as there is no evidence to show it works and not enough is known about potential risks. What’s more, the womb would not be the right environment for an embryo at this stage of development as it would usually still be in the tube which connects the ovary to the womb.

Pre-implantation genetic screening, or PGS, has two different lights. It gets a red light if it is carried out on day 3 after egg collection and is offered to women over the age of 37, to couples who had had several miscarriages or failed IVF cycles or to people who may be at risk of chromosomal problems. During PGS, a cell is taken from the embryo to test the chromosomes, but there is no evidence to show that this type of PGS is beneficial. In fact, studies have shown that it can actually reduce success rates, probably because of damage to the embryo. There is, however, some limited evidence that carrying out PGS on a blastocyst on day 5 or 6 may be helpful in finding the best embryo to transfer for younger women with no history of unsuccessful IVF or miscarriage, so PGS at this stage of treatment gets an amber light.

The final red light is for reproductive immunology, which is based on the idea that a woman’s immune system may not accept an embryo due to differences in their genetic codes. There are a variety of treatments which may be offered for this including steroids, intravenous immunoglobulin (IVIg), ‘TNF-a’ blocking agents, and intralipid infusions. There is no convincing evidence for the theory behind reproductive immunology, and not only do these treatments not improve your chances of getting pregnant, there may be very serious risks to using some of them.

Most of the other add ons get an amber light which means more research is needed. For example, there may be inconsistencies in existing evidence about the add on, or there may just be one trial or small studies. The add ons with amber lights include embryo glue, a substance which is added to the dish embryos are stored in before transfer to try to improve the chances of them implanting when they are transferred to the womb, and endometrial scratch, which involves scratching the womb using a small plastic tube. The theory behind endometrial scratch is that it may trigger the body to repair the area where the womb was scratched, sending out chemicals and hormones which can make the lining of the womb more receptive to an embryo implanting. There is currently a large multi-centre trial for endometrial scratch and if you sign up at one of the participating clinics, you may be randomised to get the scratch without having to pay for it.

There is also a national trial (E-Freeze) for elective freeze-all cycles, which involves freezing all the embryos created in an IVF or ICSI cycle for transfer at a later date once the effects of the drugs used to stimulate the ovaries have worn off. Some believe it may be easier for embryos to implant if they are transferred later, and it also reduces the risk of getting ovarian hyperstimulation syndrome (OHSS) when the ovaries become overstimulated after IVF/ICSI treatment.

Finally, the last amber light is for time-lapse imagining, a widely-offered add on which is used to help to choose which embryo to transfer. It allows the embryologist to view regular images of the developing embryos without having to take them out of the incubator to look at them. It means the embryos are undisturbed while they grow and the embryologist can select one based on how they have developed. Although initial research has shown some promise, there is not yet enough evidence to prove that time-lapse imaging improves birth rates.

We have seen that there is no certainty that any of these add ons will increase the chances of successful treatment. Some clinics offer some add ons as part of a standard IVF cycle, and do not charge extra for this. The majority of clinics do charge for add ons and you will want to think carefully about whether you want to pay for something which you are not sure will make a difference.

If you decide to go ahead, you should check how much your clinic charges for the add on and whether this is in line with what other clinics are charging. The prices can vary hugely, and if you are going to pay for an add on, you want to be sure you know what the average price is. For example, some clinics now include embryo glue in a standard cycle, others may charge £75, or £150, or even £350. The embryo glue isn’t different, but the prices are.

Before going ahead with any add on, make sure you are happy with the evidence that your clinic has given you about it and that you have read the information on the HFEA website. Check the price, and think carefully about whether you can afford it. Think about whether paying for add ons would have an impact on your chances of affording another cycle if you need it.

Going ahead with an add on is fine as long as you are fully aware of the evidence about any risks and benefits, and have made an informed decision. It may be worth bearing in mind that there have been no huge leaps in national success rates since add ons were introduced, and any differences they make to treatment outcomes may be relatively small.

You can find the evidence about all the main add ons and their risks and benefits on the HFEA website (https://www.hfea.gov.uk/treatments/explore-all-treatments/treatment-add-ons/).

To find out more about the E-Freeze trial, visit https://www.npeu.ox.ac.uk/e-freeze and for more information about the Endometrial Scratch trial, visit https://www.sheffield.ac.uk/scratchtrial/patients

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Fertility 360

NEWS: Get access to adult photos of the Cryos sperm donors

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Adult Cryos Sperm Donors Photos

Viewing adult photos of Cryos sperm donors is now a reality. Visit dk.cryosinternational.com today and get access to the new feature.

At Cryos it is now possible to access adult photos of sperm donors on our website, thus adding another dimension to your search for the perfect donor.

The unique chance to see both childhood and adult photos of your sperm donor, provides you with a more comprehensive idea of who your sperm donor is and moreover of the features of your future child. We hope that this extra dimension will upgrade your experience making your decision of a sperm donor easier.

The 5-6 adult photos are taken by a professional photographer and are a part of the donors extended profile where you also have access to childhood photos, an audio recording of the donor’s voice, a handwritten message, an emotional intelligence profile, and finally our staff impressions of the donor, amongst other exclusive features.

The adult photos require special access on our website. Visit our website and find out more and get access to this new feature now.

Please note that the person in the photos is a model and not a Cryos donor.
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Fertility 360

Fertility And Sex: Why Her Orgasm Matters

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Why her orgasm matters

For many couples, trying to conceive can make sex feel less fun and more pressured. Instead of being an intimate and enjoyable experience, baby-making sex can start to seem like a finely choreographed routine. Often, the female orgasm is one of the first things to go, but the maleorgasm is not the only orgasm that matters when it comes to fertility.

Before I dive into discussing the potential benefits of the female orgasm for fertility, it’s important to note that reaching climax is not technically essential for conception. If you never, or rarely, achieve orgasm, don’t worry, you can still get pregnant! Around 1 in 10 women don’t experience orgasm, ever. What’s more, the exact nature of the female orgasm remains somewhat elusive. Some experience orgasm through clitoral stimulation, some through vaginal intercourse, some through both, and others through something else entirely, or not at all.

Even without reaching orgasm, sexual arousal is itself beneficial to fertility. Like an orgasm, arousal is, first and foremost, a good indication that sex is enjoyable. Sexual arousal and climax causes significant changes in your levels of neurotransmitters including noradrenaline, oxytocin, prolactin, dopamine, and serotonin. These ‘reward’ neurohormones help you bond to a sexual partner and make it more likely that you’ll have sex more often, thereby increasing your chances of conception.

Second, orgasm and arousal have a range of physiological effects that might aid conception, which I’ll discuss in a moment. And, third, sexual arousal and orgasms for everyone can help sperm-producing partners avoid feeling like they’re being used just for their sperm. In fact, some studies show that male partners who engage in cunnilingus prior to vaginal intercourse have greater sexual arousal and produce more semen!

HOW ORGASMS ENHANCE FERTILITY

The female orgasm can help relieve stress, and promote healthy circulation and balance in the body. Stress is a key cause of diminished libido and may also reduce the chances of conception by raising levels of the stress hormone cortisol. Conversely, good sex can help raise levels of oxytocin and the other neurohormones mentioned above. These help you to relax and bond to your partner.

Published in 1967, the author even went as far as suggesting that the increase in these hormones after orgasm help support conception by temporarily incapacitating you. Put simply, this ‘poleax’ effect means you’ll feel so relaxed that you’ll stay lying down, which may increase your chance of conceiving. Whether staying supine does make conception more likely is still under debate, but I’m all for promoting relaxation, so if this theory provides added motivation, go for it!

CERVICAL TENTING

There is some suggestion that orgasm affects the shape and function of the cervix. These effects, which may include cervical ‘tenting could enhance the likelihood of conception by promoting the movement of sperm into the uterus and beyond. If you are curious as to what your cervix looks like during different stages of your cycle, check out these photos.

THE ‘UP-SUCK’ THEORY

One of the main ways in which female orgasm has been linked to fertility is something called the ‘upsuck’ theory (or, sometimes, the ‘insuck’ theory). This theory proposes that the female orgasm causes uterine and vaginal contractions that actively draw semen up into the uterus and towards the fallopian tubes, thereby increasing the chances of an egg being fertilized.

Scientific evidence to support this theory is rather inconsistent, but there’s certainly no harm in trying! One proposed underlying mechanism of this theory is oxytocin-mediated uterine peristalsis, i.e. the same mechanism that causes uterine contractions during labour could be partially responsible for increasing the likelihood of conception. Indeed, some research has found higher pregnancy rates in women shown to experience this ‘insuck’ phenomenon.

SPERM RETENTION AND FERTILITY

More recently, one small study found that orgasm may increase sperm retention. This study involved women using a syringe to insert a sperm simulant (lube) prior to external stimulation to orgasm. As such, the study’s findings may be especially applicable to anyone undergoing artificial insemination (IUI).

The take-away: Chances are that if you orgasm 1 minute before or up to 45 minutes after insemination (whether artificial or otherwise), you will probably retain more sperm, which may increase your chance of conceiving.

IN CONCLUSION

To sum up, the female orgasm might enhance fertility in a variety of ways, but it isn’t essential to conception.

The take home message is that orgasm and sexual arousal itself have many benefits to fertility, partner relationships and stress relief. Don’t worry though, if you have a low libido, conception can still happen even in the absence of arousal and orgasm!

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What Is Polycystic Ovary Syndrome (PCOS)?

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Polycystic Ovary Syndrome

Polycystic Ovary Syndrome or PCOS is a hormonal imbalance that affects 5 to 10 percent of women of reproductive age across the world, and results in irregular or absent periods, acne, excess body hair and weight gain. It is also a major cause of infertility and yet is frequently misdiagnosed and often missed completely.

PCOS gets its name because under an ultrasound scan, the ovaries can look like a bunch of grapes, each one covered in what look like multiple cysts. In fact, these aren’t cysts at all, but are small, undeveloped follicles.

Symptoms

Not every woman with PCOS will get the same symptoms, but common signs to look out for include:

  • Few or no periods
  • Excess hair on the face or breasts or inside of the legs or around the nipples
  • Acne
  • Oily skin
  • Scalp hair thinning or loss (male pattern baldness)
  • Skin tags (known as acrochordons)
  • Skin discolouration (known as acanthosis nigricans) where the skin looks ‘dirty’ on the arms, around the neck and under the breasts
  • Mood swings
  • Depression
  • Lack of sex drive
  • Weight gain especially around the middle of the body
  • Difficulty in losing weight
  • Cravings and binges
  • Irregular or no ovulation
  • Difficulty in becoming pregnant
  • Recurrent miscarriages

PCOS creates a vicious cycle of hormone imbalances, which has huge knock-on effects throughout the rest of your body. With PCOS, the problem often starts with the ovaries, which are unable to produce the hormones they should, and in the correct proportions. But linked to this is the very common problem of insulin resistance. Women with PCOS very often have difficulties with blood sugar levels which can cause weight gain and the excess insulin can stimulate your ovaries to produce yet more testosterone. Half of all women with PCOS do not have any problems with their weight, yet they can still have higher insulin levels than normal.

How is Polycystic Ovary Syndrome diagnosed?

The most widely accepted criteria for the diagnosis of PCOS says that you should have two out of these three problems:

  • Infrequent or no ovulation
  • Signs (either physical appearance – hirsutism or acne – or blood tests) of high levels of male hormones
  • Polycystic ovaries as seen on an ultrasound scan

The Seven Nutritional Steps to beat Polycystic Ovary Syndrome

Good nutrition is the foundation of your health and you should never underestimate how powerful it can be. It is the fuel that provides you with the energy to live your life and it gives your body the nutrients it needs to produce your hormones in the correct balance. The better the supply of those nutrients, the more healthily your body will function.

The fundamental aim of my nutritional approach to PCOS is to target a number of areas simultaneously so that you get the maximum effect in the minimum amount of time.

Here’s how:

  1. Switch to unrefined carbohydrates (eaten with protein) and never go more than 3 hours without food to keep your blood sugar levels balanced
  2. Eat oily fish and foods rich in Omega 3s to help your body to become more sensitive to insulin so it can overcome insulin resistance
  3. Cut out all dairy products for 3 months to bring levels of male hormones under control
  4. Eat more vegetables and pulses to which helps control male hormones
  5. Cut right back on or cut out alcohol for 12 weeks to allow your liver function to improve
  6. Cut down on caffeine to give your adrenal glands a rest
  7. Cut down on saturated fats and eliminate trans fats to help control the potentially damaging inflammatory processes PCOS causes in the body

PCOS Symptons

Best Supplements for PCOS

The use of certain vitamins and minerals can be extremely useful in helping to correct Polycystic Ovary Syndrome, along with a good diet.

Chromium

Chromium helps to encourage the formation of glucose tolerance factor (GTF), which is required to make insulin more efficient. A deficiency of chromium can lead to insulin resistance.  It also helps to control cravings and reduces hunger. Can help to reduce insulin resistance associated with PCOS

B vitamins

The B vitamins are very important in helping to control the symptoms of PCOS. Vitamin B2 helps to burn fat, sugar and protein into energy. B3 is a component of GTF which is released every time blood sugar rises, and vitamin B3 helps to keep the levels in balance. Vitamin B5 has been shown to help with weight loss and B6 is also important for maintaining hormone balance and, together with B2 and B3, is necessary for normal thyroid function.

Zinc

Zinc helps with PCOS as it plays a crucial role in the production of your reproductive hormones and also regulates your blood sugar.

Magnesium

Magnesium is an important mineral for dealing with PCOS because there is a strong link between magnesium levels and insulin resistance – the higher your magnesium levels the more sensitive you are likely to be to insulin.

Co-Enzyme Q10

Co-Q10 is a substance that your body produces in nearly every cell.  It helps to balance your blood sugar and lowering both glucose and insulin.

Alpha lipoic acid

This powerful antioxidant helps to regulate your blood sugar levels because it releases energy by burning glucose and it also helps to make you more insulin sensitive. It also has an effect on weight loss because if the glucose is being used for energy, your body releases less insulin and you then store less fat.

Omega 3 fatty acids

Omega 3 fatty acids taken in supplement form have been found to reduce testosterone levels in women with Polycystic Ovary Syndrome.

Amino Acids

Certain amino acids can be very helpful for PCOS as they can improve your insulin sensitivity and also can have an effect on weight loss.

N-Acetyl cysteine

In women with PCOS this amino acid helps reduce insulin levels and makes your body more sensitive to insulin. Study using NAC in women who were clomiphene resistant and had ovarian drilling.  After ovarian drilling, the women given NAC compared to a placebo showed a significantly higher increase in both ovulation and pregnancy rates and lower incidence of miscarriage.

Arginine

Arginine can be helpful in reversing insulin resistance. In one study, a combination of both arginine and N-acetyl cysteine were given to women with Polycystic Ovary Syndrome.  The two amino acids help to improve blood sugar and insulin control and also increased the number of menstrual cycles and ovulation with one women becoming pregnant on the second month.

Carnitine

Carnitine helps your body break down fat to release energy and can help improve insulin sensitivity.

Tyrosine

Tyrosine is helpful for women with PCOS who are overweight as it helps to suppress the appetite and burn off fat.

Glutamine

This amino acid is useful for helping with sugar cravings as it can be converted to sugar for energy and so takes away the need to eat something sweet.  It also helps to build and maintain muscle which is important for fat burning.

Branched Chain Amino Acids (BCAAs)

BCAAs include three amino acids leucine, isoleucine and valine. They are important in PCOS because they help to balance blood sugar and having good levels of these BCAAs can have a beneficial effect on your body weight

Inositol

A study used inositol (2,000mg) in combination with NAC (600mg), a significant increase in ovulation rates.

Having a good diet, regular exercise, controlling stress and taking key nutrients will help in getting your hormones back in balance and reducing the negative symptoms associated with PCOS.

More information can be found on www.naturalhealthpractice.com

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