Clowning helps IVF patients become pregnant: study

Dr. Shevach Friedler an infertility doctor with the Infertility and IVF unit at Assaf Harofeh Medical Center, in Zrifin, Israel, led a study of the effects of a bedside encounter with a professional medical clown on the pregnancy rate of women undergoing in-vitro fertilization (IVF).
Dr. Friedler and colleagues tracked 219 women undergoing IVF treatment at the medical center and, over a period of a year, treated half of them to a medical clown's 15-minute routine of jokes, magic tricks and other clowning immediately after their embryos were implanted. The clown’s routine was created especially for the study by Friedler and a colleague.
The results showed 36.4 percent of women exposed to clowning immediately after embryo transfer became pregnant, while only 20.2 percent of the controls became pregnant. Dr. Friedler said the reason was probably because the clowning reduced the stress of what for many was many years of grueling IVF treatments, but this is not certain. It is also unclear what role, if any, stress may play in the success of IVF treatments.
Dr. Friedler, who is also trained in movement and mime, originally thought of the research after reading about laughter as an anti-stress mechanism. He realized that IVF patients are often extremely stressed, and wondered if relieving that stress through clowning at a crucial moment in the treatment could help.
Dr. Friedler and colleagues conclude that medical clowning may be a beneficial adjunct to IVF treatments and it deserves further investigation. Medical clowning is already used to good effect in hospitals in Europe, Australia, North America and Israel, particularly in children’s hospitals.
Dr. Friedler also pointed out that clowning is “one of the least hazardous interventions in our field.” Other methods of reducing stress could also be investigated. The findings are reported in the journal Fertility and Sterility.
More information: The effect of medical clowning on pregnancy rates after in vitro fertilization and embryo transfer (IVF-ET), Shevach Friedler, M.D et al., Fertility and Sterility, published online 06 January 2011, doi:10.1016/j.fertnstert.2010.12.016

IVF clinics' success rates online

IVF success rates are now almost indistinguishable between clinics so patients need to take other factors into account, the regulator says.

The HFEA is launching a new website providing patients with detailed information on every UK clinic, from waiting times to multiple birth rates.

But it will not include data on cost, or mishaps like embryo mix-ups.

For the first time the predicted chance of a fertility clinic delivering a baby based on key factors will be given.

The number of IVF treatments continues to rise. For women under 42 the success rates are up.

But for those aged 43 and above the already low success rate fell again between 2006 and 2007, the last year for which figures are available.

Predicting babies

The website - Choose a Fertility Clinic - will allow would-be patients to examine details of the diagnosis, age and length of infertility of those typically treated at the clinic.

For the first time, it will give a prediction of the chances of a live birth based on a range of factors.

Traditionally statistics have failed to differentiate between a small clinic where three out of 10 patients have delivered a baby and a larger one where 30 out of 100 have done so.

Both have a nominal success rate of 30%, but if the smaller clinic delivers one more baby the rate jumps to 40%, while for the larger clinic it rises by just 0.7%. A new way of displaying data will enable patients to gain a more accurate picture of success rates.

It will also allow them to search for clinics providing specialist services such as pre-genetic diagnosis, PGD. New legislation coming into force on Thursday includes a liberalisation of the rules governing which inherited diseases individual clinics can screen for.

More than one

The site will also allow patients to look at statistics on multiple births and urges patients to look for a clinic which has both a good success rate and a high number of single births.

Multiple births are risky for both mother and baby, but some prefer to transfer more than one embryo at once to increase the chances of a live birth and reduce the prospect of another round of expensive treatment.

At 32.3% overall success rates from IVF were highest for the under 35s, up slightly from the previous year, and indeed chances of having a baby increased between 2006 and 2007 for all age groups up to 42.

But they fell to just 3.4% for those aged 43-44, and 3.1% to those over 44.

The majority of clinics offer success rates within these figures, and while there are "some who come top and some who come bottom", patients should ask themselves whether it is really worth travelling many miles for marginal increases in success rates, the HFEA said.

"Every patient is different and most clinics have live births around the national average. These factors make it even more important for patients to see in detail what each clinic has to offer," says Professor Lisa Jardine, chair of the HFEA.

"Fertility treatment is big business in the UK. People can spend thousands of pounds in the hope of having a baby. It is only right that they have as much information as possible to help them make a choice about where they go for their treatment."

No price tags

Clare Lewis Jones, of the Infertility Network, also urged patients not just to consider success rates but to use the site to find a clinic which met "their own specific treatment needs".

A lack of transparency about cost is one of the key issues raised by patients, but the HFEA says it has no "statutory authority" to include this information on the site - and that in any event it would rapidly become out-of-date.

Private IVF treatment costs on average £3,500, but fees incurred by extra drugs and diagnostic tests can push this up to over £8,000.

It was also deemed inappropriate to provide information on where there had been mishaps, such as embryo mix-ups.

IVF success set to drop under single-embryo policy

IVF success rates will fall by up to 20 per cent because of a UK government policy designed to cut the number of damaging twin pregnancies, research has suggested.

An initiative to limit multiple births by persuading IVF patients to use only one embryo at a time will cause a “significant reduction in treatment success”, according to an analysis of a clinic’s patients.

The Human Fertilisation and Embryology Authority strategy, which aims to cut the twin birthrate by 2012 from one in four to one in ten, would in practice reduce the IVF success rate at St Mary’s Hospital in Manchester from 21 per cent to 17 per cent, the study found.

Daniel Brison, of the University of Manchester, said that the strategy was right to encourage single-embryo transfer because a multiple birth was the greatest IVF risk to mothers and babies, but its implementation needed to be backed by better NHS access to IVF, especially for follow-up courses using frozen embryos.

About a third of NHS trusts do not offer frozen back-up treatment and 85 per cent do not provide the three full cycles that the National Institute for Health and Clinical Excellence recommends.

“Single-embryo transfer is the right way forward, but we have to fund more than one cycle,” Dr Brison said. “It is very difficult to ask patients to accept any reduction in success rates if they have only one shot. Embryo freezing is also crucial, as is careful selection of patients who are suitable for a single embryo.”

IVF produces a higher rate of twins and triplets because multiple embryos are often used to maximise the chances of pregnancy. Such babies, however, are more likely to be stillborn, die in their first year, suffer disabilities or be born prematurely. There are also risks to mothers.

In the study, published in the journal Human Reproduction, Dr Brison and his colleagues Stephen Roberts and Cheryl Fitzgerald constructed a model of what would happen to their clinic’s success rates under the single-embryo strategy.

To achieve the target of 10 per cent multiple births, about 55 per cent of patients would have to have single-embryo transfer. The current rate is about 10 per cent. This would bring the success rate down by about 20 per cent. If women were selected carefully, the decline would be slightly smaller but the live birthrate would still fall to 18.5 per cent.

The paper suggests ways that women could be selected, including analysis of their embryos as well as their age and hormone levels. Such measures would be essential to limit the policy’s impact on pregnancy success, the scientists said.

The St Mary’s success rate is below the national average of 31 per cent for women under 35 who use their own fresh eggs. It is an NHS centre with a waiting list of up to three years, so couples with a good prognosis often conceive spontaneously while waiting for treatment, leaving the clinic to treat harder cases.

Professor Peter Braude, of King’s College London, led the group that drew up the single-embryo strategy. He said that patients could be chosen who would not be disadvantaged by the policy.

“It doesn’t reduce pregnancy rates in women who are most likely to get pregnant, and who are also most likely to have twins,” he said.

“We have never said that a single embryo is right for every woman and the 10 per cent target is an aspiration. A very small proportion of patients give rise to most of the twins and by identifying them, we can reduce multiple births but not the pregnancy rate.”

Limiting IVF cycles may deny women the chance to conceive

Researchers from Israel believe that limiting the number of IVF cycles can deny women the right to the possibility of having a baby.Raoul Orvieto (Barzilai Medical Center, Ashkelon, Israel) and colleagues found that, although the number of pregnancies achieved in cycles 1 to 3 is significantly greater than that in subsequent cycles, the number remains constant through cycles 4 to 20.

The researchers note that in most countries couples are limited as to how many cycles they can undergo, mainly due to financial constraints.To see if the chances of pregnancy decline with increasing number of cycles, they surveyed women in Israel, where IVF is completely covered by medical insurance allowing couples to perform as many cycles as they want.

A total of 2,760 cycles were studied, which resulted in 602 clinical pregnancies.In cycles 1 to 3, 25.2 percent of clinical pregnancies were achieved per cycle. This was significantly greater than the 17.8 percent rate per cycle for cycles 4 to 6. However, there was no further decline for cycles 7 to 9, 10 to 12, and 12 or more, at 17.5, 13.0, and 11.2 percent per cycle, respectively.

Orvieto et al conclude: "The number of attempted cycles available in the vast majority of countries severely and unjustly denies women the right to the possibility of having a baby."