Professor Robert Edwards at NID 2008

Presentations available:

Jonathan Pearce - Adoption DOWNLOAD Powerpoint Presentation
The talk will outline how the UK adoption system works, including:

• The types of children who are adopted from the care system.
• A brief overview of overseas adoption.
• Assessment and preparation process for prospective adopters
• Adoption support.
• Key issues in adoptive parenting.

It will also cover the work of Adoption UK and how it can help prospective adopters and adoptive parents.

Laura Hughes - The Emotional Impact of Infertility – “It’s Good to Talk” – a Patient’s Perspective DOWNLOAD Word Presentation
Infertility, as well as being so emotionally, physically and financially demanding, is all too often a lonely and isolating experience. This talk will focus on the importance of counselling and support groups and the mixed experiences of talking to family and friends from the perspective of a patient who endured 10 long years of fertility treatment before finally achieving a family.

Jani White - DOWNLOAD Powerpoint Presentation
This talk will discuss the value and benefits of complimentary therapy in support of fertility, and will discuss the importance of finding a well qualified practitioner.

Acupuncture and Chinese herbs, nutrition/supplements, western herbs, reflexology, hypnotherapy and massage can all contribute a beneficial effect in supporting fertility.

This talk is aimed at helping you to learn how to find a practitioner who knows their stuff and is also practicing member of a recognised governing body.

This talk is aimed at helping you learn more about which therapy may be most suitable for your circumstances to add the most appropriate kind of support to developing your fertility.

Presentations still to be added:

Dian Shepperson Mills - Fit for Fertility, healthy baby = healthy mother and father
Why is there so much infertility in the twenty-first century?
What does the human body need to strengthen it’s reproductive system?
How can you improve your fertility?
Dian Shepperson Mills will take you through the way the reproductive system works with nutrients. We will study the major causes of sub-fertility and explore the way healthy food confers health to the uterus, ovaries, ova and sperm. Dian has a 52 per cent fertility rate and has worked with 20,000 women with endometriosis and PCOS over the years. She advises on diet and the short term judicious use of supplements. We will look at the type of healthy eating to ensure that your body is taking In the essential nutrients and phytochemicals it needs to trigger fertility - and what substances may be harmful to fertility.

Dr Lily Hua Yu - Treatment of Infertility with Chinese Medicine
For several millennia the Chinese has a continuous recorded medical documentations relating to the treatment of infertility in both women and men. The holistic syndrome analysis of the pathological imbalance and relational disorders in Chinese medicine demonstrate a thorough understanding of the female and male reproductive physiology. Clinical experience of these documentations forms the basis for a modern approach to the problem of infertility that is unique in Chinese medicine. How then in simple terms does Chinese medicine (which incorporates acupuncture as part of its technique together with Chinese herbs) treat infertility? Positive clinical investigation results published internationally show that Chinese medicine is having an important role in the treatment of infertility.

Dr Gillian Lockwood – Biopsies/Sperm Retrieval
Although many men may suffer from azoospermia (the absence of sperm in the ejaculate) the majority will be producing viable sperm in their testes. In this talk I shall describe the tests that can be undertaken to identify these men who can be helped to achieve genetic fatherhood via surgical sperm retrieval and ICSI

Professor Sheena E.M.Lewis - Lifestyle Hazards and Male Fertility
Environmental factors appear to be amongst the major culprits of the damage caused to the male reproductive tract. Since the second World war our environment has become more toxic as the chemicals industries have thrived. We come in contact with xenobiotics on a daily basis through pesticides, herbicides, cosmetics, preservatives, cleaning materials and pharmaceuticals. We even choose to consume them in the form of phytoestrogens as part of our fast food diet. We have performed studies to assess their effects on spermatogenesis and sperm function. In recent years, recreational drugs have been added to the list of potential lifestyle hazards to human fertility. An estimated 4 million young people smoked cannabis in the UK in 2002. Our group has examined the in vitro effects of tetrahydrocannabinoid; THC the primary psychoactive cannabinoid in marihuana on human sperm fertility potential using important sperm function biomarkers such as quantitative motility and acrosome reaction and found significant changes occur when sperm are exposed to the drug. We have also shown that long term use can impair sperm production.
Another recreational drug that has become instantly popular is Viagra. Although initially restricted to older men with impotence problems, its use has now spread to men of all ages for both medicinal and recreational purposes. This includes men of reproductive age and particularly men undergoing infertility treatment. Indeed, in our audit of all the UK fertility centres, 42% were prescribing Viagra to help patients produce semen samples. Yet its effects on sperm function are not fully understood. Since Viagra alters the levels of energy available to cells it can have deleterious effects on sperm function and also on early embryo development. Further studies are ongoing.

Dr Simon Wood – Investigating and Diagnosing
This presentation will provide an overview of the various causes of Male infertility. It will focus on the different defects of sperm production and transport and the tests available to clinicians to appropriately investigate the male.

Dr Steve Roberts – Single Embryo Transfer
The high twin rates associated with IVF, and the increased risks associated with such pregnancies, have led to pressure to increase the proportion of IVF treatments in which just a single embryo is transferred. However there is considerable controversy and disagreement over whether or how such a move should be implemented. In particular the chances of success from a single embryo transfer are lower than that when two-embryos are transferred; although this can probably be offset by additional cycles using frozen embryos. Also many patients view a twin pregnancy as a positive and not a negative outcome. The “towardSET?” project was set up with funding from the Department of Health to explore the options around increased use of SET. This project is using advanced statistical analysis of IVF outcome data to model the effect of potential routes to increasing the use of SET, thus quantifying the potential gains and losses. This modelling work is integrated with a parallel interview study of patient perspectives on SET and these are being used both to inform the modelling process and to review the results obtained.
We will present preliminary results from this project and give a first opportunity to respond to the work and inform the future direction of the project.

Alan Thornhill – Combining Science and Empathy, the New Approach to Fertility Treatment
Fertility centres currently use a number of different selection tools allowing them to choose which embryo or embryos to transfer after IVF. Most centres still use a visual assessment of the embryos according to a ‘gold standard’ morphologically ‘perfect’ embryo. A number of other tools are beginning to be used including (i) measurements of the nutrients the embryo consumes (ii) the waste products it generates (iii) its genetic make-up and (iv) the activity levels of important genes within the embryo. This overview will introduce these exciting new areas of investigation along with their strengths and limitations towards selecting the ‘best’ embryo for transfer.

Dr Helen Picton – Professor of Reproduction and Early Development, University of Leeds
A small number of IVF clinics around the world are now are attempting assisted conception in a completely different way. Immature, Germinal Vesicle (GV) stage oocytes are retrieved before they undergo the final stages of nuclear maturation in the body. The oocytes are then matured in laboratory for 24-48 hours until they become fertile at which point they are inseminated using conventional methods of IVF or ICSI. In theory, the in vitro maturation (IVM) of oocytes is very attractive as it has a number of practical advantages over conventional treatments. Most IVM protocols are relatively simple, for both the patient and clinician, with fewer consultations, a shorter period of treatment, and significantly less pharmacological intervention. This carries a numbers of major advantages in terms of reduced costs of treatments, and greater safety as a result of minimising the amount of hormone injections required. An immediate application of IVM is for the treatment of polycystic ovarian disease as these patients are at the highest risk of hyperstimulation from gonadotrophins and they already have a large crop of suitably sized follicles which can be harvested at egg collection. The immediate goals for IVM programmes are to improve the efficiency and fertility of fully grown eggs and following fertilisation to produce pregnancy rates which are at least equivalent to, or preferably higher than those obtained using conventional assisted conception protocols.

Anya Sizer – Fertility Coaching
Looking at the infertility journey using coaching techniques we will leave you feeling empowered resourced and equipped to deal with whatever lies ahead. Giving both practical and emotional tools with the end goal being to realise afresh that infertility may be a rollercoaster but it needn’t be the sum total of who you are.

Helen Allan and Janet Owen – Does the word ‘Counselling’ scare you?
Helen Allan and Janet Owen will talk about the counsellor’s and the user’s views and experiences of counselling in infertility. Using their experiences as respectively a user and nurse, and a counsellor, they will describe the benefits, barriers and hopefully the potential for counselling in coming to terms with both the emotions during treatment and investigation cycles and infertility itself.

Professor Adam Balen - Polycystic Ovary Syndrome and Infertility
The polycystic ovary syndrome (PCOS) is the commonest hormonal disturbance to affect women. The main problems that women with PCOS experience are menstrual cycle disturbances (irregular or absent periods), difficulty in controlling body weight and skin problems (acne and unwanted hair growth on the face or body). Not all women with PCOS experience all of the symptoms and furthermore a woman’s problems may change over time. In particular if an individual becomes overweight then her problems are likely to worsen. If ovulation occurs erratically it will take longer than average to get pregnant and if ovulation is not occurring it is not possible to conceive without treatment. If the menstrual cycle is irregular it is necessary to take steps to make it regular in order to achieve monthly ovulation and hence a better chance of conception. There are a number of treatments that are used to stimulate regular ovulation. The first drug to try is usually a tablet called clomifene citrate (Clomid), which induces ovulation in about 75% of women of whom perhaps 50-60% can expect to get pregnant after 6 months’ therapy. If clomifene does not work the alternatives include daily hormone injections of a drug that contains follicle stimulating hormone (FSH) or alternatively an operation performed by laparoscopic (“key hole”) surgery in which the ovaries are cauterized (called ovarian diathermy or “drilling”) – both will induce ovulation in about 80% of women. Metformin has been proposed as a drug which may also help some women although the latest research has failed to show a benefit.Treatments to induce ovulation must be monitored by ultrasound observation of the developing follicle in the ovary. This requires attending the fertility clinic on a regular basis in order to prevent the main side effect, which is multiple pregnancy. The aim of the treatment is to induce the release of only one egg. Another risk of treatment is the ovarian hyperstimulation syndrome (OHSS), when the ovaries respond over-sensitively and can make the individual very unwell

Mr Geoffrey Trew – Causes & Diagnosis
There are many causes of infertility. We strongly believe that finding the correct diagnosis not only is what patients want, but, also helps improve the overall success of any treatment. IVF is not the only treatment, for some patients there may be other options which can be explored if the correct diagnosis is made. But also IVF success rate may be improved if other problems are found and correctly treated prior to IVF. Such as hydrosalpinges or intrauterine adhesions

Dr Luciano Nardo – Monitoring Ovarian Reserve
The rising trend towards delayed parenthood is resulting in a greater number of patients seeking conception at an older age. It has therefore become very important to assess accurately the ovarian performance, as determined by the number of primordial follicles in the ovary. Social habits, non-clinical and clinical factors have been shown to contribute to the decline of the primordial follicle pool either directly or indirectly. Given the considerable individual variability in the female subfertile population, the criteria used to investigate ovarian function, and also to accept patients for assisted conception have been a matter of much debate.

Chronological age is considered as a simple way of obtaining information on the extent of ovarian function, in terms of both quantity and quality. However many have highlighted that chronological age cannot be used as a surrogate of ovarian age. Various biochemical and ultrasonographic markers of ovarian performance have therefore been employed in routine clinical practice to assess ovarian function, though the accuracy and reproducibility remain far from optimal. Recently, measurement of anti-mullerian hormone (AMH) levels has been proposed by myself and other researchers as a marker of ovarian follicular reserve. A large body of evidence has suggested that circulating AMH concentrations are highly correlated with the number of antral follicles and reflect the ovarian reserve better than other known clinical markers such as baseline follicle stimulating hormone (FSH), ingibin B and oestradiol (E2). Unlike AMH, these hormones are involved in the dynamic of pituitary-gonadal axis feedback system and are therefore subject to cycle-to-cycle fluctuations.

Anti-mullerian hormone is expressed in both sexes at different stages of development and it is best understood for its role in fetal sex differentiation. In females, AMH is not detected before 36 weeks of gestation and is produced throughout reproductive life. Antti-mullerian hormone is secreted by the granulosa cells of pre-antral and small antral follicles and gradually diminishes in the subsequent stages of follicle development unti disappearing in large-sized antral follicles (>6mm). Thus, circulating concentrations of AMH reflect the number of selectable follicles during the early follicular phase and low levels suggest a depleted ovarian follicle pool.

A quantative measurement of ovarian ageing may also be obtained by ultrasound assessment of the number of antral follicles. Like AMH, antral follicle count (AFC) correlates significantly with ovarian performance and is highly predictive of clinical pregnancy in women undergoing in-vitro fertilisation. While baseline FSH remains a screening ovarian reserve test, baseline AMH and AFC are diagnostic markers with greater precision than anything else available, and they should always be requested for assessing ovarian ageing in many areas of reproduction, including puberty, infertility and premature menopause. The appropriate use of these markers is of paramount importance when counselling, referring for and planning treatment.

Kate Brian – Treatment Overseas – the Pros & Cons
Kate Brian will consider the pros and cons of travelling overseas for fertility treatment, and will discuss the findings of the IN UK patient survey on travelling abroad for treatment.

Bill Ledger – The Effect of Your Lifestyle on Your Fertility
Changing lifestyle is one of the few things that a couple can do to help improve their fertility without input from specialists. Any doctor or nurse working with patients with problems of infertility will frequently be asked about advice regarding lifestyle modification. While some strategies are well supported by research evidence, such as stopping smoking and having more sex at the right time, other pieces of advise may be little more than old wives’ tales. This talk will explore the science behind some of the lifestyle modifications used by infertile couples and try to reach an evidence based approach to lifestyle and fertility.

Richard Fleming – Anti Mullerian Hormone and Ovarian Stimulation Strategy
It has recently been shown that Anti-Mullerian Hormone (AMH) can predict the degree of response to standard controlled ovarian stimulation. Correspondingly, a programme can be designed to select treatment protocols appropriate to a patient’s likely response – in contrast to the ‘one size fits all’ approach.
Patients who are particularly sensitive to FSH, can be treated with a ‘mild regime’ using low dose of FSH and GnRH-antagonist, which results in a high clinical pregnancy rate (>50%) with a low incidence of excess response and negligible ovarian hyperstimulation syndrome. Patients with a predicted normal response can be treated with a ‘standard’ agonist regime with its clinical simplicity and convenience, and also a negligible risk of excess stimulation. Patients with a low AMH value show a reduced response to all forms of treatment, and prospective evaluation is needed to determine the best protocol for this group of patients. Patients with very low AMH are probably unsuitable for controlled ovarian stimulation by any protocol.

Rachel Cutting – The Embrology Lab
The embryologist of today has many roles and has to face many challenges. Providing a good service is fundamental but integrating new scientific advances and regulatory requirements into clinical practice is essential to keep laboratories at the forefront of developments. Although lab duties are often priority developing communication skills to be able to give results and explain situations to facilitate understanding with empathy is key to making the patients’ journey less stressful.

Embryology is a fast moving dynamic science and although a relatively new field, the changes over the past few years to how we practice are significant. Applying the changes to the laboratory such as the development of commercially available medium to improve embryo culture have enabled the embryologist to extend the culture period to the blastocyst stage, giving more information and enabling better selection of embryos. Learning new techniques such as vitrification complement new culture methods which enable the embryologist to improve on success rates. The embryologist also has to face the challenges of meeting the regulatory requirements such as the HFEA Standards and elective single embryo transfer guidance. Many embryologists have also been involved in quality management.

The role of the embryologist in any ACU team is important to ensure good laboratory practice is in place to maximise success rates, to provide support to other members of staff and to build up trust between laboratory staff and patients.

Dr Simon Thornton – Optimising the Outcome in Fertility Treatment
In his presentation Dr Simon Thornton, Medical Director of the CARE Fertility Group will look at the many factors which may have a bearing on the success of fertility treatments and explore how these may be addressed to optimise the outcome of treatment for individual patients and couples. Reviewing CARE’s experience treating couples often rejected by other centres will highlight the importance of an individualised approach.

Joanne Adams – Recruiting Donors
We are now 2 years into the removal of donor anonymity and the change has hit us hard. There are waiting lists for DI treatment where none existed previously, and patients themselves are shopping around for donors that are in short supply. However, a handful of clinics have managed to recruit donors successfully in these difficult times. Manchester Fertility Services is one such clinic. With a proactive recruitment campaign and dedicated staff we have managed to provide a continued supply of donors for our own patients and to help some way in alleviating the national shortage. This talk covers our recruitment strategy over the last few years and will perhaps stimulate some discussion and evolution of plans for future recruitment campaigns.’

Dr Kamal Ahuja PhD – 10 Years of Egg Sharing in the UK
The introduction of egg sharing in the UK in 1992 was greeted with deep suspicion. The HFEA came under tremendous pressure to ban the practice and seemingly came very close to doing just that.
The key objectives of this presentation are: 1.To examine how the HFEA argued the merits of egg sharing and what was initially perceived as the shortcomings of egg sharing, 2. The promise egg sharing may hold for clinical research and treatment in future, and, 3. The vigilance and research required to ensure that the practice does not deviate from its objective of providing a safe and affordable form of IVF treatment.

Olivia Montuschi – ‘Time to Tell’
Telling children about their origins by donor conception is not only in their best interests but is actually good for family relationships and much easier than keeping a secret. The why, when and how to start talking with young children about donor conception will be explained and illustrated with materials.

Carol O’Reilly – Surrogacy – A Personal Story
I have been involved in surrogacy since 1994 and have given birth to 5 surrogate babies.
So I feel I am in a position to be able to share my experiences with others.

I started Surrogacy UK in August 2002 and have seen many wonderful surrogacy’s happen but I am also very well aware of the pitfalls.

I hope my talk will help those that wish to learn more and understand what is really involved when you embark on a surrogacy arrangement.

Caroline Gallup – Just the Two of Us – Involuntary Childlessness
Entering into fertility treatment, for most people, is a time of hope and optimism. The treatment, even with the best of care, can be arduous and challenging emotionally, physically and financially. How do you form relationships with the clinic and its staff that makes certain that you fully understand what you are entering into, and help them to help you?

How do you handle enquiries from family and friends and make sure you build a support network to really help you cope with the challenging times ahead?

How do you make sure that your relationship stays intact, and that ‘blaming’ doesn’t become an outlet for your frustrations with unsuccessful cycles?

Despite cautions from specialists that success rates run at an average of 20 – 30% no-one truly believes that they won’t hold a baby in their arms before too long. But what if, after years of heartbreaking failure, great expense, strain on your health and the well-being of your relationships you decide that you don’t want to continue. How do you make the decision to call a halt to treatment and walk away from the clinic, happy with the outcome? How do you make sure that, not only have you gained the most from your treatment, but that you are both resolved to the same degree? How do you make that decision together?

Adoption isn’t for everyone and by using her own story, Caroline will talk about how to survive treatment; sharing the happy resolution leading from her and her husband’s mutual decision to remain childless.

Jacky Boivin – Achieving Patient Friendly IVF in th UK: Psychology Makes a Difference
To achieve patient friendly IVF and maximise success rates clinics need to take account of how stress impacts on IVF. About 15% of patient response to IVF is due to patient and team stress. Stress predicts who starts IVF, drops out prematurely, gets pregnant and delivers. A major contribution to the ‘psychological burden’ of IVF is stressful organisational care and poor patient-centred care. Effective interventions exist to tackle these issues and clinics need to start implementing them.

Robab Latifnejad Roudsari – New directions Toward Handling Infertility: How Religion & Spirituality Help
Background and objectives: Infertility can be a complex life-crisis which may last for many years. But as it is not a disfiguring, life-threatening or fatal condition society may neglect the concerns of infertile women. I argue that infertile women need to be cared for holistically by an experienced multidisciplinary team and in a holistic care the significance of religious and spiritual aspects of care must not be underestimated. This exploratory study examined how do religion and spirituality inform infertile women’s efforts to construct meanings about the adverse effects of infertility and how these beliefs affect the attempts made by infertile women to deal with different aspects of infertility.

Methods: In this study, which was underpinned by the theoretical framework of feminist grounded theory, 30 infertile women affiliated to different denominations of Christianity (Protestantism, Catholicism, Orthodoxy) and Islam (Shi’a and Sunni) were interviewed. Volunteer women with fertility problem were recruited in one Iranian and two UK fertility clinics using theoretical sampling. Data were collected through semi structured in-depth interviews and analyzed using grounded theory.

Findings: Infertile women encountering infertility in their primary appraisal showed attributes like disbelief, uncertainty, and questioning, which was virtually the same in all participants. But religious and spiritual infertile women in their subsequent reappraisal using religious/ spiritual meaning-making framework tried to preserve themselves from emotional collapse. They reappraised infertility in a positive manner as God’s plan, God’s gift, God’s test, being chosen by God, and a life enriching experience to gain more spiritual strength. Through this way they succeeded to acknowledge their new identity as infertile and tried to cope with the situation adopting religious coping strategies. Their trust and reliance on God and their benevolent reappraisal helped them to be optimistic, calm, hopeful and confident, as they believed in God’s wisdom, beneficence and power. Their religious worldview guided them to talk about an internal knowing, certainty and assurance that they would be blessed by God, either through being granted a child or in other ways. As a result, they became capable to disclose their situation to others. Following disclosure they started to find a solution on their own or through seeking help from their husbands/ partners or close relatives and friends. In relation to their marital relationships, they tried through establishing supportive relationships, being positive, offering spiritual sympathy and adopting religious role models to be more understanding, compassionate and gentle to each other and maintain a family cohesion. Their religious views on socialization as a religious value motivated them to search reassurance through the love and care of religious congregation as well as offering support to others to gain intimacy and as a consequence being liberated from social isolation caused by infertility. They tried to get help from their religious beliefs and perspectives while they were struggling to find a solution. They had healing beliefs as believing in God-given cure, healing through prayer, belief in miracles and belief in spiritual healers which maintained them hopeful to the outcome of treatment. They employed assisted reproductive technologies as long as they were compatible with religious authorizations. At the same time, they had a transcendental hope that they would be blessed one day and this divine hope motivated them to go ahead with their treatment procedures.

Conclusion: Religious infertile women after experiencing ups and downs in their long-term journey were convinced that they could have a fruitful and dynamic life even without a child. They believed that the whole process of struggling with different dimensions of infertility could not threaten their belief in God and they would be still appreciated. Hence, it seems that their spirituality as far as they came to terms developed and they achieved a kind of spiritual strengthening embedded in religious hope in a Higher Being. This spiritual strength gave them a sense of empowerment to handle infertility more peacefully.

Key words: Infertility, religion, spirituality, feminist grounded theory

Sam Abdalla - "Doctor. I am not pregnant after 3 attempts, what is my chance at the 4th attempt?" Answers from HFEA long term data analysis.

An analysis of 15 years of data from the HFEA register.