- Bourn Hall offers six-week fertility diagnosis service free upon GP referral
- New monitored Ovulation Induction (OI) treatment increases chance of natural conception through specialist care
- Largest ever study finds ‘fertility window’ varies widely so individualised treatment is vital
- Fertility is impacted by both physical and emotional wellbeing so care for the whole person is an important element of success
Dr Thanos Papathanasiou, Bourn Hall’s Medical Director explains, “In up to a third of women who have not conceived after a year, the problem is due to the ovaries not producing an egg (ovulation). If this is the only problem then there are a number of ways this can be overcome, but it is important to personalise this treatment and also to support the couple to become pregnancy-ready.”
Bourn Hall has over 40 years of fertility experience and is the world’s first IVF clinic. In July 2019 it gained NHS qualified provider status for secondary fertility services and this is enabling it to help couples earlier in their fertility journey.
GPs are now able to refer patients directly to Bourn Hall for fertility testing after they have been trying for a year to conceive. They will receive a diagnosis within six weeks and if ovulation induction (OI) is appropriate, this treatment can start immediately. The new service aims to get patients pregnant quicker without the need for IVF.
Carefully monitored OI highly successful
Women with no periods or infrequent ovulations (cycles longer than 35-40 days) may benefit from ovulation induction. This increases egg production and only one egg is required and fertilised naturally so it is a low cost treatment that in the right hands can be highly successful.
Dr Thanos Papathanasiou continues: “Fertility drugs, such as Clomid, are effective at stimulating the ovaries. About 70% of women will ovulate with this treatment, the majority within the first three months. Of those who ovulate, between 20% and 60% will become pregnant. The wide range is due to many other factors affecting fertility such as age, weight, sperm quality and lifestyle or other health issues.
“However, Clomid needs to be used with care as it can over stimulate the ovaries resulting in multiple births and should only be used for six cycles. Our fertility nurses are trained in ultrasound monitoring and work closely with patients to maximise their chance of natural conception.
“A concern is that Clomid can be prescribed or purchased online without this monitoring. The treatment is also not suitable for everyone, so a full suite of tests is also needed to eliminate other issues.”
Largest fertility study supports advice
Dr Papathanasiou stresses the majority of people can get pregnant naturally, and says instead of stressing about the ‘fertility window’ they should aim for regular intercourse a couple of times a week.
This advice is supported by the findings for the largest real-world investigation of women of childbearing age. The study of 600,000 women published in npj Digital Health* found that egg release on day 14 is not true for the majority of women and it can vary from seven to 19 days. This is concerning as many of the widely used tests and predictors are based on this 14-day assumption.
Additionally, it was found that the cycle length decreased with age with ovulation earlier for women over 35. Ethnicity, high body mass index (BMI) and stress can also affect the cycle length. Women with a BMI of over 35 also had a reduced rate of ovulation. This means the fertility window when fertilisation can occur varies between individuals and this has implications for advice and treatment.
New service free for NHS patients
Bourn Hall’s new Fertility Diagnosis and OI Treatment service is available free for NHS patients referred by their GP. All the testing is carried out at the same dedicated clinics with no waiting times, minimal appointments and the same fertility specialist team.
In consultation with a fertility specialist the patient is given the findings of the diagnosis and a personalised treatment plan – this may include lifestyle advice such as stress management and how to achieve a healthy weight for fertility health and OI treatment if appropriate. A similar service is also available for self-funded patients.
Need to try for a year as the majority of couples conceive within this time
Couples need to have been trying to conceive for a year before they are eligible for NHS fertility diagnosis. Dr Papathanasiou says that keeping records of dates of periods and using fertility apps that use an additional measure such as basal body temperature can be useful as they enable an objective conversation with a health professional.
He explains: “Many people are embarrassed to talk about infertility. Having a record can help to overcome this and is valuable for a fertility specialist, as we can use this information to predict the chances of pregnancy both naturally and by assisted conception techniques helping people make informed decisions.
“The majority of people will get pregnant if they are otherwise healthy, and have regular intercourse a couple of times a week. Sometimes reassurance of this is all that is needed. Fertility is impacted by physical and emotional wellbeing, the importance of looking after the whole person is often underestimated.”
Free Fertility Fayre to mark World Fertility Day 2nd November
To help people to get pregnant quicker - Bourn Hall is hosting two free fertility fayres in the region during Fertility Week; the second is at Bourn Hall Cambridge on 2 November 2019 to provide advice from a range of fertility specialists, therapists and support organisations.
There is also a training session for GPs and other Health professionals in association with the Essex Faculty of the Royal College of General Practitioners on 25th January 2020.
* Reference: Jonathan R. Bull, Simon P. Rowland, Elina Berglund Scherwitzl, Raoul Scherwitzl, Kristina Gemzell Danielsson, Joyce Harper. Real-world menstrual cycle characteristics of more than 600,000 menstrual cycles. npj Digital Medicine, 2019; 2 (1) DOI: 10.1038/s41746-019-0152-7