Good news may be round the corner for the thousands of women who have trouble conceiving and resort to costly IVF treatment involving a four-week course of potentially harmful hormonal drugs. Some of the world’s leading names in fertility gathered in London this week to discuss the potential of natural, virtually drug-free, methods of IVF, and the technology that has made it more feasible.
Dr Geeta Nargund, the organiser of the Congress on Natural Cycle and Minimal Stimulation IVF, and head of reproductive medicine at St George’s Hospital, London, believes it is time to stop giving women hormones to make them more fertile. In the week that IVF laws had a government shake-up, she says there is a back-to-basics approach to help women conceive that is safer, cheaper and, according to new studies presented by her peers at the congress, just as effective. Dr Nargund has pioneered techniques of scanning the ovaries for blood flow, which enables specialists to accurately predict which eggs are most likely to be fertilised successfully, doing away with the need to artifically stimulate the production of lots of eggs.
Conventional IVF treatment has a success rate of 10 to 28 per cent, depending on age. Natural-cycle IVF has a comparable success rate, but evidence presented at the conference shows that some older women have more success with natural IVF treatment than with conventional.
So how does it work? In conventional IVF treatment women take hormones that first suppress ovulation, then stimulate the ovaries to produce eggs. This can be gruelling, with side- effects that include flushes, headaches and occasionally a severe reaction called ovarian hyperstimulation syndrome. The stresses are such that women have a three-month gap between cycles to allow their system to recover.
Speaking exclusively to Body&Soul, Dr Nargund explained that with natural-cycle IVF, a doctor waits until a woman’s egg ripens, then collects and fertilises this egg in a test tube, before replacing it in her womb. Louise Brown, the world’s first test-tube baby, born in 1978, was the first natural-cycle IVF baby.
But according to Dr Nargund, this natural technique was dropped because doctors could not time exactly when a woman would ovulate, meaning that often they had to rush into theatre in the middle of the night or risk missing the short window to collect an egg. Hormones solved this problem and also produced a collection of eggs from which to choose, giving a higher chance of successful pregnancy.
Now, 30,000 women a year have IVF treatment, taking daily hormonal drugs for a month. IVF drugs are the only drugs listed in the British National Formulary without recommended minimum and maximum effective dosages, so doctors are left to use their clinical judgment. As the common perception is “the higher the dosage of drugs, the more chance of a baby”, this usually means giving women more and more drugs.
We’ve known for a while that conventional IVF techniques substantially increase the likelihood of multiple pregnancies: 1 in 50 births resulted in twins a decade ago; now the figure is 1 in 37. But research to be presented at the congress also indicates a correlation between higher doses of stimulating drugs and a rise in chromosomal abnormalities in babies, which can lead to disabilities, and damage to the lining of the womb. Dr Louise Brinton, from the National Cancer Institute in Maryland, says the risks are not yet fully understood. “Recent investigations provide reassurance against the major increases in ovarian cancer that were suggested by early studies. But more recent studies raise the possibility that there may be other cancers that should be monitored in future investigations, including breast and endometrial cancer.”
Dr Nargund believes that high doses of stimulating drugs are not only potentially harmful but also have been rendered unnecessary by her new techniques of screening eggs. “It is the quality, not the quantity of eggs that determines a successful pregnancy,” she says. “My research shows that we are able to select the best follicle that is likely to produce the best-quality egg. To avoid multiple pregnancies, this is more important than ever.” New ultrasound technology allows doctors to check the volume and speed of of blood flow to particular organs. This is called Doppler scanning, and Dr Nargund uses the latest colour machines to study the blood circulation to a woman’s reproductive organs and to see tiny capillaries and blood vessels that were undetectable until 15 years ago. Her studies have shown that there is a strong correlation between high blood flow to an egg follicle and the quality of the egg that it will produce. Poor follicular blood flow results in poor-quality eggs with chromosomal abnormalities.
By using Doppler scanning to identify and monitor the egg follicles with the strongest blood flow over the course of a woman’s reproductive cycle, Dr Nargund can select the follicle that is most likely to produce a high-quality egg and a healthy embryo. If the egg follicle appears to have poor blood flow, she can advise the woman not to go through with IVF treatment that month, saving her time and money, and avoiding stress, discomfort and disappointment.
Dr Nargund admits that natural-cycle IVF is not for everyone. “To produce quality eggs we sometimes have to advise a woman to have something called minimal stimulation, giving a tiny dose of drugs, via a daily injection for 10 to 12 days, to help ripen her eggs. Doppler can identify those women who need drugs, avoid giving drugs to those who don’t, and make sure that we aren’t giving doses that are too high.”
Dr Nargund has many high-powered supporters. Jonathan Van Blerkom, Professor of Molecular Biology at the University of Colorado, says he finds it surprising that colour Doppler imaging isn’t used routinely in fertility clinics. He claims it is because of a lack of training and familiarity with the technology and a reluctance by doctors to change their practices.
Women can get natural IVF treatment only at a handful of private clinics across the country, including Dr Nargund’s private clinic in London. The treatment is more widely available in Europe and the US.
According to Dr Nargund, natural-cycle IVF treatment costs £1,000 a cycle compared with upwards of £3,000 a cycle for drug-stimulated IVF. She says this should make it more affordable for everyone: “If NHS units start using natural-cycle IVF, they will be able to afford to give women more than just one cycle.”
For futher information on Dr Nargund’s clinic contact the reproductive charity HER Trust, hertrust.org, 020-8947 9600; and the British Fertility Society, britishfertilitysociety.org.uk, 01454 642217
‘We had twins — naturally’
Polly Walker-Penn, 37, lives in Pembrokeshire with her husband Reuben, 37, and twins Asher and Jacob, 1
“After trying to conceive for four years, Reuben and I were told we had unexplained infertility. Since I was already in my mid-30s, I was starting to panic, but I was reluctant to have IVF. I’d heard horror stories about the side-effects of the drugs and I was worried about the risks to my health and to any baby I might conceive.
“We tried three IUI treatments first (where sperm is inseminated high up in the uterus), but they didn’t work. So we looked into natural-cycle IVF and found that it isn’t done on the NHS. We went to see Geeta Nargund at her private clinic. My ovaries were scanned before ovulation and then when the egg follicles grew to a certain size, I had one injection to help mature the eggs.
“A single egg was then harvested while I was under a light anaesthetic and it was fertilised with my husband’s sperm in a test tube. Three days later, it was implanted back into me. The whole process was relatively painless and straightforward.
“Unfortunately, I didn’t become pregnant the first time. Although we were gutted, we knew that I could try again the following month, which wouldn’t be the case if I were taking hormones, for which you need a three-month gap between cycles. We were successful on our third cycle.
“Finding out I was pregnant was a wonderful moment. I’d had only one egg implanted, but when I went for my 12-week scan I was amazed to discover that this egg had split into two and I was expecting identical twins. I had a natural birth and the boys were born healthy. We had a ready-made family.
“Apart from being rather sleep-deprived, Reuben and I couldn’t be happier.”
