I am head of the laboratory at Waterstone Clinic. My main role involves the fertilisation of eggs through in vitro fertilisation (IVF). In traditional IVF, with normal sperm count and motile sperm, we add the sperm to eggs and let nature take its course. We then check the eggs have been fertilised the following day.

When dealing with low sperm numbers or poor motility there is a higher chance fertilisation will not occur, so we use intracytoplasmic sperm injection (ICSI). This allows us to inject a single sperm into each egg. Selecting the eggs for ICSI is straightforward in that we only inject mature eggs, as an immature one does not have the potential to fertilise. The sperm, which has already gone through a selection process when it was prepared, is added to a viscous medium to slow it down and capture a healthy sperm.

We use high-powered microscopes with micro-manipulators to keep the egg in place while the sperm is injected — the eggs are smaller than a speck of dust.

ICSI has revolutionised IVF treatment as it allows us to overcome many forms of male fertility problems. Even when there is no sperm in the ejaculate, it’s not the end of the line: we can perform a biopsy to retrieve sperm from the testes, and use that to create embryos.

This is one of only two IVF clinics in Ireland authorised to carry out embryo biopsy to facilitate preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS). For PGD, this gives a couple the option of trying to reduce the risk of passing on a genetic condition.

We only recommend PGD treatment for couples where a life-limiting condition has been identified and will be passed on to their children. We do not use the treatment for “designer babies”.

There are a number of rare single-gene conditions we get inquiries about, but the one we are asked to test for most in relation to PGD is cystic fibrosis. Ireland has one of the highest carrier rates of cystic fibrosis in the world.

Our first couple for PGD involved a man affected with cystic fibrosis whose partner was a carrier. They had a one in two chance of every pregnancy being affected with the disease. When a couple is faced with this tough decision, they have a number of choices, one of which is to carry out PGD. Alternatively, they could pursue a treatment cycle with donor sperm.

In this case, we had to check if the male was producing sperm: one of the features of cystic fibrosis is that there is no sperm in the ejaculate. Fortunately there was sperm, so we fertilised a number of eggs, and on day three removed one cell from each embryo and sent them to a genetics testing lab in the UK. Forty-eight hours later we got the results: there were five embryos suitable for transfer. This meant that while all the embryos were cystic fibrosis carriers, they would not be affected by the condition.

That couple had a healthy baby girl — the ultimate measure of success in PGD.

http://www.thesundaytimes.co.uk/sto/news/ireland/article1672082.ece

Whether actively trying for a baby or planning a family at a later stage in life, reproductive health is hugely important for both men and women. Simple things like lifestyle choices, exercise habits and medical history all play an important role in fertility. Here are 15 ways to become fertility aware, from Mary McAuliffe, Head of Clinical Services at Waterstone Clinic 

1. Educate yourself about the link between age and fertility.

Fertility is age related and knowing how your fertility changes with age is so important, especially for women. Women’s fertility rate begins to decline from age 32, with a more pronounced decline from 35 and a sharp decline from 40 onwards. Men’s sperm can start declining in quantity and quality from 40 years. The key to fulfilling your desire to have a family is to take charge of your reproductive health and plan accordingly.

2. Maintain a healthy weight.

Being underweight or overweight can have a negative impact on fertility for both men and women. If you are actively trying for baby, it’s a good idea to calculate your BMI. Aim for a healthy weight; a BMI of between 20 and 24.9 is ideal. Optimising your weight will help regulate your menstrual cycle and increase your chances of conceiving.  The key message is to get active and engage in an exercise that you enjoy.

3. Eat a healthy and balanced diet.

It’s as important for your fertility health as for your physical health. Maintain a balanced diet with plenty of fresh fruit and veg., avoid processed foods, junk food and fizzy drinks and reduce your caffeine intake as much as possible.  Omega 3 essential fatty acids found in fish oils and good-quality flaxseed oils are not only recommended for healthy cell development, but also play an important role during pregnancy

4. Quit smoking.

As well as being beneficial for your overall health, research shows that it takes longer for smokers than non-smokers to become pregnant. Smoking can cause damage to the ovaries and fallopian tubes and alter the hormone levels required for pregnancy. Smoking also increases the risk of miscarriage within the first 12 weeks of pregnancy. Men who smoke have a lower sperm count that those who don’t and there is some association with increased sperm DNA damage.

5. Reduce alcohol intake.

Heavy alcohol intake in men has been linked to reduced testosterone production and reduced sperm quality. It has also been linked to ovulatory problems in women. It is not known how much alcohol you need to drink before fertility is affected, so it is best to reduce alcohol intake or try to cut it out completely while trying to conceive.

6. Folic acid.

Women should start taking 400mcg folic acid before trying to conceive and during the first three months of pregnancy. Folate is an essential ingredient in cell division and a baby starts out as a single cell that divides again and again. It can also be beneficial for men to take folic acid while trying to conceive. Taking a folic acid supplement can help improve sperm quality and reduce sperm abnormalities.  Foods rich in folic acid include spinach, brussels sprouts, asparagus and avocado.

7. Up your supplements.

Increase your Vitamin D intake; this is important for bone health and also for normal embryo development. Vitamin C and CoQ10 are beneficial for healthy egg and sperm development.

8. Understand your fertile period – especially after time on the pill. 

Take note of your menstrual cycle; keep a record so that you have a good understanding of your cycle length. For example, when women stop taking the contraceptive pill, it can take a while for menstruation to regulate. so it is especially important to stay tuned into any changes. Usually, ovulation occurs on day 14 of a 28 day cycle, so your best chance of becoming pregnant is between day 12 and day 16, sometimes known as the fertile window.

9. Chat to your Mum.

Ask your mum when she started the menopause as this can give you a good indication of when you may expect to start. If your Mum had early menopause, then you should be aware that this may narrow your fertility window.

10. Get to grips with your medical history.

For women who have had surgery for problems such as appendicitis or removal of an ovarian cyst, becoming pregnant can be more challenging as the surgery can sometimes cause blockages in the fallopian tubes. If you have had any medical concerns, or have a history of a sexually transmitted disease, book yourself in for a quick fertility assessment to see if there are any issues you may need to address. Men who have had surgery for undescended testes, have had mumps (this can affect sperm production) or trauma to the groin region, should seek an early fertility assessment.

11. Keep it cool.

It is important not to overheat sperm. Avoid resting laptops on your lap, using heated car seats and keeping your mobile phone in your pocket. Avoid wearing too-tight underwear or jeans for prolonged periods.

12. Don’t over-exercise.

If you are trying to conceive, avoid vigorous exercise or long cycles as these activities can compress or potentially overheat the testicles.  Also avoid hot baths, saunas and Jacuzzis as they can temporarily decrease sperm production.

13. Get amorous.

New research from Indiana University suggests that the more times a woman has intercourse outside of her fertile window, the more her immune system is primed for pregnancy when she has intercourse while ovulating. While this research is novel (September 2015), it is recommended to have intercourse two to three times per week when trying to conceive. Take care of your relationship, communicate with one another and remember to have sex for fun!

14. Don’t stress out.

Take time out to listen to relaxing music, meet with friends or download apps for mindfulness to keep those stress levels in check.

15. Take a positive approach, book a fertility assessment.

It’s becoming ever more convenient to have a fertility assessment. Self-referral services where you book online or over the phone are hassle free and fertility centres will usually offer a discounted rate for a couple having a fertility assessment together. Ensure that you always discuss your results with a fertility expert.

The Minister for Health has announced plans to fund fertility treatment in conjunction with envisaged legislation. The aim is to provide public funding for assisted human reproductive (AHR) treatment in conjunction with the introduction of legislation in this area.

While fertility treatment is not now provided in the Irish public health service, financial support is available to individuals. For example, tax relief for medical expenses and the cost of certain approved fertility medicines are covered under the Medical Card or Drugs Payment Scheme (DPS).

Funding for fertility treatment would be considered in tandem with “closing the current legislative gap” in this area of healthcare, said Minister Leo Varadkar. “Fertility treatments should be funded in such a way that not only maximises efficiency but that ensures equity of access as well,” said the Minister.

“Nevertheless, the provision of public funding for assisted human reproduction must be accompanied by a robust system of legal governance that will promote and protect the health and well-being of patients and most especially the children who will be born as a result of the treatment.”

In February 2015, the Government gave approval to draft a General Scheme of legislative provisions dealing with a broad range of aspects relating to AHR. Drafting is under way and the General Scheme will be published in the first half of 2016.

The aim of the legislation will be to promote and ensure the health and safety of parents, others involved in the process (such as egg/sperm donors and surrogate mothers) and, most importantly, the children who will be born as a result of assisted reproduction.

The Department of Health is commissioning an evidence review of international public funding models. The review will inform policy regarding the optimal mechanism for any future public funding of AHR in the State.

AHR encompasses in vitro fertilisation (IVF), pre-implantation genetic diagnosis, intra-uterine insemination, intra-cytoplasmic sperm injection and gamete donation. Currently, there are a number of fertility clinics operating in Ireland offering a broad range of AHR services, which remains largely unregulated.

Although IVF treatment is not provided by the Irish public health service, there is some support available in that patients who access IVF treatment privately may claim tax relief on the costs involved under the tax relief for medical expenses scheme.

In addition, a defined list of fertility medicines needed for fertility treatment is covered under the High Tech Scheme administered by the HSE. Medicines covered by the High Tech Scheme must be prescribed by a consultant/specialist and approved by the HSE High Tech Liaison Officers. The cost of the medicines is then covered, as appropriate, under the Medical Card or DPS.

[email protected]

http://www.imt.ie/news/latest-news/2016/02/funding-for-fertility-treatments-due.html

The Government’s decision to fund infertility treatment will relieve some of the pressure on women who already face a hugely stressful and emotional journey, a leading support group has claimed.

Health Minister Leo Varadkar has confirmed his intention to provide public funding for assisted reproductive treatment in conjunction with the planned introduction of legislation saying fertility treatments should be funded in such a way “that not only maximises efficiency but which ensures equity of access as well”.

A review of international public funding models is to be carried out and it is hoped the legislation could be in place by the end of 2016 or early next year.

Dr Cathy Allen, consultant obstetrician and gynaecologist at the Merrion Fertility clinic at the National Maternity Hospital welcomed the news. She said about one in six couples will need help. “They will experience some sort of a delay in conceiving when they want to,” she said. “For many of them a visit to their primary care physician GP can be extremely helpful, sometimes its a lifestyle adjustment that needs to be done. For people who are referred on for more expert help to secondary level fertility clinics in hospital or tertiary level assisted reproductive medicine units, about half of those will be referred on for in vitro fertilisation.”

While the Government has not provided final details of how the scheme will operate and be funded, it is likely to be consider factors such as the age of the mother and number of treatments of IVF treatments it is willing to pay for.

Dr Allen told the Anton Savage Show on Today FM: “If you are looking at an economic model, I think the Government will have to considering funding, possibly certain in categories up to three cycles to give people a fair crack of the whip.” She confirmed the treatment is expensive, about €4,000 per cycle.

“That is fresh creation of embryos,” she said. “But some couples will be lucky and they might make three or four or even five embryos. So we put back one and cryo-preserve or freeze the other ones for the future. Once they are safely in the cryo-preservation, that is not quite so expensive and they can remain there.”

Dr John Waterstone, President of the Irish Fertility Society and medical director of the Waterstone Clinic said: “My hope is that whatever funding arrangements are made are comprehensive, and I would particularly hope that they provide for the area of pre-implantation genetic diagnosis. This treatment is used for couples at genetic risk, who are endeavouring, in a proactive way, to prevent transmitting life limiting conditions to their children.”

Helen Browne, co-founder of the National Infertility Support and Information Group, said going for fertility treatment is a stressful and emotional journey for women.

“Having funding will relieve some of that stress,” she said. She pointed out that, prior to the economic crash, some women could afford to pay privately for one cycle of IVF treatment and, if a second was required which was the case in more than half of cases, they would maybe seek help from relatives.

She said after the crash, that was all gone. While some were left with no treatment option because of the cost, others were forced to travel to other countries, such as the Czech Republic, to seek treatment as it was as much as 50% cheaper.

By Stephen Rogers

http://www.irishexaminer.com/ireland/states-fertility-care-plan-to-relieve-pressure-379421.html

Fertility treatments for couples who are finding it difficult to have a baby naturally are to be publicly funded under new proposals to be announced by Health Minister Leo Varadkar today.

Learning that your conception story is going to be completely different than the way that you had always imagined it can be a complete shock to your system. Undergoing In Vitro Fertilization specifically, is a rarely welcomed but necessary decision for one out of every eight couples. It’s no small feat to familiarize yourself with the new language and concepts associated with this involved process, let alone managing all of the constant variables like family, friends and work. Know that just like everything else in life, with a little bit of patience, a willingness to learn and an openness to new possibilities, you will master everything you need to know about the IVF process. Having undergone several cycles myself, I am all-too-familiar with the feelings of confusion and overwhelm that come along with this phase of your life. The silver lining for me is that this un-welcomed adventure has shaped the person I am today and is responsible for so many blessings that have since shown up in my life. Please remember these words as you navigate your way through this new journey – You are a whole person, complete and perfect in every way and fully equipped to move through this phase of your life with grace and with ease, regardless of the ultimate outcome.

Acknowledge That You May Undergo Multiple Cycles

Unfortunately Reproductive Endocrinology is an imperfect science and does not always deliver the results that we ache for immediately, if at all. Every woman’s body responds differently to the various protocols and the medication pairings, so results can vary greatly. The good news is that with each cycle, you will learn more about your body and how it responds to various internal and external stimuli and use that information to change up subsequent cycles for improved results. There are many instances where in vitro does work on the first try, however going into this new and unchartered territory with the awareness that a successful outcome may take some time and require an evolving understanding of which protocols are best for you, can be very reassuring. My husband and I threw ourselves into our first IVF, certain that it would be successful. To our complete shock, a positive cycle took a lot longer than we anticipated. Managing our expectations became key so that we could move forward mindfully and cautiously.

Strengthen Your Relationship With Your Spouse

More often than not, undergoing any form of assisted reproductive technology puts a great deal of pressure on the relationships in your life, particularly the relationship with your spouse. Stay mindful of the reasons that you and your partner are together and why you have mutually decided to expand your family. Understand that you would not be yearning for a child so deeply with anyone more than your chosen life partner. Based on pure biology, the woman is the one who has to bear the burden of most infertility treatments, doctors appointments and procedures, irrelevant to the cause of the infertility. This does not mean that her partner is not enduring his own personal battles with this all-consuming process. It is imperative for both parties in the relationship to try to empathize with the others perspective. Understand that this process is not easy on either of you and will often bring on feelings of shame, guilt or blame for one or both of you. Acknowledge the feelings that come up, but refrain from aiming your heartache at each other. More than ever, this is a time when you need to energetically and emotionally align.  Although there was definitely a learning curve for us, the more my husband and I united and focused on our love rather than our fear in this situation, the sooner we were able to heal and move closer to our resolution.

Nourish Your Mind

Creating a mindfulness practice can be a life line in order to maintain balance and peace throughout your cycle. There will be ups and downs and moments of despair and confusion; moments when you will absolutely need to access your own intuitive voice to to console and comfort you.  Mindfulness practices are very individual and can essentially be practiced in any form that brings you peace, comfort and release. For some, this practice involves meditation, affirmations and positive self talk. For others, it’s about indulging in an activity that brings you pure joy. Find your flow and move with it. For me, it was all about surrounding myself with new people, indulging in a favorite meal and getting lost in a good book.

Do Not Substitute the Internet for Medical Advice

Given the age of technology that we all live in, it seems only natural to get online and look for immediate answers to all of your critical IVF questions. Please refrain from doing this. It will only cause you more confusion in the face of an already uncertain time. Choose your Reproductive Endocrinologist wisely and put your faith in their knowledge, expertise and commitment in doing their best to give you your desired outcome. Become friendly with your nurses and don’t hesitate to contact them for any questions regarding your protocol. It took me a very long time, some unnecessary tears and an abundance of suffering to learn this very valuable lesson.

Be Mindful of Where You Seek Support

Never underestimate the power of a meaningful support system. When undergoing infertility treatment, it is imperative that you have an army of angels by your side. Seek support from the sources that feel most natural to you. When sharing with friends and family however, know that they will be waiting on you for results and updates so be sure to set parameters and let them know what to expect from you throughout the process – the last thing you need is to bear any extra pressure now. There are a myriad of online groups where women unite to mutually support each other through their cycles and beyond. Free local support groups are also always welcoming new members. A therapist or a coach is another great resource to keep you aligned, balanced and grounded. I chose to start my own support group which provided me with a great deal of purpose and connection and so much comfort in knowing that I was able to support others on this journey as well as myself.

Your fertility journey is only a piece of your story, it is not your whole life. Remember to be gentle with yourself, seek the support that is right for you and use this experience as an opportunity to evolve, grow and access your own unwavering inner strength.

Source: http://www.huffingtonpost.com/melody-pourmoradi/how-to-mindfully-support-_b_8697358.html

More than three quarters of Irish adults have no idea what age their fertility will start to decline.

A new national study has also discovered that more than half of us think our fertility will start to decrease at 35, that is five years after it actually does.

Health website myfertilitycheck.ie spoke to almost a thousand people between the ages of 25 and 44, after it was revealed that Irish mothers are among the oldest in Europe.

46% of women say they are waiting for the right partner before they have a baby, while 37% of men claim financial concerns are making them put off fatherhood.

Head of Clinical Services at My Fertility Check, Mary McAuliffe, said: “I see so many women and couples attending for fertility treatment and IVF who are surprised that it has proven so difficult to have a baby naturally.

“A substantial portion of adults think fertility declines at a much later age than it does in reality. 41% of people think the decline begins at 35 while one third believe it starts later – at 40 years.”

She said this was a concern.

She said: “The results really highlight the need for a nationwide, State-funded education campaign on fertility and reproductive health, particularly targeting students at third level.

Young people need to be educated on the lifestyle choices that can affect their fertility; in particular, age, smoking, alcohol and health issues such as sexually transmitted diseases.”

Here are the basic numbers:

* National survey reveals 79% of adults do not know the age at which fertility declines

* 41% incorrectly believe that fertility starts to decline at 35 years

* 46% of women say waiting for the right partner is the primary reason to delay having a baby

* 37% of men say finances is their main reason to put off fatherhood

* 710 men and women aged between 25 and 44 took part in the study

Source:http://www.breakingnews.ie/ireland/survey-finds-startling-percentage-of-adults-dont-know-when-fertility-declines-715071.html

More than seven in 10 adults do not know when fertility declines, a study shows. A national survey reveals that 41% of Irish people incorrectly believe that fertility starts to decline at the age of 35 when, in fact, it occurs five years before that.

The study also shows that 46% of women say waiting for the right partner is the primary reason to delay having a baby, while 37% of men say finances is their main reason to put off fatherhood.

The report was commissioned by My Fertility Check — a self-referral fertility assessment service for men, women,and couples. It revealed that the majority of adults in Ireland are misinformed about the age at which fertility declines.

Commenting on the results, Head of Clinical Services at My Fertility Check, Mary McAuliffe, said: “I see so many women and couples attending for fertility treatment and IVF who are surprised that it has proven so difficult to have a baby naturally.

“A substantial portion of adults think fertility declines at a much later age than it does in reality. Forty-one percent of people think the decline begins at 35 while one third believe it starts later — at 40 years. The proportion of people that are misinformed is of concern.”

Ms McAuliffe said the results of the study highlighted the need for a nationwide state funded education campaign on fertility and reproductive health, targeting students at third level.

“Young people need to be educated on the lifestyle choices that can affect their fertility; in particular, age, smoking, alcohol, and health issues such as sexually transmitted diseases,” she said.

Some 86% of respondents said they had never had a fertility assessment. Six out of 10 of these said it was because they were unaware of the existence of fertility check services.

“Having a fertility check at an earlier age will empower people with the knowledge they need to make informed decisions about their future plans for starting a family and, will also help them avoid the emotional and high costs associated with fertility treatment,” said Ms McAuliffe.

“From fertility awareness studies and population surveys, we have learned that most young people are too optimistic about their chances to conceive spontaneously after age 35. Also, young people tend to overestimate the effectiveness of IVF, in part due to the number of celebrities giving birth in their forties and, also due to ‘miracle’ stories in the media.”

Respondents were also asked on why people in Ireland are leaving it later in life to start a family. A recent Eurostat survey showed that first time mothers in Ireland are among the oldest in Europe, with 52% aged between 30 and 39.

For more information, see www.myfertilitycheck.ie

Source:http://www.irishexaminer.com/ireland/most-adults-do-not-know-when-fertility-levels-decline-375662.html

With the general election looming in early 2016, it’s time for those candidates who purport to be invested in long term planning about the future of the country to step up to the plate and make a case for a state-funded, nationwide education campaign on fertility awareness.

Ireland is one of three EU countries that do not fund IVF treatment for couples struggling with subfertility and with current health budget restrictions, this situation is unlikely to change anytime soon.

What politicians can do is commit in their election manifestos to an education programme on reproductive health for third level students. This campaign should be rolled out in all of our universities and third level institutions across the country.

Recent decades have seen huge advances in reproductive technology, which can now overcome previously insurmountable infertility problems. However, complex fertility treatments are expensive and Irish couples often struggle to afford these unsubsidised costs.

It is not unusual for couples to take out bank loans, borrow from parents or even re-mortgage their homes in order to pay for IVF treatment. These financial burdens are worth every cent when treatment is successful and couples achieve their dream of having a baby.

Fertility education

However, fertility treatments do not always succeed  –  the most common cause of repeated failure is poor egg quality caused by increasing age. To put it simply, if women leave it too late in life before starting to try to have a baby, they may find it impossible to do so with or without treatment – women who would probably have been able to become pregnant easily had they only started trying at a younger age, avoiding a huge and unnecessary emotional and financial toll.

The women I treat often express anger that they were not made aware at a younger age of basic realities surrounding fertility, particularly that women’s fertility starts to decline at age 30 with a sharp plunge after age 35. It’s clear that these women would have benefitted from an education and awareness programme about fertility in their early twenties.

I am not in favour of encouraging men and women who have just started their college life to start having babies, but I strongly believe that they should be armed with the knowledge they need to make informed decisions about their future plans for a family.

Men as well as women need to be educated about reproductive responsibility. They need to be aware that, in the future, if they refuse to commit to parenthood soon enough, they may be depriving their partners the opportunity of motherhood.

College students should also be made aware of the negative impact on fertility of cigarette smoking and obesity. Lifestyle choices made now can affect future fertility prospects.

Take the steps now

Women in their early 30s, who intend to have children should be aware of fertility assessment services which can provide information on their reproductive health. The results are usually positive and reassuring, but if a concern is identified steps can be taken to deal with it at an early stage.

In some cases advice should be sought at an earlier stage. Fertility difficulties can be anticipated where women have irregular periods, have thyroid problems or have a family history of fertility problems or early menopause.

Men should seek early assistance where there is a history of undescended testicles or childhood mumps. The problem is that many men and women are unaware of fertility check services. A nationwide education campaign can go a long way towards educating them on the existence and benefits of these checks.

A fertility assessment check involves a blood test to measure the level of AMH (Anti-Mullerian Hormone) which gives a good indication of a woman’s ovarian reserve (the numbers of eggs in her ovaries).

A transvaginal ultrasound scan is also carried out to provide information about a woman’s uterus and ovaries. A semen analysis test is straightforward with immediate results about the male’s fertility prospects.

Our election candidates need to take responsibility for the future health of the population they wish to serve. The first step they can take is to ensure our young people have access to vital knowledge that will empower them to make informed plans for their reproductive futures.

http://www.thejournal.ie/readme/women-fertility-education-2521404-Dec2015/?utm_source=shortlink