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The Great IVF Debate – Is the NHS Letting You Down?

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The IVF Debate

It is not easy living with fertility problems, but recent cuts to NHS-funded treatment services are making things even tougher for those who need IVF or ICSI. The past year has seen services reduced in many parts of England, with some areas no longer offering any NHS-funded fertility treatment. Campaign group Fertility Fairness, which works to improve access to NHS treatment, has branded the current provision a ‘national disgrace’ after it carried out an audit which found that just 2%of areas are now offering the recommended levels of treatment.

Decisions about whether to provide IVF are made on a local basis despite national guidance from NICE (the National Institute for Health and Care Excellence) on what should be offered. The NICE guidance is very clear; eligible women of 39 and under should receive three full cycles of IVF or ICSI. A “full” cycle means a fresh cycle with ovarian stimulation and then the transfer of any frozen embryos created too. For women of 40 to 42 who have been trying to get pregnant for at least two years, who haven’t had any previous treatment and who have a good ovarian reserve (which means their ovaries have a good capacity to produce eggs), NICE recommends one full cycle of treatment.

In England, decisions about whether to fund treatment are made by local Clinical Commissioning Groups, or CCGs. Although the national guidance is based on what is both clinically effective and cost effective, the local CCGs are able to choose whether or not to follow it. The majority don’t, with just four out of 209 CCGs in England currently funding what NICE recommends.

Many fund just one cycle, and others don’t include full cycles. CCGs are also setting their own criteria about who is eligible for treatment which restricts access further. In Scotland, Wales and Northern Ireland, the decisions about what to provide are made nationally but each nation funds differently and none are currently completely compliant with NICE guidance.

If you are in England, Essex is one of the worst places to live for anyone who needs IVF, with three areas providing no NHS fertility treatment at all, and South Norfolk has also decided to cut all services. Susan Seenan, who is Co-Chair of the campaign group Fertility Fairness, says the situation has become increasingly bleak; “Our audit shows that 98% of CCGs in England do not follow national guidance on access to NHS fertility treatment. This is cruel and unethical, and a national disgrace for the country that pioneered IVF. There can be no justification for ignoring NICE guidance. Infertility is a disease, and women and men who cannot become parents without medical help are as deserving of healthcare as people with other medical conditions.”

So, is there anything you can do if you discover what fertility services in your area are under threat? There is usually some kind of public consultation before services are cut or reduced, and there may be open public meetings too. If you don’t feel comfortable about going along to a meeting, responding to any online surveys or consultations and giving comments is worthwhile. It can sometimes feel as if these consultations are a rubber-stamping exercise, but this isn’t always the case. When a proposal was put forward to cut the single cycle provided in Bedfordshire, commissioners decided to continue to fund after the consultation as Dr Alvin Low, Clinical Chair of the local CCG explained when the decision was announced: “At Bedfordshire CCG we always put the voice of clinicians and patients at the heart of what we do. We have used the consultation period to ensure that we heard views from the public, patients, clinical staff and support organisations and those views have genuinely informed our decision making.”

As well as contacting the CCG, you can also email or write to your local Member of Parliament. If you aren’t sure who your local MP is, you can find their name and contact details by putting your postcode into the UK Parliament website (www.parliament.uk). There are also template letters you can use to write to your MP on the Fertility Fairness website fertilityfairness.co.uk. These are a good basis for your own letter, but personalising it as much as you can is helpful.

If your MP understands the impact that cuts or proposed cuts to NHS fertility treatment would have the lives of their constituents, they will be more likely to get involved in raising awareness of the issue in Parliament.

In the meantime, what are your options for treatment if you discover you do not meet the local criteria or your CCG does not offer IVF? You can launch an appeal, but you are only likely to win if you can demonstrate that you have an exceptional reason why you need to be offered treatment when most other people in your situation would not. Although people do win appeals, it is not easy to convince a CCG that your case is exceptional.

Eventually, paying for treatment may be the only option and it is expensive. Many NHS fertility clinics offer self-funded treatment and this can be less costly than a fully private service. At Guy’s and St Thomas’ Hospital in London, they have found self-funding is popular with patients, as Yacoub Kahalaf, Director of the Assisted Conception Unit, explains; “I think self-funding at an NHS unit is a very good idea for patients. If they have used up all of their NHS funding, or if they have had no access to NHS funding at all, they can still benefit from what the NHS offers and can get the best possible care at an affordable price.”

The other element of IVF or ICSI treatment which can add to costs is the medication, as the drugs you will need to take during an IVF cycle are not cheap. Most clinics can provide them for you and this may be a reasonable option, but supermarket pharmacies can offer value too. You may find considerable variations in price from different providers, so shopping around may help to reduce the overall cost of treatment. If you want to use an online pharmacy, check that they are registered with the General Pharmaceutical Council (GPhC) – most say this in the small print on their websites.

Treatment costs can also be kept down by thinking carefully about what you pay for. More and more fertility clinics are offering a wide range of additional treatments and although some include them as part of the cost of a cycle, patients are often given the option of paying for them on top of their standard treatment.

If you are presented with a long price list of add-ons, it can be hard to work out what, if anything, is worth paying for. Do ask why you are being offered extras, whether there are any side effects or risks, what the benefits might be and whether there is scientific evidence to back this up. There is no real proof that the many of these add-ons increase the likelihood of a successful treatment outcome, but they certainly can add to the already considerable cost of treatment.

There are now some fertility finance schemes where you pay a lump sum which is refunded if you don’t get pregnant. These involve paying more than one cycle would usually cost privately, but if you don’t get pregnant after the third cycle, they give you your money back. The drawback with these schemes is that you pay more than you might have done otherwise if you get pregnant on the first cycle, and they are only open to those who are most likely to be successful, so although they sound promising not everyone will be eligible.

For younger women, egg sharing can reduce the cost of treatment but this is not something to be undertaken lightly as it involves donating some of your eggs to another patient. Being an egg donor is a huge consideration in itself, and you would want to think carefully about the implications and spend time talking it through with a counsellor before coming to any decision.

In the past, travelling elsewhere in Europe for treatment was often a cheaper way of accessing IVF. When you factor in travel and accommodation costs as well as recent changes in the exchange rate, this may not work out to be such a saving in the current climate. It is also vital to do your homework if you are considering treatment overseas and to remember that different countries have different rules and regulations about assisted conception.

It is 38 years since the first ever IVF baby, Louise Brown, was born here in the UK, and at that time the future had never seemed so rosy for couples with fertility problems. Sadly, now that access to treatment depends on where you live or how much money you have, that rosy future has not become a reality for everyone.

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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 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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