A message from our family to yours:

NOTICE FOR PATIENTS UPDATE TO SERVICES AT WATERSTONE CLINIC

A message from Dr John Waterstone, Medical Director

Please bear with us while we work our way through contacting each of our patients. We will give priority to patients who were cancelled/delayed and will schedule at the nearest available time. If you would like to speak to one of the team, feel free to contact us on 0818 333 310 / [email protected]

The safety and welfare of our patients and staff are of utmost importance to us at Waterstone Clinic. Due to the increase of Coronavirus cases in Ireland, we have taken the decision to limit the services we can provide at the moment, and are following guidelines from the European Society of Human Reproduction and Embryology (ESHRE). The experts at ESHRE have advised that patients who are considering or planning fertility treatment at the moment should avoid becoming pregnant at this time due to the uncertainties around the impact of Coronavirus.  

As we begin our phased return to providing treatment, we are following guidelines from the HSE and ESHRE and our Clinic is COVID-19 FREE. Life at the Clinic will not be back to normal just yet, and it will look a little different when you attend. The first change is that we are introducing two new forms for all patients and partners: a Patient Charter and a COVID19 Risk Assessment form.

The Patient Charter outlines your responsibilities while you are access treatment with us, and we will ask you to read, sign it and return it to us prior to attending the clinic for your next visit. The Charter describes the new procedures we will have in place, and our commitments to you to keep you safe in the Clinic so that your treatment can go ahead as planned. 

The COVID-19 Risk Assessment form will help our clinical team assess the level of risk you are exposed to in your daily life. We will ask you each to make yourself available to complete this process by phone before treatment and again during treatment. Treatment will not proceed without completing these steps. 

The team may suggest things to reduce your risk, to keep both you and all at the Clinic, safe from COVID-19. Risk assessment is a process, and you may be risk assessed at additional points. We would ask you to be vigilant and report any changes to your risk: we are in this together and must do all we can to protect one another as a community.

Please do bear with us as we implement these new policies and an additional consent process for treatment during the pandemic. We know patients are anxious to return to treatment, as are we, and we are doing everything we can do resume our work safely.  

Our Treatment Roadmap: 

Phase 1 w/c 18 May: Fertility testing and scans 

Phase 2 w/c 25 May: IVF/ICSI Cycles and Egg Freeze cycles (priority for those who were cancelled)

Phase 3 w/c 8 June: FET Cycles (priority for those who were cancelled/had freeze-all cycles)

Phase 4 w/c 15 June: OII & IUI Cycles (priority to those who were cancelled)

Donor Sperm Cycles: The donor team are recommencing treatment, under the phased return. The donor team are continuing preparatory work and ensuring compliance with the new Irish legislation concerning donor treatments.

Donor Egg Cycles: We are working hard on your behalf to resume the service and are continuing preparatory work with patients for treatment. We are dependent on the full removal of travel restrictions, and on the resumption of donor bank activity. We will update you on as soon as there is new information. Once we can return, priority will be given to those who were cancelled/delayed. The donor team are ensuring compliance with the new Irish legislation concerning donor treatments.

Dr John Waterstone, Medical Director of Waterstone Clinic

Article in the Irish Examiner, 25 June 2019 – Press Association

A popular strategy for raising IVF pregnancy rates by freezing embryos has been shown to have no improvement in a large trial. Success rates after freezing all embryos for later transfer were no better than fresh transfers, a randomised trial at eight clinics in Denmark, Sweden and Spain found.

Dr Sacha Stormlund, from Copenhagen University Hospital in Denmark, said: “Our findings give no support to a general freeze-all strategy in normally menstruating women.

“The results of this trial were as we expected, namely to see similar pregnancy rates between the fresh and freeze-all treatment groups. So I think it can now plausibly be said that there is no indication for a general freeze-all strategy in women with regular menstrual cycles who are not at immediate risk of overstimulation in IVF.”

She presented the findings of the trial, which involved 460 IVF patients, at the European Society of Human Reproduction and Embryology in Vienna, Austria. The study was prompted by the growing trend of freezing all embryos generated in the first cycle of pregnancy and transferring them after thawing in a later cycle.

This approach has proved a popular alternative to using fresh embryos in the initial cycle. However, the freeze-all approach is still advised as a safety measure for IVF patients responding excessively to ovarian stimulation, such as women with polycystic ovary syndrome.

https://www.irishexaminer.com/breakingnews/world/freezing-embryos-has-no-impact-on-ivf-success-rate-study-concludes-932678.html

Marriage Diaries is a column by Telegraph Family in which people share snapshots of their relationships and their dilemmas.  They are published every Wednesday. The below story is available here.

It’s 7.30 on a Thursday morning. The post-coital glow quickly dissipates as I get out of bed and give my wife a perfunctory nod. She is distracted and is adding the time and a record of our activity to an app on her phone. While we are trying very hard to make a life, somewhere along the way something has died.

I like sex and believe it to be an important component in a loving relationship. I have been blessed with a healthy, regular intimacy with my wife. But lately, everything has become rather – how do I say this? – mechanical. We rely on diaries and ovulation aids, rather than luck and seduction.

It was not always thus. Initially in our relationship there were fireworks, as in most new loves. Sometimes there were several fireworks a day in various locations. These fizzled out over time, but have remained regular. Every so often, when the touch paper is lit, they explode unexpectedly again in impromptu displays that the neighbours can sometimes hear. These are always the moments of intimacy and excitement that reconnect us when the banality of everyday life gets in the way. They are the little reminders of the passionate people we were and can still be.

Eventually, after several carefree years of courtship and marriage, talk of children surfaced and recently we went to discuss matters with a fertility specialist (we are both over 40, so there are no guarantees). I was heartened to be told that to maximise our changes we should be having regular sex. That’s sex, on prescription, as advised by a clinician. Naturally, I had a spring my step after the appointment and in the days that followed, as I reminded my better half of this medical recommendation.

Naively and hopefully, I envisaged that the fertility mission would be accomplished with the sexual equivalent of a sustained campaign of indiscriminate carpet-bombing, which I was very much looking forward to. The reality, however, was a little more meticulous and it became apparent that, rather than shock-and-awe, we were instead going to be conducting a series of carefully controlled and targeted surgical strikes. Each was concentrated within a five-day fertility window and dictated almost to the minute by an app, which alerted us each month when the time had come to launch Operation Conception.

Day one was always a relief, coming as it usually did after a period of abstinence. Days two and three weren’t bad either. But by days four and five, the intimacy had drained from the experience and both of us knew we were just going through the motions. The pressure to perform sucked the romance and excitement from the occasion. My wife marshalled and organised. I felt like a cow being milked.

I know I should be grateful and should look at these monthly opportunities as a time of bounty. And they are by no means unpleasant. We do laugh about them and share our thoughts and feelings honestly. My wife often feels the same way. We both accept that the carefree love life we enjoyed early in our relationship was of a time and that now there is a bigger purpose. Yet I still mourn the thrill of desire for desire’s sake, and there is a small, perhaps insecure and egotistical part of me that begrudges having to perform at set times, much like an actor playing to an audience that has only turned up because the tickets are free, not because they are necessarily eager to see the show.

I am an optimist, however, and I hope that after a successful mission, normal service will resume somewhere down the line. I am also a realist and recognise that with a baby in town, there may well be a lengthy ceasefire first.

From: https://www.telegraph.co.uk/family/relationships/trying-baby-taking-joy-sex-life/?wgu=272965_16644_15613681422734_018240d3fe&wgexpiry=1569144142&WT.mc_id=tmgoff_paff-4551_subsoffers_basic_planit&utm_source=tmgoff&utm_medium=tmgoff_paff-4551&utm_content=subsoffers_basic&utm_campaign=tmgoff_paff-4551_subsoffers_basic_planit

The Irish Times Health Supplement (10 April) reported that many Irish fertility clinics are offering optional “extras” in IVF treatment, recommended by clinics in order to boost chances of becoming pregnant. A survey of patients being treated at two Dublin IVF clinics found that add-ons had increased the costs for 84 per cent of these patients.

Our medical director, Dr John Waterstone, has often spoken out against these extras as they cost patients “several thousand more euro than they had anticipated spending in the course of an IVF treatment cycle”. Dr Waterstone has suggested that the Department of Health should be aware of the potential for “financial exploitation” of patients in the area of assisted reproduction, and has urged that IVF clinics be regulated. He strongly encourages patients to check what is, and is not, included in the prices quoted by clinics.  

Waterstone Clinic operates with transparency at its core. Our clinic is committed to providing treatments that are evidence-based and proven to succeed. We make no empty promises, and we perform no unnecessary tests. Our treatment costs are all-inclusive, and there are no hidden extras. 

There are many “add on” treatments patients can access when pursuing IVF treatment, Dr John Waterstone notes that “none are likely to increase the chance of taking home a baby.” The clinicians at Waterstone Clinic only suggest tests and treatments that are medically warranted. We believe our skills, experience and state-of-the-art facilities give our patients the best chance possible to achieve their goal, without these expensive extras.

READ MORE:https://www.independent.ie/irish-news/health/desperate-couples-at-risk-of-exploitation-fertility-expert-35256095.html

https://www.irishtimes.com/life-and-style/health-family/the-high-mysterious-and-added-costs-of-ivf-1.3845858

Environmental factors such as air- borne pollutants and pesticides in our foods are leading to a decline in the quality and quantity of male sperm, says Lorraine Courtney

Men’s sperm counts have fallen by almost 60% since the 1970s, according to major new research which cautions that our modern world may be prompting a male fertility crisis. Over the past few years, various studies have pointed to declining sperm quality and quantity. This latest research, and the first systematic review of trends, looked at 180 studies over four decades. It concluded that total sperm counts in Western countries have fallen by 59% since 1973, with a 52% fall in sperm concentration, or the concentration of sperm in a man’s ejaculate.

“Decreasing sperm count has been of great concern since it was first reported 25 years ago,” says Dr Shanna H Swan, a professor in the Department of Environmental Medicine and Public Health at the Icahn School of Medicine at Mount Sinai, New York and study leader.

“This definitive study shows, for the first time, that this decline is strong and continuing. The fact that the decline is seen in Western countries strongly suggests that chemicals in commerce are playing a causal role in this trend.” The chemicals he refers to range from everyday air pollutants to pesticides or even soap. So should the average man panic?

A first glance at the statistics suggests that we are faring well. Ireland had the highest birth rate among EU countries last year. 2016 saw 63,900 live births recorded according to figures from Eurostat, the EU statistics agency. That’s a super healthy rate of 13.5 births for every 1,000 of the population. Italy was the lowest with just 7.8 births for 1,000 of the population.

However, male infertility is a factor for half of the couples who seek fertility treatment here in Ireland. Azoospermia (absence of spermatozoa in the ejaculate) is a condition present in approximately 1% of males in the general population. Between 10-15% of infertile men who attend assisted reproductive technology clinics here have had a diagnosis of azoospermia. However, approximately 30% of couples present where there is suboptimal sperm count or reduced motility, impacting on the couples’ ability to conceive a child.

Dr Tim Dineen, head of laboratory services at Cork’s Waterstone Clinic, says the study draws attention to a trend that doctors and scientists working in reproductive medicine have been aware of for many years.

“The decline in sperm counts is very gradual and is unlikely to prevent any individual man fathering children naturally in the short term,” says Dr Dineen.

“It is also important to point out that if a man’s sperm count is so low that natural conception is impossible, intracytoplasmic sperm injection (ICSI) treatment is able to compensate for the problem very successfully.”

Treatments, in the form of ICSI, have been very successful in overcoming male subfertility and male infertility. In the Waterstone Clinic, for those couples where the female partner is younger with good ovarian reserve, a live birth rate of at least 50% (first fresh cycle) is expected.

ICSI costs €4,750 including blastocyst and embryoscope incubator culture at the clinic, which offers a range of treatments.

“It is reasonable to assume that environmental factors are to blame but no one knows exactly which factors are involved,” says Dr Dineen. “Research is urgently required to identify the environmental causes; only then can public health initiatives be undertaken in order to address the problem.”

With an eye on the future, Dr Dineen maintains that if the exact cause of the drop in sperm counts is not discovered and corrected soon, the decline will continue and major problems will arise with regard to the ability of men to father children naturally.

Read more