I have been lucky. My children were created and were born with relative ease. Speaking to those who I know have struggled with infertility gives some small insight into the complex series of physical, emotional, financial and medical transactions that operate on a intensely heightened plane of reality.
For the one in six couples in the UK who struggle to conceive, the news of successful ovarian tissue transplants leading to pregnancy could bring new hope. A Danish study followed women who underwent the procedure after cancer treatment had reduced their fertility. The transplanting of frozen tissue was found to be safe and a third of women went on to become pregnant – half without the need for IVF. The procedure offers tangible results, not just for cancer patients but also for women who want to postpone motherhood until later in life. Equally heartening is the news that womb transplants are soon to take place in the UK as part of a clinical trial.
As the fertility expert and author Kate Brian explains: “It is easy to underestimate the impact that fertility problems have on every aspect of people’s lives.” The losses, disappointments and dead ends are bleak and sometimes destructive, often permeated and intensified by an escalating cocktail of hormones. It is therefore important to develop treatments and technology in response to this, while being aware of the enormous complexity of the issues.
Women and their partners are vulnerable at this time. And yet they are often forced into the private marketplace where that vulnerability is met with big bills. While women under 40 are supposed to be able to obtain three cycles of IVF on the NHS, for most this isn’t a reality. According to the Human Fertilisation and Embryology Authority (HFEA), inequalities in service provision, advancing age and repeated failures push 59% of fertility patients into the private sector.
The IVF pioneer Lord Winston criticised private clinics for their highly exploitative prices and misleading information about the chances of success. Winston’s criticisms were particularly directed at egg freezing, which could be superseded by ovarian tissue freezing. Though the Danish study was small, it suggests that freezing ovarian tissue may be far more effective than freezing eggs.
Less than 2% of egg freezing procedures lead to a live birth yet it was reported that the numbers of women enquiring about private harvesting and storage of their eggs (something associated with thousands of pounds in ongoing storage costs) had risen by 400%. Apple and Facebook offer egg freezing as a perk for female employees. The fact that it doesn’t seem to work very well isn’t stopping clinics and employers from marketing the idea. Thankfully freezing techniques are improving, with flash-freezing designed to minimise damage to eggs, but the latest news from Denmark may mean real advancements in the UK, where ovarian tissue transplants are not yet used widely.
The more that treatments can increase real chances of success while managing the complex needs of those undergoing them the better. Intracytoplasmic sperm injections (ICSI) were developed in the 1990s and are now used more often than straightforward IVF. In ICSI a single sperm is injected directly into an egg – particularly useful in cases of male fertility problems or when eggs have been frozen and are thus harder to fertilise. In another breakthrough, clinics in Spain have pioneered a technique that uses timelapse photography of the early development of the embryo to judge which will have the greatest chance of being implanted and developing normally.
Yet Brian says that we don’t need to look to the cutting edge of science for the most profound developments in reproductive medicine. The reduction in multiple births as a result of fertility treatment “is a huge success story that gets overlooked in all the excitement about new advances”.
In 2006 the Expert Group on Multiple Births After IVF reported that a quarter of all IVF pregnancies led to a multiple birth. The sometimes dangerous reality of women with complex needs carrying twins and triplets at significant cost to their lives (and associated dangers for the baby) with little impact on the chance of success was thankfully shown to be unacceptable. In 2012 the HFEA set targets of no more than one in 10 multiple pregnancies following IVF, with reassuring statistics for patients that show that using a single embryo has only a tiny impact on the chances of success.
Refinements such as single-embryo transfer and cutting-edge developments such as ovarian tissue transplants may make having a baby after cancer treatment, or delaying motherhood until the time a woman decides is best for her, a graspable reality, which is an incredibly positive thing. But with all such scientific breakthroughs must come the responsibility to be realistic, to treat women as individuals, and to ensure that services are safe and accessible.
