Understanding Fertility

INDEPENDENT PUBLICATION BY RACONTEUR.NET #0514 24 / 04 / 2018 UNDERSTANDING FERTILITY

DARING TO UTTER SHOULD THE BOSS CAN TECHNOLOGY 03 THE ‘F’ WORD 06 GET INVOLVED? 14 GET YOU PREGNANT? Start your fertility journey with…

34 specialist clinics and referral centres

• Glasgow • Dundee • Edinburgh • Belfast • Ballykelly • Letterkenny • Chesterfield • Stoke-on-Trent • Nottingham • Burton upon Trent • Salisbury • Oxford • Milton Keynes • Stratford- upon-Avon • Worcester Giving Life a Helping Hand • Swindon • Cheltenham • Chelmsford Excellent success rates across the UK; A new Fertility Partnership baby • Romford among the highest success rates arrives every 4 hours* • Maidenhead in Europe Helping people start a family is our passion • Reading With some of the leading embryologists and with 32 centres around the country, • Windsor and fertility experts in the world, through appointments closer to home are so much easier. • Great Missenden “We thought it was the most amazing clinic, investing in state-of-the-art technologies from • London we felt like individuals there and really felt like time-lapse photography to the latest genetic Harley Street everyone was rooting for us to have a baby” screening, and containing one of only two UK • London Isla, Wessex Fertility clinics ranked above the national average** we Boston Place are among the most successful in Europe. The Fertility Partnership is the largest • Gatwick “I really felt that they did everything to get me 99% of patients would recommend provider of fertility treatment cycles • Portsmouth pregnant, and stay pregnant” treatment with us in the UK ** • Southampton Joanne, Boston Place Stepping through our doors, you’ll immediately Our clinics have been helping people start • Poole be greeted by welcoming staff, in elegant families for over 35 years. When all you want is surroundings where our people will hold your to have a baby, you need to know that you’re • Basingstoke hand every step of the way through your in safe hands: it’s no wonder we’re the largest • Waterlooville fertility journey. provider of fertility treatment in the UK. • Guernsey “You’re not just a person or a number or a “The care we received during the treatment • Krakow client, you’re more of an individual” was exceptional” • Szczecin Ruth, Simply Fertility Lucy, GCRM Let’s start your fertility journey

Visit thefertilitypartnership.com to find your nearest clinic and open event Giving Life a Helping Hand CARE EXPERTISE PASSION TRUST INNOVATION

*(HFEA data published March 2016) **(HFEA data published March 2018). Names have been changed to protect patient anonymity. RACONTEUR.NET 03

PROGRESS UNDERSTANDING Start your fertility journey with… FERTILITY Daring to utter

Distributed in 34 specialist the ‘f’ word clinics and Published in association with Advances in fertility treatments must be matched with greater referral centres understanding of the personal impact of dealing with infertility • Glasgow • Dundee • Edinburgh • Belfast CONTRIBUTORS MAGDA IBRAHIM rounds to have twin girls at 44 and explains. “The more we talk about • Ballykelly ertility: the “f” word so taboo fertility, IVF and what it means to • Letterkenny MARTIN BARROW KATE BRIAN that six out of ten women are have children for both sexes, the Former health editor, Author, blogger and more reluctant to talk about better,” she says. “It’s important • Chesterfield news editor, foreign journalist, she has it than sexually transmitted Jacobs/Unsplash Jenna to discuss fertility and decision- news editor and written four books on • Stoke-on-Trent Fdiseases or mental health. making that concerns creating business news editor fertility and is women’s • Nottingham at The Times, he voices lead at the Royal Yet 3.5 million people in the UK a family freely and frankly in as specialises in the NHS College of Obstetricians are affected by infertility at the many forums as possible, includ- • Burton upon and social care. and Gynaecologists. same time as groundbreaking ing the media, but also at home Trent research is delivering leaps in sci- and in schools.” • Salisbury DANNY BUCKLAND ANNA entific innovation. With official figures showing an Award-winning health CODREA-RADO In the 40 years since IVF was increasing average age of mothers – journalist, he writes for Freelance culture and • Oxford introduced, advances including it’s 30.4 years in the UK – openness national newspapers and technology journalist, her • Milton Keynes magazines, and blogs on work has been published gene editing, growth in reproduc- around fertility decline is evermore health innovation and in The New York Times, tive medicine, egg freezing, dona- significant. • Stratford- technology. The Guardian and tion and surrogacy have created a And while birth rates from IVF upon-Avon WIRED. brave new fertility landscape. treatment have increased by around • Worcester But it’s not hard to see why many 85 per cent in the last 25 years, there HAZEL DAVIS OLIVER GRIFFIN facing fertility challenges stay are no guarantees, as a third of fertil- Freelance business writer, Based in Latin America, • Swindon silent. Societal pressure, lack of ity treatment cycles result in a birth Giving Life a Helping Hand she contributes to The he writes for the i, The • Cheltenham Times, Financial Times, Economist and The Daily employment support, and feelings for women under 35, dipping to less The Daily Telegraph and Telegraph from countries of confusion and despair can be than 15 per cent for those over 44. • Chelmsford The Guardian. including Colombia, overwhelming. “We are living longer, healthier Excellent success rates across the UK; A new Fertility Partnership baby • Wickford Honduras and Argentina. Stigma around fertility can lives, so people can be astounded by among the highest success rates arrives every 4 hours* • Maidenhead stem from its personal nature, natural and IVF fertility rates,” says MAGDA IBRAHIM JOHN ILLMAN says Professor Tim Child at the Professor Child. “Many people think Helping people start a family is our passion • Reading Award-winning Award-winning author, in Europe journalist, working he is a former national University of Oxford’s Nuffield being healthy and going to the gym With some of the leading embryologists and with 32 centres around the country, • Windsor across consumer and newspaper health Department of Obstetrics and is to empower patients to make Meanwhile, political cogs are must help, but it doesn’t help the business media, she is editor and medical Gynaecology. informed decisions and improve turning and an inaugural All Party genetic quality of eggs and sperm.” and fertility experts in the world, through appointments closer to home are so much easier. • Great Missenden contributing editor at correspondent. “It involves sex and reproduction, their chances of having a longed-for Parliamentary Group on Women’s The complexities of the fertil- “We thought it was the most amazing clinic, investing in state-of-the-art technologies from • London MadeForMums. and most people assume at some family,” she says. Health, including fertility, ity question can make it tricky to we felt like individuals there and really felt like time-lapse photography to the latest genetic Harley Street point they will have children,” says While high-level data engenders launched last month supported by grasp, especially for those who have screening, and containing one of only two UK everyone was rooting for us to have a baby” Professor Child, who is the medical transparency, it’s the grass roots that health minister Jackie Doyle-Price. never experienced the struggle. But • London director at Oxford Fertility. “When are critical in changing attitudes. “Fertility is a fundamental aspect a new exhibition launching at the clinics ranked above the national average** we Isla, Wessex Fertility Boston Place that doesn’t happen, some are Despite running a success- of our society,” says Professor Child. Science Museum in London on July are among the most successful in Europe. The Fertility Partnership is the largest • Gatwick embarrassed, or feel a sense of fail- ful podcast that has been down- “More people talking about it has to 5 will put fertility under the spot- “I really felt that they did everything to get me 99% of patients would recommend provider of fertility treatment cycles ure or shame.” loaded 150,000 times in 50 coun- be positive.” light for around 370,000 visitors. • Portsmouth Fertility Network UK chief execu- tries since launching in 2014, The But an honest fertility narra- The five-month showcase will pregnant, and stay pregnant” treatment with us in the UK ** • Southampton Publishing manager Head of production tive Aileen Feeney adds: “There’s a Fertility Podcast producer Natalie tive is a tough ask when faced with not only celebrate 40 years since Joanne, Boston Place Stepping through our doors, you’ll immediately Our clinics have been helping people start Alexandra Justyna O'Connell huge stigma. It is so unfair that peo- Silverman spent the first year host- miraculous celebrity pregnancy the birth of the first IVF baby, • Poole Bowman Bassin be greeted by welcoming staff, in elegant families for over 35 years. When all you want is Digital content executive ple think they can’t speak about it.” ing the show anonymously. tales. Researchers from New York Louise Brown, at Oldham General Look at the statistics though and “Eventually I felt like a hypocrite University who analysed maga- Hospital, following pioneering surroundings where our people will hold your to have a baby, you need to know that you’re • Basingstoke Production editor Elise Ngobi Benjamin Chiou it’s clear the secret’s out, at least discussing taboos around fertil- zines covering 240 celebrities with treatment from Patrick Steptoe, Sir • Waterlooville Design hand every step of the way through your in safe hands: it’s no wonder we’re the largest within the fertility community. ity, while not willing to share my an average age of 35 found they con- Robert Edwards and Jean Purdy, Managing editor Samuele Motta fertility journey. provider of fertility treatment in the UK. • Guernsey More than 1.1 million IVF treat- own name,” she reveals. “Now cre- tributed to misunderstanding of but also explore the ongoing nego- Peter Archer Grant Chapman “You’re not just a person or a number or a “The care we received during the treatment • Krakow Kellie Jerrard ment cycles have taken place in UK ating a constant digital dialogue is reproductive ageing. tiation between science and society licensed clinics since 1991, while empowering people and challeng- Only two mentions were made of around the once-fringe technology. client, you’re more of an individual” was exceptional” • Szczecin Head of design at least 20,000 babies are born ing misunderstanding.” celebrities over 40 using assisted Connie Orbach, content developer Tim Whitlock Ruth, Simply Fertility Lucy, GCRM here each year as a result of fertil- Education in schools has a role, reproductive technology with their for the Science Museum exhibition, ity treatment, around 3 per cent of with the British Fertility Society own eggs, with no mentions of explains: “It is important this exhi- all births. leading a task force to bring issues donated eggs. bition is a catalyst for conversations

Although this publication is funded through advertising and Worldwide it is estimated 6.5 mil- including future fertility on to the TV presenter Julia Bradbury has around fertility.” sponsorship, all editorial is without bias and sponsored features lion people are alive today because national curriculum. been candid about her five IVF As the scientific world celebrates are clearly labelled. For an upcoming schedule, partnership of IVF technology. four decades of IVF contribution Let’s start your fertility journey inquiries or feedback, please call +44 (0)20 3877 3800 or The Human Fertilisation and to reproductive health, Louise email [email protected] Embryology Authority (HFEA), Brown emphasises the real-life Raconteur is a leading publisher of special-interest content and the independent regulator for the of women with impact of the sector. “I think my research. Its publications and articles cover a wide range of topics, fertility problems Visit thefertilitypartnership.com to find your nearest clinic and open event Giving Life a Helping Hand sector, believes sharing its data mum, Lesley, would be amazed at including business, finance, sustainability, healthcare, lifestyle and did not seek help – like the fact that male infertil- how many different techniques technology. Raconteur special reports are published exclusively in 43% when trying to The Times and The Sunday Times as well as online at raconteur.net ity accounts for 37 per cent of IVF become pregnant there are now to help both men CARE EXPERTISE PASSION TRUST INNOVATION The information contained in this publication has been obtained cycles carried out – can challenge and women with their fertility,” from sources the Proprietors believe to be correct. However, stereotypes and shine a much- she says. “Almost 40 years after no legal liability can be accepted for any errors. No part of this needed light on relatively new pro- of men with my birth, doctors and scientists publication may be reproduced without the prior consent of the cesses such as egg freezing. / fertility problems are still doing fantastic work. They Publisher. © Raconteur Media 1 6 Joanne Triggs, HFEA’s head couples have difficulty 47% did not seek help should never forget at the heart of of engagement, says knowl- conceiving this are ordinary people who just @raconteur /raconteur.net @raconteur_london edge is a powerful tool. “Our aim London School of Hygiene & Tropical Medicine 2016 want to have a family.” *(HFEA data published March 2016) **(HFEA data published March 2018). Names have been changed to protect patient anonymity. raconteur.net /understanding-fertility-2018 04 UNDERSTANDING FERTILITY RACONTEUR.NET 05

Commercial feature MALE INFERTILITY

We want to

empower women to Naibaho/Unsplash Hanny take control of their fertility, whether that’s to prevent or plan for a pregnancy

trialled the concept with fellow CERN Stigma about male colleagues, in Geneva, and discovered that many of her female colleagues were looking for an effective alternative to hormonal contraception. infertility remains “As the only certifi ed contraceptive app, we are providing women with an additional option to choose from Fertility is a medical frontier where the gender gap is that is effective, non-hormonal and non-invasive,” she says. “Our typical disturbingly wide and male infertility an under-researched users, and those who we believe are most suitable for Natural Cycles, are part of the conception equation 30 years old on average, in a stable relationship and for whatever reason fi nd that hormonal options are not suitable for them. Most of our users were previously using less effective and Community Studies at Leeds Dr Sheryl Homa, who runs methods of contraception such as DANNY BUCKLAND Beckett University. Andrology Solutions, a male fer- withdrawal or condoms.” “I am really surprised by how lit- tility clinic licensed by the Human machines and blood pumps for The app is used in two thirds of cases he biology of how a sperm tle research we have about men’s Fertilisation and Embryology heart-lung machines. to prevent pregnancy and in one third swims to and fertilises infertility and their voices are lack- Authority, believes couples are “Receiving EU certifi cation indi- to plan a family. an egg remains, largely, ing from the discussions. We don’t directed too readily towards IVF A contraceptive app cates how Natural Cycles is lead- “At Natural Cycles, we are pioneering unchartered scientifi c ask about how they feel if they can’t based on a rudimentary sperm ing the charge in digital health,” a new era in which women are more Twaters, and lags behind under- have children or about their desire analysis without full considera- adds Dr Berglund, who co-devel- aware and in control of their bodies standing of female fertility. to have children. tion of health issues that might be oped the app with husband Dr Raoul than ever before. We want to empower The alarming statistic is that “There is a stigma about male infer- impinging on male fertility. that can map fertility Scherwitzl, a fellow physicist. The women to take control of their fertility, although a healthy, successful tility. Our social constructs of mas- “It is a gold-standard test, but it couple researched how levels of pro- whether that’s to prevent or plan for a sperm is 50 per cent of a success- culinity and being a man are about is not the only test,” says Dr Homa, gesterone, a hormone that plays an pregnancy,” says Dr Berglund. ful fertilisation, there is only one someone who is sexually active and a clinical embryologist and honor- Technology is transforming every aspect of modern life important role in the menstrual cycle, After helping discover the Higgs- licensed fertility clinic dedicated virile, and we can confl ate fertility ary senior lecturer in biosciences are increased after ovulation causing Boson particle, Dr Berglund has con- to men, while the legions of others with virility.” at the University of Kent. “It is for women – and health is no exception women’s body temperature to rise by tinued on a route that is using science focus almost solely on women. This barren zone of knowledge is a poor indicator of fertility and up 0.45C compared with the rest of to make important advances in soci- Research into male factors is min- pushing couples towards expensive World Health Organization guide- their cycle. This provides the foun- ety. “We believe Natural Cycles offers imal, allowing myths to prolifer- and emotionally draining IVF cycles lines recommend that you can- ore and more tech-savvy the data builds into an individualised fer- Dr Elina Berglund, a former member dation of the Natural Cycles accurate exciting possibilities for the future in ate and an undercurrent of placing or intracytoplasmic sperm injections, not investigate male reproductive IVF; you would investigate to make women are now turning to tility indicator that identifi es green days, of the CERN team that discov- fertility calibration. terms of providing healthcare profes- responsibility on the female side. which involves the direct injection of health based on just that test. sure she doesn’t have other con- apps to monitor and track when it is safe to have unprotected sex, ered the Higgs-Boson particle, who In a study of 22,785 women aged sionals with valuable information that “The lack of research is crucial. sperm into eggs obtained by IVF. “You need a full reproductive Our social constructs of founding issues such as fi broids in the Mvarious aspects of their or red days, when condoms should be invented the app. 18-45, through 224,563 menstrual could help inform diagnoses, and on Men have not featured as heav- Allan Pacey, professor of androl- health test looking at fertility masculinity and being a man uterus that impair embryo implanta- health and wellbeing, including fertility. used. After approximately three months, “Unlike other fertility awareness cycles across two years – the largest a macro-level, to better understand ily in research in reproduction ogy at Sheffield University, is history, general health – because tion which if removed may result in Natural Cycles is the only app to be users can expect to see roughly 60 per- methods, Natural Cycles eliminates trial of a natural contraceptive to date fertility as a whole,” she says. and socially we construct repro- among many academics and systemic illness could be a cause are about someone who is natural pregnancy. certifi ed for use as a contraceptive in cent green days in one cycle. human error because the app does and published in the peer-reviewed duction much more as a female experts who confirm that levels of of poor semen quality – medical “So why would you send a man Europe and now has more than 700,000 “The algorithm behind Natural all of the calculations and interpreta- journal, Contraception – the “typi- issue,” says Dr Esmée Hanna, a scientific evidence on sperm cell and urological history, underly- sexually active and virile, off without a testicular scan that users worldwide. The app is powered by Cycles was created to help women tions for you.” cal use” effectiveness rate of Natural For more information please visit researcher at the Centre for Health function fall way behind other ing infections, and issues such as and we can confl ate fertility might reveal the underlying cause a sophisticated algorithm, which enables understand their own unique cycles. Natural Cycles has received Cycles was 93 percent, which is com- naturalcycles.com Promotion in the School of Health branches of medicine. varicoceles – enlarged veins in the of his sperm quality and infertility? women to tune into their unique monthly It takes into account sperm sur- European Union certifi cation as a parable with the pill. with virility Detection of a varicocele, for exam- cycles to map and predict ovulation, and vival, variation in cycle length, ovu- Class IIb medical device, in the same Dr Berglund, 33, who is based in ple, may explain poor semen param- is backed by a wealth of scientifi c data. lation day, temperature fl uctuations, classifi cation as dialysis equip- Stockholm, got the idea when she eters and indicate damaged sperm Users take their temperature with a and the length of the follicular and ment, intensive-care monitoring wanted to give her body a break from Three myths about male infertility DNA, and there is evidence to show basal thermometer each morning and luteal phase,” says particle physicist and alarm devices, anaesthesia hormones before starting a family. She that varicocele repair can improve Allan Pacey, professor of andrology at Sheffi eld University and editor of the sperm DNA quality and increase British Fertility Society’s journal Human Fertility, puts the record straight scrotum – which can all contribute both natural and assisted concep- to poor fertility for men. A physical tion pregnancy rates.” EFFECTIVENESS OF CONTRACEPTIVE METHODS, TYPICAL USE 1, 2 Case study exam is also advised.” Dr Homa also believes that more Results from detailed health research is needed to gauge the Planning it like a Cycling is checks give clinicians better options impact of exposure to chemicals and Sofi e, a search engine that this was a good idea too. military operation damaging Save it up to address and manage male infertil- medications, such as antidepres- >99% optimisation consultant, After discussing it together, we ity, she adds. sants, on male fertility, while edu- IUD Implant started using the Natural decided to give it a go. This can lead to stress Cycling to work is not This is a bad thing to do “Treatment management should be cating young men on their role in Cycles app a year ago and says: “It only took one menstrual for some men which in something you should worry as the stored sperm gets assessed on these results rather than conception needs to be improved. “It has helped me learn so cycle for the app to detect my turn leads to poor sexual about and moderate exercise older, dies and releases saying ‘off to IVF’ on the basis of the “It is absolutely key that men look much about my body.” ovulation, I got to know my performance and can is good for you. I would not free radicals which damage semen test,” says Dr Homa. “I believe after their reproductive health if 90-95% The 27 year old says: “When body and just how regular my change the ejaculatory suggest giving it up unless younger sperm. The point there are a lot of people having IVF they are considering trying for a The pill Natural Cycles a friend told me about Natural cycle is, and with it came the response. There might be you were a triathlete because is to have a healthy sex life who don’t need it or who are handi- family,” she concludes. “Men need Cycles, I was excited as the understanding of my moods something in theories that there is evidence that men at and, if a man is ejaculating capped because the man has an under- to understand that the whole point idea of natural contraception and emotions throughout sperm quality is better at the edge physiologically have two to four times a week in lying infection, a varicocele that is of the sperm is to deliver healthy <85% really appealed to me. my cycle. It has now been a certain times, but this is poorer sperm because they sex, this means the sperm damaging the sperm DNA or oxidative genetic material into the egg and “Because I’m in a year-and-a-half since I started insuffi cient to provide a have pushed themselves to production process is in tip- stress interfering with the functional- any anomalies passed on will have Condom Traditional FABM* relationship, it was important using Natural Cycles and it marginal gain. the max. top condition. ity of the sperm including fertilisation. consequences in every single cell for me that my partner felt feels amazing.” “If you had a female patient who of that embryo – they are 50 per Dr Elina Berglund User dedication Chief technology offi cer Low High 01 02 03 has problems with her hormones, you cent responsible for the health of and co-founder, Natural Cycles wouldn’t simply send her straight to that embryo.” 1 Berglund Scherwitzl E et al. Contraception 2017; 96; 420-425 2 Trussel J. Contraception 2011; 83; 397-404 *Fertility awareness-based methods 04 UNDERSTANDING FERTILITY RACONTEUR.NET 05

Commercial feature MALE INFERTILITY

We want to

empower women to Naibaho/Unsplash Hanny take control of their fertility, whether that’s to prevent or plan for a pregnancy

CORPORATE FERTILITY Commercial feature

y heart sank when I fi rst career, and that is a step backwards. businesses to stand out in the mar- heard about fertility bene- If we want to live in a society where ketplace by acknowledging this. fi ts because it just seemed families prosper, we’ve got to move Organisations that are brave to me like another fi x cre- away from the unconscious behaviour enough to do things diff erently can Should the Mated to keep business as usual. of placing women into the outdated walk away from the gender-box From the moment women entered “mothers” box and fathers into another bias and behaviour, and be seen as the workforce, they’ve been forced historically limiting box. It’s time we a sustainable and inclusive brand, to fi t into a box – let’s call it the busi- started talking about the roles and creating a culture where both par- boss get ness-world box – and as we all know, responsibilities of both parents, and ents and their children thrive. This that box was created by men for men. acknowledging that every child has the makes for a really magnetic brand, Women have been continuously right to be raised by both parents. irresistibly attractive for both the trying to fi t into that limiting box, It is vitally important for us all right talent and clients. involved? bowing down to all sorts of demands to raise our awareness about the to be accepted. Women are told they historic gender-bias boxes and need to be competitive, to “lean in” be brave enough to look at our Two thought leaders debate the pros and demand their space. At the same responsibility for becoming the time, women should be cautious, change we want to see in our world. and cons of corporate intervention in making sure not to expose too much There is a massive opportunity for cleavage and heaven forbid women women’s fertility through a “freeze dress in a way that’s too sexy. your eggs” benefi t scheme In 2018, isn’t it time to say good- Runa Magnus bye to old boxes limiting 50 per Founder of The Change Makers and cent of human beings? leader of the #NoMoreBoxes movement This new “freeze your eggs” as a benefi t scheme is, for me, a feeble and misguided attempt to fi x a prob- Celebrating 350 years lem and a way to avoid looking at the whole picture. It might be done with good intentions, especially from Against a business perspective, but in my of dedicated service opinion, by encouraging women to plan for families by freezing fertilised eggs, businesses are not being With a long history of achievement, Merck is striving to help provide authentic. They are not giving both parents the space to have a role in the best outcomes for couples hoping to have a family raising their family and also have a

For erck is celebrating its these needs through invest- a drugs company into a holistic fertil- Aliya Vigor-Robertson 350th anniversary this ment in innovation, research and ity provider, to help women and cou- Co-founder of JourneyHR year. Founded in 1668, patient support. ples fulfil their dreams of parenthood. Mthe world’s oldest phar- Business unit director Phil Krzyzek Working with both the NHS and pri- maceutical and chemicals business says: “At Merck we are very proud of vate sector, Merck Fertility strives of life for staff, then leaders and has evolved into a science and tech- our long heritage in fertility treat- to leverage the science behind the HAZEL DAVIS HR have a place to provide it. nology company in healthcare, life ment, primarily focusing on drug company’s heritage, supporting clin- If handled effectively, benefits sciences and performance materi- development to support the patient ics in their patient management deci- Science Photo Library/Getty Images Library/Getty Photo Science that respond to the challenges als. Around 50,000 employees work across key stages of fertility treat- sions. The company recognises the f good mental or physical well- around fertility can help improve to further develop technologies that ment. While the success rate of IVF importance of continuing to support being are at risk, then a for- staff wellbeing and create a sup- help create, improve and enhance has improved significantly over time, the improvement of success rates in ward-looking business will porting culture. But again, as with life, from biopharmaceutical thera- there are still phases of both the clin- ART by investing in research and edu- take responsibility for assist- parental benefits such as shared pies to cutting-edge systems for sci- ical and emotional journey that could cation in innovative technologies as Iing in any way it can to make sure leave, it takes time for these entific research and production. be further improved. research and development plays a staff are well cared for. things to be adopted or seen as the Since the 1950s, Merck has provided “As a science and technology critical role in increasing treatment So if it has an impact on the industry norm and it all goes back healthcare professionals and patients company, we are now applying our success rates. employee, then it makes sense to remembering who these bene- with innovative fertility treatment broader capabilities to provide fertil- Merck has a strong commitment that fertility may well be the busi- fits are for. options, devices and advanced fertility solutions beyond drug treatment to training and medical education, ness of human resources. If the focus remains on the indi- ity laboratory technologies. to help drive success rates even fur- which is designed to support fertility Women are feeling more empow- vidual members of staff, then cor- Assisted reproduction technolo- ther. We are investing in technolo- specialists, specialist nurses and lab- ered than ever to achieve both porate fertility has the potential gies (ART) have made tremendous gies, which are utilised within the IVF oratory technicians with their contin- motherhood and career fulfil- to support individuals wanting progress since the birth of the first laboratory, as well as developing ser- uing medical education. Educational ment. Both are possible and, for to start a family. The second this IVF baby Louise Brown 40 years ago, vices to support clinics and patients events are held at various locations some women, corporate fertility becomes a method to delay preg- and now provide options that were throughout the whole IVF journey.” throughout the UK and Republic of can help on this personal mission. nancies or avoid parental leave, the previously unavailable to women Merck’s innovations are driven by Ireland, and are well supported by It’s about responding to staff business has taken a wrong turn. and couples experiencing fertility a focus on areas that make the most healthcare professionals. needs. The emphasis here is on To avoid slipping into this problems. Nevertheless, infertility relevant difference to patients, Mr Krzyzek concludes: “The innova- benefits; they’re an option that “employer benefit” trap, HR needs remains not only an area of high clin - aiming to improve the treatment tion process requires that we lever- staff can utilise if they want and to stay aware of how this is being ical need, but is also a psychosocial experience and success rates. In age capabilities right across our own not something the employer forces communicated and ensure no one issue, which needs to be addressed addition, Merck is actively exploring organisation, but also work in part- on them. They are employee ben- is pressuring employees to take up through a patient-centric approach. the use of novel services that may nership with others. We believe that efits not employer benefits and the option for the wrong reason. Merck is committed to addressing help make the treatment journey by working in partnership with other should be treated as such. But equally, information about psychologically easier for the patient, organisations, which share our strong This may be helping to conceive the benefit should be easily acces- and help improve communication commitment to innovation, quality a child where there are problems sible and openly discussed to keep channels between the patient and and excellence, we can achieve the in doing so. Or, perhaps, it is about any taboo at bay. the fertility clinic. best outcomes for those hoping to helping a woman to plan when she Ultimately, if you keep it This foundation and commitment have a family.” wants to have children, whether employee led at all times, lives to pioneering ideas makes Merck an that’s now or later in life. could be transformed. As with any 40years expert in the field of fertility, offer- Just as with shared parental benefit, the right package has to of progress in assisted ing a broad portfolio of fertility For more information please visit leave or childcare support, not reflect the drives and motivations reproduction technologies options at every stage of the repro- merckgroup.com every member of staff will want to of employees, and establish the (ART) since the birth ductive cycle. By establishing Fertility use fertility services, but if it could right balance between work and of the first IVF baby Technologies and partnering with significantly improve the quality personal life. Louise Brown other experts, Merck has grown from 06 UNDERSTANDING FERTILITY RACONTEUR.NET 07

CORPORATE FERTILITY Commercial feature

JAPAN Growing pains of Japan’s fertility drive

Low fertility rates likely to work,” says Dr Jones. “If they get money for having babies they don’t and an ageing have to work, and the government wants them to work and have babies.” population are Another thing that needs to be an unwelcome Ortego/Unsplash Jason tackled to kickstart a baby boom is Japan’s culture of workaholism, combination which is so severe that karoshi – lit- erally death by overwork – is now an threatening Japan’s infamous phenomenon. Dr Jones says the government is currently economic future considering legislation that would cap the total amount of overtime a worker could do at 100 hours a month, limited to 720 hours a year. By reducing the number of hours that people can work, Japan is trying to improve work-life balance and free people up to spend more time with their families. So far, initiatives to boost Japan’s OLIVER GRIFFIN fertility rate have had limited success, at least according to a case ll is not well in the Land of study published by the Centre for the Rising Sun. Japan, a Public Impact. The organisation says country whose gross govern- that while Japan’s fertility rate has ment debt as a proportion of increased, it continues to lag behind AGDP rose to 253 per cent in 2017, faces the OECD average of 1.7. the dual challenge of an ageing popu- What’s more, despite even limited lace and dwindling births. success in growing fertility rates, If left unsolved, these twin issues the Centre for Public Impact also will squeeze Japan’s shrinking found that the number of women of workforce with the burden of pay- child-bearing age leaving the labour ing for the old and young. Combined force has increased; the exact oppo- with a low fertility rate of around site of what the Japanese govern- 1.4, which represents the number of ment is hoping to achieve. With day- children that an average Japanese Co-operation and Development very dramatic,” Dr Jones says. “We’re care waiting lists in the 20,000s, it woman will have in her lifetime – a (OECD). “Companies are starting to not going to be able to stabilise the is unlikely that returning to work sustainable rate is 2.1 – Japan’s ris- cut back their services, restaurants population for quite some time. It’s a Low fertility rates, coupled with for many young mothers will be an ing costs will have to be close early, delivery services won’t very stark picture.” option any time soon. paid by an ever-smaller cover parts of the country.” Aware that time is of the essence, ageing populations, are testing One more side effect is that if the proportion of workers. According to Dr Jones, if fertil- prime minister Shinzo Abe has nations across the Far East baby boom really does take off, the “There is a terri- ity rates do not improve, Japan can focused considerable effort on per- first two decades are going to see ble labour shortage expect its population to fall from suading Japanese families to up their the working population come under in Japan,” says Dr around 128 million at present to game when it comes to baby-making. immense pressure. “The first 15 to 20 Randall S. Jones, 98 million by 2050. As that hap- While Japan has seen its fertility rate included boosting the number of years, if they did get a rise in the num- head of the Japan pens, the proportion of elderly peo- grow since a low of 1.3 in 2005, Mr childcare places available throughout ber of babies, would be even more dif- and Korea ple aged over 65 will increase from Abe is going to have to hope he can the country, with free childcare for ficult,” says Dr Jones. “That would desk at the about 26 per cent now to 45 per cent persuade his citizens to get on board infants aged three to five years old. be a short-term transition to a steady Organisation at the mid-point of the century. if the country is going to meet his fer- Japan has also doled out cash pay- equilibrium, but would mean more for Economic As a result of the country’s rapidly tility rate target of 1.8. ments for new mothers. However, spending on education.” ageing population, April saw credit rat- To facilitate this, Japan’s govern- this can’t be extended to paying Whatever Japan’s future, the coun- ing agency Moody’s warn of near-term ment has tried a number of differ- women to take care of their own chil- try is not alone in facing such prob- and long-term credit challenges, as ent initiatives. Examples include the dren, as Japan still needs to address lems. Low fertility rates, coupled well as slower GDP growth, caused by Plus One Proposal, which has tried to its impending labour shortage. with ageing populations, are testing lower household savings, a narrower encourage Japanese families to grow “Giving people money to have babies, nations across the Far East, includ- tax base and rising welfare costs. by “plus one”, as well as the Angel Plan like an allowance, makes women less ing Taiwan and South Korea. “We’re talking about losing 30 mil- and the New Angel Plan, which were lion people – the situ- used to make having children easier ation now is and more attractive. Incentives Dwindling numbers present Fertility rate (number of children a worrying picture for Japan a woman is expected to have over a lifetime) 2 Comparing the annual number of births, fertility rate and population growth Yearly population growth (%)

Annual number of births (m)

0 0

1947 1952 1957 1962 1967 1972 1977 1982 1987 1992 1997 2002 2007 2012 2017 Ministry of Health, Labour and Welfare/Worldometers 2017 08 UNDERSTANDING FERTILITY RACONTEUR.NET 09

JAPAN Commercial feature

Changing demographic trends across Growth in egg-freezing rates2 Growing pains of Japan’s fertility drive the European Union1 1970 2014 Low fertility rates likely to work,” says Dr Jones. “If they 2012 get money for having babies they don’t Rebirth of and an ageing have to work, and the government population are wants them to work and have babies.” 25-30% Another thing that needs to be 16.4 10.1 2013 increase year

Jason Ortego/Unsplash Jason tackled to kickstart a baby boom births per births per on year in egg- an unwelcome a company freezing in is Japan’s culture of workaholism, 1,000 people 1,000 people the UK which is so severe that karoshi – lit- combination 2014 erally death by overwork – is now an threatening Japan’s infamous phenomenon. Dr Jones for women’s says the government is currently economic future considering legislation that would cap the total amount of overtime 3 1 4 4 4 a worker could do at 100 hours a wellbeing month, limited to 720 hours a year. 10% 29 80% 60% 70% By reducing the number of hours of couples are years is the average of respondents of respondents of respondents that people can work, Japan is try- experiencing age of fi rst support egg-freezing support eggfreezing under the age In an information-rich society, with women infertility time mothers when a woman ing to improve work-life balance and for lifestyle reasons of 35 support becomes infertile due egg-freezing free people up to spend more time keen to make informed decisions about to medical reasons with their families. So far, initiatives to boost Japan’s their general and reproductive health, an OLIVER GRIFFIN fertility rate have had limited suc- Who should bear the cost of egg-freezing prior Individual/couple Government Other cess, at least according to a case innovative healthcare company is garnering to undergoing cancer treatment? 4 ll is not well in the Land of study published by the Centre for attention with its commitment to exclusively the Rising Sun. Japan, a Public Impact. The organisation says Percentage of respondents by country country whose gross govern- that while Japan’s fertility rate has support women’s health and wellbeing UK ment debt as a proportion of increased, it continues to lag behind France AGDP rose to 253 per cent in 2017, faces the OECD average of 1.7. the dual challenge of an ageing popu- What’s more, despite even limited Germany lace and dwindling births. success in growing fertility rates, Italy If left unsolved, these twin issues the Centre for Public Impact also Spain will squeeze Japan’s shrinking found that the number of women of K-based Theramex is poised health concerns. Making sure those Sweden workforce with the burden of pay- child-bearing age leaving the labour to work alongside women of needs are addressed effectively, for 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ing for the old and young. Combined force has increased; the exact oppo- all ages and their healthcare them and for all women, is impor- with a low fertility rate of around site of what the Japanese govern- providers (HCPs) to offer tant to me, personally and profes- U Percentage of respondents by demographics 1.4, which represents the number of ment is hoping to achieve. With day- products and solutions to meet con- sionally,” he says. “At Theramex, we children that an average Japanese Co-operation and Development very dramatic,” Dr Jones says. “We’re care waiting lists in the 20,000s, it traceptive, fertility, menopausal and recognise there are unmet needs in Male woman will have in her lifetime – a (OECD). “Companies are starting to not going to be able to stabilise the is unlikely that returning to work bone health needs. women’s healthcare and a discern- Female sustainable rate is 2.1 – Japan’s ris- cut back their services, restaurants population for quite some time. It’s a Low fertility rates, coupled with for many young mothers will be an Headquartered in London and able gap in innovation. Our team 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ing costs will have to be close early, delivery services won’t very stark picture.” ageing populations, are testing option any time soon. operating across 50 countries, the is committed to partnering with paid by an ever-smaller cover parts of the country.” Aware that time is of the essence, One more side effect is that if the revamped specialty pharmaceuti- women, with healthcare providers 1 Eurostat. Fertility statistics. http://ec.europa.eu/eurostat/statistics-explained/index.php/Fertility_statistics#Main_statistical_fi ndings proportion of workers. According to Dr Jones, if fertil- prime minister Shinzo Abe has baby boom really does take off, the cal company dates back to the 1970s and with development companies to 2 Fertility treatment 2014. Trends and fi gures. Human Fertilisation and Embryology Authority. http://ifqtesting.blob.core.windows.net/umbraco-website/1783/fertility-treatment-2014-trends-and-fi gures.pdf nations across the Far East 3 Berg Brigham K, Cadier B, Chevreul K. The diversity of regulation and public fi nancing of IVF in Europe and its impact on utilization. Hum Reprod. 2013 (2): 666-675 “There is a terri- ity rates do not improve, Japan can focused considerable effort on per- first two decades are going to see and has a reputable history among present affordable and accessible 4 LIFE Survey conducted in 6110 individuals from 6 European countries ble labour shortage expect its population to fall from suading Japanese families to up their the working population come under women and healthcare professionals treatment options.” in Japan,” says Dr around 128 million at present to game when it comes to baby-making. immense pressure. “The first 15 to 20 with a portfolio of well-established As part of the commitment that Randall S. Jones, 98 million by 2050. As that hap- While Japan has seen its fertility rate included boosting the number of years, if they did get a rise in the num- brands. Its employees have dec- Mr Mehta talks about, Theramex head of the Japan pens, the proportion of elderly peo- grow since a low of 1.3 in 2005, Mr childcare places available throughout ber of babies, would be even more dif- ades of experience in the health- launched the CHLOE and LIFE ini- As world fertility rates drop, could drive discussions among leg- benefi cial to women whose fertility and Korea ple aged over 65 will increase from Abe is going to have to hope he can the country, with free childcare for ficult,” says Dr Jones. “That would care arena, with an in-depth knowl- tiatives to broaden the channels of Theramex is committed to improving islators and payers for the funding of may be compromised as a result of desk at the about 26 per cent now to 45 per cent persuade his citizens to get on board infants aged three to five years old. be a short-term transition to a steady edge of the clinical issues women communication between women and awareness of the impact infertility has these procedures. cancer treatment or a family history of Organisation at the mid-point of the century. if the country is going to meet his fer- Japan has also doled out cash pay- equilibrium, but would mean more face. Further, the company fuels their healthcare providers. CHLOE on women and to providing access to Results from the LIFE survey are early menopause. for Economic As a result of the country’s rapidly tility rate target of 1.8. ments for new mothers. However, spending on education.” its commitment to providing solu- (Contraception: Helping for Women’s solutions to manage the condition. currently being analysed for further Dr Stuart Lavery, senior consultant at ageing population, April saw credit rat- To facilitate this, Japan’s govern- this can’t be extended to paying Whatever Japan’s future, the coun- tions for these challenges by working Choice) is a questionnaire designed The LIFE (Listening in: IVF and insights by a group of experts in the Hammersmith and Queen Charlotte’s ing agency Moody’s warn of near-term ment has tried a number of differ- women to take care of their own chil- try is not alone in facing such prob- with specialists who are prevailing to capture a woman’s healthcare con- Fertility in Europe) survey was fi eld of fertility treatment, in addi- Hospitals, says: “No matter what their and long-term credit challenges, as ent initiatives. Examples include the dren, as Japan still needs to address lems. Low fertility rates, coupled thought leaders in the fi eld. ditions, individual needs and prefer- launched by Theramex to assess the tion to sociology experts, and will be situation is, if cancer might affect their well as slower GDP growth, caused by Plus One Proposal, which has tried to its impending labour shortage. with ageing populations, are testing Anish Mehta, chief executive of ences to facilitate choosing the best European perception of IVF and fer- published in a peer-reviewed journal fertility, it is important to ensure they lower household savings, a narrower encourage Japanese families to grow “Giving people money to have babies, nations across the Far East, includ- Theramex, wants people to know that contraceptive option for them. The tility preservation using oocyte freez- before the end of 2018. know there are steps they may be able tax base and rising welfare costs. by “plus one”, as well as the Angel Plan like an allowance, makes women less ing Taiwan and South Korea. supporting women’s health is the summary of responses is passed on ing. The technique is currently aimed Bart Fauser, emeritus profes- to take to have children after treat- “We’re talking about losing 30 mil- and the New Angel Plan, which were backbone of the “new” company. to the healthcare provider, enabling at women who delay family planning sor of reproductive medicine at ment. Cancer could have a big impact lion people – the situ- used to make having children easier “I have an ageing mother, a wife and the choice of contraception that best due to lifestyle choices as well as to the University of Utrecht in the on a patient’s life, but if they are pro- ation now is and more attractive. Incentives a young daughter, all with individual suits the patient’s needs while opti- women with cancer or other medical Netherlands, says: “These fi ndings vided with the right information and Dwindling numbers present Fertility rate (number of children mising the HCP’s time. conditions, which may affect their fer- provide fascinating and compelling given the right support, that impact a worrying picture for Japan a woman is expected to have over a lifetime) Mr Mehta is eager to point out that tility. A total of 6,110 people across six evidence of the shifting public atti- can be managed.” 2 Comparing the annual number of births, the company is as dedicated to provid- European Union countries took part tudes around fertility procedures As women live longer and take fertility rate and population growth Yearly population growth (%) ing accessible contraception to women in the survey, which indicated general used for both medical and lifestyle greater control of their health, the Annual number of births (m) wishing to prevent or delay pregnancy acceptance of IVF and cryopreserva- reasons. I see many women, who face need for accessible and afforda- as it is to supporting women struggling tion among Europeans. The fi ndings issues with fertility, not only because ble products to manage their needs to conceive. of existing medical conditions, but grows. Theramex is listening to what He stresses: “We’re here to sup- increasingly when personal circum- women want and will continue to port women at every age, every stage. stance precludes them from having a deliver practical, dependable and 3 Whether they are seeking contracep- baby at the present time. Individuals affordable solutions for all women. tion, fertility treatments, managing and couples should feel confi dent osteoporosis or the symptoms of men- Our team is committed to about exploring egg-freezing and IVF For more information please visit opause, we are working on solutions treatment as possible solutions to theramex.com that empower women to live happier partnering with women, with their current fertility challenges.” and healthier lives.” healthcare providers and Theramex hopes that the survey’s 0 To this end, a recombinant folli- fi ndings will encourage more women 0 cle-stimulating hormone, the most with development companies and healthcare professionals to con- commonly used biologic drug during sider the importance of having a con- 1947 1952 1957 1962 1967 1972 1977 1982 1987 1992 1997 2002 2007 2012 to present affordable and Anish Mehta in vitro fertilization (IVF), was launched versation about fertility preserva- 2017 Ministry of Health, Labour and Welfare/Worldometers 2017 Chief Executive Offi cer, Theramex across Europe in 2016. accessible treatment options tion. This dialogue may be especially 10 UNDERSTANDING FERTILITY RACONTEUR.NET 11

IVF treatment cycles, by age of patient in 2016 Latest UK statistics FERTILITY 3% 42% Over 44 Under 35 1953 1970s 4% 43-44 FIRSTS Birth using frozen sperm Cryobanks founded American professor Jerome The commercial cryopreservation of sperm Sherman pioneers the method (sperm banks) becomes popular and gains wider 14% Assisted reproduction of preserving sperm using public acceptance 40-42 technologies have come a glycerol as a protectant and 1983 dry ice as a refrigerant. The long way since the 1950s, with sperm, once thawed, is able advances in research resulting Birth from donated eggs to fertilise an egg as "normal" in IVF births now accounting for through artificial insemination 14% more than 2 per cent of total Monash Group, an IVF centre in 38-39 births in the UK. This timeline Richmond, Australia, achieves 1978 the first pregnancy by a woman charts some of the major without ovaries through the use IVF baby born milestones that have changed of donor eggs fertility treatment worldwide In vitro fertilisation (IVF), where an egg is fertilised outside over the past 70 years the body, results in the birth of the first “test tube baby”, Louise Joy Brown, in Oldham General, Manchester. The specialists involved were Patrick Steptoe, Sir Robert Edwards and Jean Purdy, though others were also trying at the time. Four years later, . m Louise’s sister Natalie becomes the 40th IVF 65 23% 1984 baby. Dr Edwards later goes on to the win the last published estimate of global 35-37 Nobel prize in medicine births as a result of assisted Birth from reproduction technologies Human Fertilisation and Embryology Authority (HFEA) 2018 cryopreserved embryo European Society of Human Reproduction and Monash Group achieves the Embryology 2016 first birth from a frozen embryo, which had been preserved for two months before transfer into the uterus Reasons for IVF treatment Birth rates for IVF treatment 1991-2016 1990 1986 2018 Percentage of recorded reasons only Latest UK statistics 30% Genetic profile Birth from cryopreserved egg Drug-free IVM technique

Preimplantation genetic Human egg cryopreservation is developed to enable women A revolutionary treatment is diagnosis is introduced to to postpone their maternity beyond their most fertile developed that could provide a Male infertility 37% 25% determine the profiles of years. Dr Christopher Chen, from Singapore, the scientist safer and cheaper alternative to embryos before implantation, responsible for the breakthrough, said 80 per cent of eggs conventional IVF. While IVF uses enabling doctors to screen survived the freezing process and 85 per cent of those medication to bring eggs to maturity for a specific genetic disease. fertilised as normal; the survival rate is said to be almost before they are removed from the Preimplantation genetic double that of frozen embryos ovary, in vitro maturation (IVM) retrieves 20% 1992 screening is later developed immature eggs and brings them to Unexplained 32% to screen for abnormal maturity in a ovarian cell culture taken Birth using numbers of chromosomes from the patient, before ICSI is used for intracytoplasmic sperm in the embryo, the leading fertilisation. The new method involves injection (ICSI) cause of miscarriage and 2014 little to no hormone stimulation of 15% implantation failure the ovaries – contrary to IVF Ovulatory disorder ICSI takes place in vitro, Birth using uterine transplant – and could be beneficial 13% where a single sperm is to women with polycystic ovarian syndrome or those injected into the cytoplasm A 35-year-old woman born without a uterus undergoes IVF recovering from cancer 10% of an egg with a fine needle. with her partner before having a uterus implanted from a The process becomes 61-year-old donor. The cryopreserved embryos are then the most common and transferred a year later, resulting in pregnancy. The results Fresh: per treatment cycle Tubal disease successful treatment for of the treatment prove the feasibility of uterus donation, 12% Frozen: per treatment cycle male infertility, even from a post-menopausal donor 5% offering an Fresh: per embryo transferred

opportunity where Frozen: per embryo transferred conventional methods are Endometriosis 0% not an option 6% 1991 1996 2001 2006 2011 2016

HFEA 2018 HFEA 2018 10 UNDERSTANDING FERTILITY RACONTEUR.NET 11

opportunity where Frozen: per embryo transferred conventional methods are Endometriosis 0% not an option 6% 1991 1996 2001 2006 2011 2016

HFEA 2018 HFEA 2018 12 UNDERSTANDING FERTILITY RACONTEUR.NET 13

FERTILITY TOURISM OPINION COLUMN Commercial feature

their donor once they are 18, but There is a well-regulated sys- some countries only allow anon- tem in the UK where clinics have ymous donations, so nothing will There is a well-regulated system to meet certain standards and are ‘Is it negligence How fl ash freezing be known about the donor. regularly inspected, but this is not Nina Barnsley, director of the in the UK where clinics have to replicated elsewhere. It is, there- Donor Conception Network, says meet certain standards and are fore, important to check the rules or ignorance that it is important not to forget the regularly inspected, but this is and regulations, and also the legal is revolutionising UK couples impact this may have. “We need situation if you are using an over- to keep in mind that if treatment not replicated elsewhere seas donor or a surrogate. fertility is seen as a is successful, this new child will In addition, there are practical have their own thoughts and feel- issues to consider, such as poten- fertility treatment go abroad ings. Keeping doors open for them tial language barriers, as it can be in terms of access to informa- Jane Denton, director of the difficult to talk to a doctor through female problem?’ tion about the donor and/or half- Multiple Births Foundation, a translator and it is advisable to The fl ash-freezing technique of vitrifi cation is rapidly siblings might be really important says this is a real concern. check how communications with for IVF help in the future.” “Miscarriage, high blood pressure the clinic are handled. proving a revolution in assisted reproduction It has been recognised, in the UK, and pre-eclampsia, haemorrhage The key piece of advice to any- that multiple births are the big- and caesarean sections are more one thinking of travelling for hirty thousand years ago IVF started trying for a baby in their gest risk from IVF to both babies common in multiple pregnan- treatment is to do your home- unknown artists chose to early-30s. Fertility treatment is not says Professor Macklon, now makes Access to NHS rarely included and can quickly and their mothers, and it is best cies putting mothers at greater work before making any deci- carve exquisite ovals each the preserve of older women. Ali froze her eggs at the the London Women’s Clinic one of mount up. There is also travel practice for women to have a single risk,” she says. “The babies are sions. Fertility treatment always with an inner cleft on the To date, fertility has been fi rmly age of 40 at the London the UK’s most experienced centres in Women’s Clinic. At 46 and accommodation to factor embryo transferred where appro- much more likely to be born pre- involves a significant financial Twalls of a cave in La Ferrassie, cast as a female issue, irrespective of egg freezing. fertility services she thawed her eggs into the budget, as well as living priate. Some overseas clinics do not maturely so more die, and have and emotional investment, and France. These Stone Age sculptors men being half of the fertility equa- and successfully had The trend has also been seen in egg can be a postcode expenses abroad. take the same approach and regu- disabilities and long-term health making sure you are happy with were not alone: across the globe and tion. But the HFEA’s data reveals twins Molly and Monty. donation, a treatment method for To see Ali’s story search It is not just cost, but also suc- larly put back multiple embryos in problems. Having one child at a the clinic you choose will lead to throughout millennia, our ancestors infertility is now predominantly a women unable to produce their own lottery, resulting in London Women’s Clinic cess rates which can tempt peo- women most likely to get pregnant time is much safer for mothers a more positive experience, what- depicted female genitalia in myriad male factor in origin. Male fertil- Ali in YouTube eggs, usually as a result of increasing couples travelling ple to travel overseas and half with more than one baby. and babies.” ever the outcome. ways. The story these vaginal sym- ity problems are the most common age. Once gone, the store of eggs in the respondents to the Fertility bols tell is a vital one that fertility is reason for couples to seek fertility the ovary can never be replaced, and abroad for treatment Network UK and Fertility Clinics the most important aspect of human treatment (37 per cent), with female egg donation offers the only chance Abroad survey believed overseas life; we must protect it. Without fer- fertility problems and unexplained of pregnancy. clinics were more successful. Attitudes towards fertility tourism tility, we are dust. problems representing 31 per cent Before effi cient freezing, egg dona- It is worth noting that the high Survey of UK women and couples undergoing or considering fertility treatment Fast forward 30,000 years to and 32 per cent, respectively. tion required a donor suitably matched success rates quoted on clinic our apparently advanced age and Fertility problems are common, to the recipient and embryo transfer in websites are often pregnancies it seems we have learnt nothing. aff ecting one in six couples, so you menstrual cycles hormonally synchro- rather than live births which are Would you consider going abroad for treatment? Which countries We do not teach our children how will have a friend, family member nised in both donor and recipient. not comparable. Also clinics can Yes No would you important fertility is. They do not or colleague aff ected. Despite this, “This inevitably meant long waiting KATE BRIAN be selective about their figures by consider for know its basics, its possibilities and infertility is too often ignored as ot only has vitrifi cation made A recent audit of treatments at the lists or travelling abroad to countries excluding older patients or select- treatment? limitations. They are not aware of the majority of couples (60 per cent) embryo freezing more effi - London Women’s Clinic shows a dra- where donor eggs were more plentiful. he UK may have been the ing a short period when success 93% 7% how easily the fl ame of fertility is have to pay for their treatment, cient, with delivery rates matic increase in egg freezing, up from But banking eggs means that we have a birthplace of in vitro fer- rates were unusually high. extinguished by age, weight, drugs, they are let down by their GP not Napparently improved when just six treatments in 2012 to to 229 in greater choice in storage and the pros- tilisation (IVF), but cuts In the UK, the Human Fertilisation disease, occupation and environ- providing appropriate informa- thawed embryos are transferred but, 2017. Most of these treatments (74 per pect of more immediate treatment to NHS fertility services and Embryology Authority, which ment. Collectively, we are only now tion (74 per cent) and they are not for the fi rst time in 40 years of IVF, cent) were for freeze storage for single without having to synchronise both Thave led some people to consider regulates fertility clinics, gives What would be your main reasons for seeking treatment abroad? beginning to recognise the poten- supported at work by an effective human eggs can be frozen for viable women, whose average age was 37. parties,” says Professor Macklon. 60% travelling across the globe for verified success rates for every tially devastating impact that fertility workplace policy (75 per use at a later date. The few studies available suggest that The analysis of egg freezing at the Spain fertility treatment. licensed clinic, but there is not the 31% 28% 21st-century lifestyles may be having cent). Why do so few firms ena- Never before was it possible to these are women concerned with the London Women’s Clinic comes at a The National Institute for Health same verification process over- Higher success rates Wider range of on fertility, especially sperm health. ble employees to have time off freeze eggs without damage to their biological decline in fertility, which inev- time when the Human Fertilisation and Care Excellence recommends seas. If you see a figure which treatment options Which young adult leaves educa- for fertility treatment? Does your microstructure. Thus, while the old itably comes with advancing age; egg and Embryology Authority (HFEA), the three cycles of IVF for those who appears to be completely out 45% 44% tion knowing the female fertility employer have a fertility policy? slow freezing methods were adequate freezing represents a way to stop the UK’s regulator of IVF clinics, described are eligible, but whether you of line with anything you have Positive reputation vital statistics? 28: female fertility Is it negligence or ignorance that for sperm storage, eggs were not so biological clock and increase a woman’s freezing in its latest report as “particu- Greece get anything approaching this come across elsewhere, caution 25% is already falling. 35: female fertility fertility is seen as a female problem, robust when ice crystals formed within chance of motherhood in the future. larly striking”. It noted that birth rates depends entirely on where you live. is advisable. 47% Anonymity of egg donors plummets. 42: the chance of becom- not spoken openly about and insuffi - the cells. Vitrifi cation, however, which With more than 200 cycles com- from egg-freezing treatments have A survey carried out by Fertility One of the reasons people ing a biological mother is vanish- cient support provided in the work- reduces eggs to a glass-like state in just pleted in 2017, the cumulative total, increased year on year, “with 26 per Shorter waiting lists Network UK and Fertility Clinics started travelling overseas for 41% ingly small. Did you know the upper place? Will the way in which soci- a few seconds, avoids the ice crystals cent of patients fi nishing their treat- Abroad found that patchy NHS fertility treatment was to access age limit for egg donation is 35? ety views and responds to fertility and any micro-damage to the egg. ment cycles with a live birth in 2016, 50% Czech provision and the high cost of pri- donor eggs and sperm. In the past, 16% That’s because above 35 substan- issues change with the increasing The result has seen the emergence compared to 20 per cent in 2013”. In Access to more Republic vate IVF were the main drivers for there were long waiting times for Fewer restrictions tially reduced egg quality increases recognition of fertility’s toll on men? of egg banks in the ever-growing treat- 2016, all UK IVF clinics reported 1,173 egg donors people travelling overseas. Spain, donor eggs and overseas clinics on the number of the risk of miscarriage. Yet in the For Palaeolithic people, female gen- ment of egg donation and an upsurge in Egg freezing cycles of egg freezing, up 10 per cent Greece, Cyprus and Eastern could offer a quick route to treat- embryos transferred 17% UK, more than 68 per cent of women italia could symbolise fertility: the the numbers of women, usually in their on the previous year. Europe are all popular, along with ment. Now many UK clinics have France freezing their own eggs are over 35. male role in reproduction was not mid-30s and single, having their eggs represents a way to The HFEA recognised that this destinations further afield such as donor eggs available and most can The message isn’t being heard or are fully recognised. Today, we know frozen for use some time in the future. stop the biological cryo-revolution has not just brought the Caribbean. access donor sperm, although this these women being exploited? more about fertility, but we still have “We’ve seen a huge growth in egg egg freezing in from the cold. More IVF treatment overseas may may be imported. 68% 1% Everyone has heard of the female a long way to go in respecting it. freezing in the past two or three years,” clock and increase and more routine IVF treatments in look much cheaper, but head- The way donors are recruited, Cheaper than private Some clinics abroad 13% biological clock, but did you know says Professor Nick Macklon, medical couples are now freezing all embryos line prices on clinic websites are screened and counselled is also treatment in the UK allow you to choose Denmark the male reproductive system suf- director of the London Women’s Clinic. a woman’s chance generated, with the aim of transfer- only part of the picture. The cost something worth checking. In the the baby's sex fers the same fate? Men over 40 “Most patients are women without a of motherhood ring a single embryo in a later cycle of drugs, scans, blood tests and UK, people conceived using donor are half as likely to get their part- partner hoping to preserve their fertil- unaffected by ovarian stimulation and specialist medical insurance are eggs and sperm can find out about Fertility Network UK/Fertility Clinics Abroad 2017 ners pregnant as men under 25. ity and put their family plans on hold.” in the future storing the rest. There is a significantly higher risk Not only are these “freeze-all” treat- of miscarriage too. That’s why the ments associated with a higher suc- recommended age limit for sperm Five years of egg freezing at the London Women’s Clinic cess rate than fresh, they are also safer donation is 40. We are failing our Number of cycles and number of women 2012-2017 in encouraging the transfer of just one offspring and future generations embryo and lowering the rate of mul- 250 Egg freezing means you can store your eggs until if age and fertility are not part of In addition to the Cycles tiple pregnancy. Summarising trends MY BODY, you’re ready to have a baby. sex education. cycles represented Women in the two years to 2016, the HFEA Myths about fertility are numer- in the graph, 200 described IVF as “safer, more available the London MY FUTURE, ous. The recent Fertility Trends Women’s Clinic and more successful than ever before”. Explore your fertility options at our free, friendly report from the Human Fertilisation runs a successful 150 and Embryology Authority (HFEA) egg donation For more information please visit MY CHOICES and informative ‘Future of Your Fertility’ seminars. programme with shatters several fertility misconcep- more than 1,000 100 www.londonwomensclinic.com Saturday 19th May 1:30pm, 112 Harley Street, W1G 6AP tions. The average age of women hav- women having ing IVF in the UK is just 35.5, but cou- frozen their eggs 50 ples will have been trying to conceive Aileen Feeney for donation Thursday 31st May 6pm, 1 St Thomas Street, SE1 9RY purposes in the for several years before fertility treat- Chief executive last fi ve years 0 ment, so on average women having Fertility Network UK 2012 2013 2014 2015 2016 2017 To book your place call 020 7563 4309 or visit londonwomensclinic.com 12 UNDERSTANDING FERTILITY RACONTEUR.NET 13

FERTILITY TOURISM OPINION COLUMN Commercial feature

TECHNOLOGY

is to make a difficult process easier for both the patient and medical Can technology really get you pregnant? It’s about improving provider. The app works by syncing with the clinic to provide the patient treatment and with personalised treatment infor- Smart technology, including apps and therefore chances of mation. It has all the data regard- ing the patient’s care, acting as a wearable devices, can now aid women success, which is very medication manager, appointment reminder and also resource centre. to monitor their fertility ElectronicsValley important because “It’s about removing someone’s ultimately it’s about stress and anxiety around the prac- Take control! tice,” says Charlie Kennedy, Salve’s getting pregnant chief executive and co-founder. “That could be all of the drugs they have to take, all their appointments The fertility awareness method they have upcoming, with support- ANNA CODREA-RADO (FAM) is a misunderstood form researchers linked the pill to an ing information, so this will be vid- 24-hour advance ovulation prediction of contraception. It relies on the increased risk of breast cancer and eos, texts, images, to ensure they echnology companies are physiological symptoms, such as also depression, prompting many understand everything.” getting serious about the changes in body temperature and women to rethink their options. The Manchester Fertility Clinic baby-making business. In cervical fluid, which reveal where “There wasn’t really a situation was one of the first to use Salve and the last few years smart a woman is in her cycle to deter- where women who didn’t want to says they have seen an improve- Clinically proven 99% accurate Tdevices and apps, from bracelets mine her six-day fertility window. use synthetic hormones at all had ment in their internal processes that tell you if you are ovulating, By monitoring and tracking these something they could go to,” says as a result. Jonathan Koslover, the ovulation detection to at-home hormone testing kits, signs, a woman is able to pinpoint if Ms Grigg-Spall. “People are now clinic’s managing director, says one have radically changed our under- she is fertile. happy to and want to learn more of the biggest advantages for clin- standing and approach to fertility. Often confused with the rhythm about fertility awareness.” ics to use an app such as Salve is an Investors are also paying attention, method, the crudest and most unre- FAM monitors and apps can also be improvement in the level of patient Best in class customer support and with the global fertility services liable way to use FAM, many women used in planning pregnancy, as they service the clinic is able to offer. market predicted to grow to $21 bil- do not believe FAM works. And enable women to track when they are “We’re using it to educate patients fertility nurse consultation lion by 2020. while it’s rarely, if ever, offered as an likely to be ovulating. There are now about what their treatment will Women now have access to a wealth option by a GP, according to the NHS also plenty of products specifically involve,” says Mr Koslover. “This is of data to help them self-regulate, website: “If natural family planning geared towards women trying to con- particularly important in fertility monitor and enhance the chance of is followed correctly, it can be up to ceive, such as Ava, a bracelet that because people are nervous. It’s an pregnancy, as well as smart devices 99 per cent effective.” By compari- tracks when a woman is ovulating. intrusive and emotional treatment.” Special offer 25% off with code: that offer a hormone-free contra- son, the NHS says the pill and IUD There are also technology options He emphasises that these apps ception alternative. As these apps (intrauterine device or coil) are both available for women who are strug- will never replace the doctors’ THETIMES until May 30th and products continue to play an more than 99 per cent effective. gling to conceive. At-home hor- work. “It’s a very personal treat- increasingly major role in reproduc- To be able to achieve that level of mone testing kits made by com- ment, so you still have to have that www.ovusense.com tive health, it raises the question: effectiveness with FAM, however, panies including Modern Fertility nurse or doctor contact,” he says. what happens when technology an app alone will not be enough. and LetsGetChecked offer a way for “We still make sure that we’re talk- gives fertility a reboot? Many of the period tracker apps, women to check their hormone lev- ing with patients. You can’t do it “There has been little innova- including Clue, state they cannot be els. These kits are not without their all electronically.” tion within this space since the used as contraception alone. That’s drawbacks; perhaps one of the fun- For clinics like Mr Koslover’s, creation of the contraceptive pill,” where wearables and connected damental limitations is that if there technology will continue to says Ida Tin, chief executive of the devices have come in. is an underlying fertility issue, cou- improve fertility services by offer- period and ovulation tracker Clue. “We’re all really comfortable with ples hoping to become parents still ing supplementary options that “Now, taboos around fertility and technology these days, especially need to turn to medical help. ultimately enhance a couple’s Women menstruation are disappearing, to do with tracking health, calories, More recently, new startups are chance of success. He sees a future and as they do, women want to diet, exercise, sleep, heart rate,” offering in-clinic services to address where ultrasound scanners will all round the know more about their bodies and says Holly Grigg-Spall, author of Daysy's fertility app, together with linked this need, working with established use artificial intelligence to help thermometer, reads a woman’s basal body world, just like you, the unique patterns of their men- Sweetening the Pill. “And so we’re healthcare providers to turbo-charge determine patients’ treatment. “It’s temperature and cross-references the monitored over strual cycle.” more able to understand the con- data with its on-board computer to tell their clinic’s tech offerings. about improving treatment and The Berlin-based company was cept of monitoring, data and algo- where she is in her cycle An app attempting to help ease therefore chances of success, which 16,000 cycles in one of the early period trackers that rithms, and that it can help you the emotional process of undergo- is very important because ulti- the past year gave fertility an injection from the understand what is going on with ing IVF treatment is Salve, an ear- mately it’s about getting pregnant,” startup sector. By the end of 2015, your body.” How women track their menstrual cycles ly-stage company whose mission Mr Koslover concludes. Clue had 2.5 million users in 180 Ms Grigg-Spall also works for countries and had raised €10 mil- Daysy, a fertility calculator. Daysy lion. Competitors in the market are is a highly sensitive thermometer Age App Digital Paper Birth Early Memory Do not Ida Tin, founder Kindara, which launched in 2012 as that reads a woman’s basal body calendar calendar control symtoms track of period and Source a fertility tracking app, and Glow, temperature (the lowest body tem- ovulation tracker launched by PayPal co-founder Max perature attained during sleep) and Clue, says women want to know Levchin. The most basic function- cross-references the data with its 50% 6% 9% 5% 9% 27% 6% more about their ality of these apps is to tell women on-board computer to tell where Under 18 bodies as taboos when their periods are due, but she is in her cycle. It can be used to around fertility and menstruation are some can also be used to prevent or both plan and prevent pregnancy. disappearing plan pregnancy. Its effectiveness rate for avoiding 48% 9% 8% 17% 8% 15% 8% pregnancy is 99.4 per cent. 18-23 Daysy launched in 2014, but the company behind it has been offering a similar product, Lady-Comp, 43% 12% 6% 18% 6% 20% 9% for more than 25 years. It’s only 24-29 More companies been in the last few years that similar products have started to come offering technology- on the market, including Wink, 51% 17% 9% 6% 6% 14% 8% driven contraception the custom thermometer Kindara 30-39 offers to work in conjunction with dovetails with its app, and Natural Cycles. women’s increasing The trend of more companies 34% 12% 9% 6% 9% 12% 20% offering technology-driven con- Over 40 dissatisfaction with traception dovetails with wom- existing hormonal en’s increasing dissatisfaction with existing hormonal options. options Two recent studies from Danish *Survey of US women only DUB Group/University of Washington 2017 14 UNDERSTANDING FERTILITY RACONTEUR.NET 15

TECHNOLOGY

HUMAN EGGS Commercial feature Professor David Albertini David Professor

Founder and chief executive Dr Ernest Loumaye tells of the exciting trial results from ObsEva’s Landmark research pioneering use of the first oral medication of its set to boost IVF kind – nolasiban – in IVF treatment What’s so special about the results clear relationship between any reduction you’ve just reported? in contractions and pregnancy outcomes. Latest research into growing human eggs The latest work was carried out Imagine 100 women undergoing in vitro And so we didn’t measure contractions in by Professor Evelyn Telfer and col- fertilisation receiving nolasiban and the latest trial. We just enrolled women outside the body has been hailed as a leagues at Edinburgh University, another 100 patients receiving a placebo: undergoing either their fi rst or second IVF the Royal Hospital for Sick Children, our results show that 46 women in the treatment cycle. The results confi rmed breakthrough, but it could be some time Edinburgh, and the New York Center fi rst group may be able ultimately to go that it’s not necessary to measure con- for Human Reproduction. The eggs home with a baby compared with only 35 tractions to achieve a benefi t. They also before childless couples benefit were grown from ovarian tissue in the second. This 11 per cent difference suggest that increased blood fl ow may donated by ten women undergoing represents a fantastic result in our view. be the real benefi t. Blood fl ow is a critical caesarian-section births. In gynaecology, a 5 per cent increase in factor in embryo implantation. Reported in the journal Molecular positive outcomes is considered a break- Human Reproduction, the research through – we more than doubled that The study has also shone a very bright treatment cycles, even though it is has provoked critical questions. For threshold in this clinical trial. light on the ongoing controversy over JOHN ILLMAN 40 years ago this year since the birth example, why did some of the devel- the best time for embryo transfer. Is it of Louise Brown, the world’s first test oped eggs mature in just 22 days, What is nolasiban? best when the embryo is three days old he growth of human eggs tube baby. Specialists don’t know compared with the five months it An oral treatment to prevent expul- and comprising four to eight cells or from the earliest stage to full why most IVF treatment cycles fail, would have taken in the body? And 01 why it should take human eggs sion of the embryo from the womb. It is when it is fi ve days old and made up of Magnification of maturity outside the body but advances in knowledge arising why did only 10 per cent of the eggs a lab-grown, fully months to mature. taken four hours before “embryo trans- 70 to 100 cells? has been acclaimed as a land- from the development and study of reach full maturity? matured human “The real problem is the basic lack Advances in fer” – the implanting of the embryo in We tested both three and fi ve-day Tmark development that could widen lab-grown human eggs could help Challenging the idea that matura- egg ready for of knowledge about human eggs. We the uterus or womb. embryo transfers. Overall, comparing fertilisation the scope of fertility treatments. boost IVF success rates. tion of lab-made eggs should mimic speak about lack of progress in IVF knowledge arising nolasiban with placebo, we showed a relative increase in ongoing pregnancy But does it offer real hope to the IVF success rates may be disappoint- that of the natural cycle, Professor 02 in the last 40 years. This is because from the development How many patients were in the trial? reported one in six UK couples with ing but, thanks to ongoing research, Telfer says: “The process takes much Analysis of embryo we lack a fundamental understand- There were 778 from 41 European fertil- rates of 25 per cent; with day-fi ve trans- fertility problems? Expert opinion is they are about 85 per cent better longer in the body because eggs development ing of human egg development. It’s and study of lab- ity clinics. fers, we saw a larger effect of 32 per cent following mixed. The consensus is that it rep- than in I991 when the Human and have to work in tandem with a wom- only this kind of work that will give which we consider to be a highly mean- intracytoplasmic grown human eggs resents an important step forward, Fertilisation Embryology Authority an’s hormonal cycle – there are lots sperm injection us the kind of insight we need.” How does nolasiban work? ingful result. The day-three alone data but progress in research into the (HFEA) started keeping records. of control mechanisms in the body. at the IVF Centre, Professor Telfer also dismisses could help boost Nolasiban has a quietening or blocking resulted in a 14 per cent improvement. most basic secrets of all – the origin Transforming lab-grown human “We prefer to describe the way University Women's the criticism that only 10 per cent of effect on oxytocin, a naturally occur- Hospital Bonn, IVF success rates and creation of life – is measured by eggs into viable treatments could eggs grow outside the body in our Germany eggs in the study reached full matu- ring hormone. It’s known as the “love So there may be a strong case for decades rather than years. follow a similar pattern; the research system not as accelerated develop- rity. “In the human body, only 0.1 hormone” because it is released during making fi ve-day transfers and nola- For example, two thirds of women programme started more than 30 ment, but rather as development per cent reach full maturity – 99.9 IVF ‘breakthrough’ orgasm and can generate feelings of siban a routine part of IVF treatment? under 35 undergoing in vitro fertilis- years ago and has produced live off- without brakes. That’s a big differ- per cent degenerate – so what we are peace. But calling it the love hormone We believe so, but before we can ation will not have a baby after their spring from lab-grown mice eggs. ence. Logically there is no reason doing in our in vitro system in the to preserve their fertility, but this is is a bit like calling a computer a writ- answer this question, we await the data laboratory is circumventing what not an option for women who require ing tool. It also stimulates the uterus or from women in the trial giving birth in happens in nature.” immediate therapy or for young girls. treatment womb to contract to begin childbirth. the fi nal quarter of this year and for the With her colleagues, she is now A girl’s eggs do not become viable Contractions also occur during IVF as the six-month follow-up after birth. We’re planning to develop better quality until she starts her periods. embryo is being implanted. Rapid rises optimistic that the birth outcomes eggs and to use IVF to fertilise them Ovarian tissue taken from such Pioneering use of the fi rst oral medication of its kind in IVF in contractions can expel the embryo may be consistent with pregnancy with sperm to test their viability; patients can be frozen for later pre- from the womb and prevent pregnancy. rates because most miscarriages occur a procedure the HFEA will have to implantation, but there is a risk in treatment is showing remarkable trial results Nolasiban also – and we believe this may within the fi rst 12 weeks of pregnancy. authorise. A big challenge is to cre- some cases of reintroducing tissue be critical – increases blood fl ow in the ate a receptive laboratory environ- contaminated with cancer cells back womb and womb lining. Have you a fi nal message for patients ment. Natural growth and devel- into the patient. Laboratory-grown and clinicians? Ulrich Baumgarten via Getty Images opment of eggs and the follicles or eggs would bypass the need to reim- Is there any way to identify women who There is a very simple, but critical, sacs containing them is controlled plant the tissue. bsEva, which develops Worldwide, the annual number of executive of another successful com- are prone to these problematic uterine message. Nolasiban has the poten- by the release of changing concen- Improved treatment could also reproductive health treat- treatment cycles for assisted repro- pany, PregLem, which was sold in contractions? tial to increase pregnancy rates while trations of hormones and a soup of prevent financial exploitation. ments, has reported trial duction technology is estimated to have 2010 before the launch in Europe of That’s a very good question. Our nola- reducing the number of multiple births. growth-promoting nutrients. Ying Cheong, professor of repro- Oresults of a therapy with the risen within the last decade from 1.6 mil- its lead medicine. siban studies have focused on two groups: Although single-embryo transfers are Professor Telfer says: “We’re work- ductive medicine at the University potential to increase in vitro fertilisa- lion to 2.4 million. In China it is reported ObsEva’s pipeline also includes a women with high contraction rates and now generally recommended, it is still ing on some ideas to change the lab of Southampton, says: “It is hugely tion (IVF) success rates by more than to be more than 800,000 a year. novel hormone-based therapy to treat those with low contractions. We found no often standard practice in the United environment. We’re on the path. disappointing that more than two 10 per cent. Unfortunately for couples seeking fer- both endometriosis, a common, painful States and some European countries We’re not where we need to be yet, thirds of patients who undergo an The reported fi ndings are said to rep- tility aid, quantity in demand does not condition that can cause infertility and to implant two embryos to increase but I’m confident we’ll get there.” IVF cycle will not have a baby at the resent the biggest innovation in the equate to quality of outcome. The World pain during sex, and uterine fi broids, the likelihood of having a baby. But our Patience and determination is end of their treatment cycle. Doctors fi eld in 20 years and are one of many Health Organization has estimated that causing non-cancerous growths in and clinical trial results indicate that a sin- essential. It took Sir Robert Edwards do not yet have the magic wand. examples of small niche companies only one in four infertility treatments around the womb, heavy menstrual gle-embryo transfer plus nolasiban can and Patrick Steptoe more than ten “With no scientific answers to producing some of healthcare’s biggest end with a “take-home” baby. bleeding that may result in anaemia result in a clinical pregnancy rate that years and 467 attempts at IVF before explain the majority of the failures, advances. Many of these focus on some ObEva’s founder and chief executive and other possible symptoms, includ- is similar to what has been historically Louise Brown became the world’s many clinics resort to offering point- of the areas with great unmet need that Dr Ernest Loumaye wants to fi ll what is ing a frequent need to urinate. achieved with double-embryo transfer first test tube baby in 1978. less, expensive add-ons to try to large companies often ignore. for all too many women a therapeutic and thereby potentially avoiding risks The Edinburgh research could improve their success rate to no avail.” In fertility treatment, timing can be vacuum. He is a dedicated gynaecol- of multiple pregnancy. This is of major help cancer patients. Stuart This does not deter childless cou- everything and the same is true of ogist whose prime interest is looking importance both in terms of avoiding Lavery, consultant gynaecolo- ples who are encouraged by the new companies. ObsEva was founded after patients. But he felt that repro- the health risks for both mother and gist at Hammersmith Hospital’s many success stories. More than in 2012 as demand for reproduc- ductive health had been left far behind baby, and for the considerable fi nancial Department of Reproductive 300,000 babies have been born tive healthcare was rising rapidly. in the biotech revolution. In fertility treatment, costs related to multiple births. Medicine in London, says it offers in the UK from licensed fertility Vast numbers of Western women As a clinician he was limited in what hope to women having sterilising treatments since 1991. The secret to were delaying having children to he could do. Wanting to develop timing can be everything treatment such as chemotherapy. future increased success may well pursue their careers and then in 2015 innovative treatments, he moved into and the same is true of Ernest Loumaye 02 At present, freezing eggs or lie in eggs assuming shape and defi- China suspended its one-child-per- the pharmaceutical industry. Twelve Co-founder and chief executive embryos before treatment can help nition in Edinburgh. couple policy. years ago, he founded and was chief new companies ObsEva 16 UNDERSTANDING FERTILITY RACONTEUR.NET 17

HUMAN EGGS Commercial feature Professor David Albertini David Professor

MENTAL HEALTH

while 15 per cent said their rela- Getting news that you are not tionship ended or was strained as pregnant after a round of IVF treat- a result of the impact of fertility More than half of ment can be devastating. Experts problems and treatment. advise that it is important to take Pablo Heimplatz/Unsplash Pablo The majority of respondents men would not be the time to come to terms with would have liked to have had coun- open to discussing this outcome and give your body selling if it was free; fewer than half and mind time to recover. When (44 per cent) did have counselling fertility with their you’re ready, talk to your doc- and of these more than half had to partner tor about whether you should try pay for some or all of this psycho- again and what the chance of con- logical help. More than half of all ceiving might be if you did. Health respondents reported a lack of local professionals may suggest a dif- peer support services. ferent treatment or discuss any Professor Adam Balen, chair of including the Donor Conception other options for maximising your the British Fertility Society, says: Network and Fertility Friends. chances of conceiving. It is also “The survey showed the true pic- Research shows that more than important to consider the finan- ture of living with fertility prob- half of men would not be open cial implications of your decision. lems for many people. It can be an to discussing fertility with their If you’re unable to have more incredibly distressing time, and partner, yet they are just as at risk treatment, or you’re not sure if undergoing treatment and facing of experiencing feelings of sad- you want to go through treatment costs can place a huge amount of ness, shame, anger, depression or again, you may find it helpful to stress and pressure on couples and inadequacy. Sadly, there are fewer talk your feelings through with a their families.” dedicated support options for men counsellor. Some couples have dif- The National Institute for Health than there are for women. One ferent opinions on whether to con- and Care Excellence recommends option is the Men’s Health Forum, tinue with treatment; talking to an that counselling should be off ered which has information about impartial professional may help before, during and after IVF treat- men’s health as well as an online you to think through the issues ment, regardless of the outcome. community where men can chat together and come to an agreement Counselling should be off ered by anonymously. about how to move forward. someone not directly involved in Many support groups welcome IVF treatment continues to the management of a couple’s fer- individuals and couples so this make great progress, with new tility problems. This can help cou- could be a good place to meet techniques and products bringing ples to understand the implications other men with similar experi- real hope to more couples who are of treatment and off er support at a ences, either alone or with a part- unable to conceive naturally. But critical time, such as when an IVF ner. Some men also find it easier while pushing these boundaries, cycle has been unsuccessful. to speak to a counsellor who has the IVF industry must also accept In the UK, the Human Fertilisation experience working with men its responsibility to support its cli- and Embryology Authority (HFEA) with fertility problems, and can be ents’ emotional wellbeing as well is responsible for the regulation of a trusted and impartial “outsider”. as their fertility problems. clinics providing IVF treatment. All clinics licensed by the HFEA must off er couples an opportunity to talk to a counsellor before treatment Impact of fertility problems and/or treatment on relationships begins. This helps them to think Changes to relationships beginning to give greater priority to about their treatment in advance, MARTIN BARROW the emotional support that is available and how it might aff ect them and to couples going through treatment. those close to them, in the short Friends Family Partner Emotional oming to terms with being Aileen Feeney, chief executive of term and in the future. unable to conceive nat- the charity Fertility Network UK, Some clinics off er free counsel- urally can be stressful, says women and men who are una- ling, but others charge. Couples 40% and can leave you feel- ble to start a family suff er from researching clinics are advised to anguish of Cing angry, depressed and anxious. stigma, and are likely to suff er from ask about this, and whether clinics It can also put additional stress anxiety and stress. off er support groups or the opportu- on relationships, intimacy, and “Society still largely assumes nity to meet other patients who are your connection with relatives and that you will go on to have a fam- undergoing similar treatment. infertility friends. The impact can be pro- ily, sooner or later, and so much of In addition to the counselling found and long lasting. what we do revolves around fam- couples may receive from their 30% The process of going through IVF ily life,” she says. “But it doesn’t clinic, the HFEA advises couples Diﬃ culty conceiving can have a (in vitro fertilisation) for months always work out that way and many to consider seeking counselling on and even years can take its toll as people find they cannot conceive the NHS or privately. This provides devastating emotional impact and you may experience hopes and dis- naturally. Yet, it can be extremely an opportunity to explore feelings appointments, while managing the difficult to come to terms with around fertility more generally couples should be supported with implications on your emotions, this, and society gives you con- and can be done individually or as professional counselling your body, your relationship and stant reminders.” a couple. GPs provide a gateway to your fi nances. A major survey by Fertility NHS counselling. 20% Fertility problems aff ect between Network UK in 2016 revealed that For private counselling, the 10 per cent and 15 per cent of the the emotional and social impact British Infertility Counselling population, according to the World of fertility problems was greater Association has a directory of Health Foundation. In the UK, one than previously recognised. The accredited therapists, with options in six couples are aff ected and the survey, conducted in association including telephone and Skype number seeking medical help to with Middlesex University London, counselling. The HFEA website also start a family has risen dramati- assessed the impact of failing lists other support organisations, 10% cally, with more turning to IVF. to conceive and the subsequent But mental health issues rooted impact of fertility treatment on in fertility problems are unlikely to both women and men. Some 90 per end with a clinical intervention to cent of respondents reported feel- help create a family. The incidence ing depressed and 42 per cent expe- of depression in couples present- rienced suicidal feelings. ing for fertility treatment is signif- Those who had unsuccessful IVF providers are beginning icantly higher than in the general treatment reported greater distress to give greater priority to 0% population and poor mental health as well as more frequent suicidal

can itself become an obstacle to a thoughts. More than two thirds of the emotional support that ended d i f fi c u lt Strained successful outcome through IVF. respondents (70 per cent) reported Improved Unchanged Sometimes Relationship Although the stigma of mental some detrimental impact on the is available to couples going now improved Strained initially, health remains, IVF providers are relationship with their partner, through treatment Fertility Network UK 2016 18 UNDERSTANDING FERTILITY RACONTEUR.NET 19

MENTAL HEALTH