Are we over using IVF?

Originally IVF was developed for women with tubal disease. It was then expanded for use in men with poor semen quality. Now IVF is being applied to other types of subfertility such as mild male subfertility, endometriosis and unexplained subfertility.
Are we over-treating couples who had a reasonable chance of conceiving naturally? Is it equally effective in these conditions? What are the consequences of using IVF? Do the risks outweigh the benefits?

What is meant by IVF?
IVF is commonly used term for Assisted Reproductive Technology (ART) which includes:

• Assisted insemination (AI) or Intrauterine insemination (IUI) – sperm introduced in uterus around ovulation for fertilisation
• In Vitro Fertilistation (IVF) – when egg and sperm are put together in test tube to fertilise prior to transplantation into the uterus
• Intracytoplasmic Sperm Injection (ICSI) – sperm is injected into egg for fertilisation prior to transplantation into the uterus
• Gamete & Zygote Intrafallopian Transfer (GIFT) – gamete (egg & sperm) are introduced into the fallopian tube; less often used

Rising Rates of IVF

• One million babies were born in first 25 years of IVF (1978 – 2003)
• An estimated 5 million babies will have been born to IVF by end 2013.
• 2-3% of all births occurs via IVF in developed countries

Unexplained Fertility and IVF

• More than 90% of fertile couples are expected to achieve conception within 12 months of contraception-free sexual intercourse
• Sub-fertile couples are considered to have a good prognosis for natural conception in 2-3 year timeframe of trying to conceive
• Unexplained fertility accounts for 25-30% couples presenting for IVF, and many of these conceive before treatment. A Dutch study of 500 sub-fertile couples showed 60% conceived naturally after their initial assessment at the fertility clinic.

 

Emerging Risks of IVF

• Multiple pregnancies are associated with maternal and perinatal complications; this is not such an issue in Australia where single embryo transfers are the norm
• Some studies show 50-70% additional risk of preterm birth and congenital anomalies
• Healthy children born through IVF may have higher blood pressure, glucose levels and vascular dysfunction than children conceived naturally. Epigenetic and developmental abnormalities after ART have been shown in animal studies.

Emotional Adjustment to IVF

• IVF is a multidimensional stressor; many couples seeking fertility help, especially IVF are not prepared for the challenges ahead
• The treatment (doctor visits, hormonal changes, daily injections) constitutes the primary stressor and is most likely to evoke anxiety
• The unpredictable outcome of the treatment is another major stressor and more likely to evoke feelings of depression
• Other considerations are the financial burden and the impact on the couple’s marriage

IVF or not IVF?

• IVF has allowed many infertile couples to have a family
• IVF procedures are improving and having increasing success. Although IVF success rates fall away with increasing maternal age
• Some couples will be clinically defined as infertile, that is, unable to achieve spontaneous conception within 12 months of contraception-free sexual intercourse
• However, many of these may indeed be sub-fertile, and just need more time to try for spontaneous conception

Next week: Nutritional Support for IVF
If you would like more information on IVF procedures and support, please call the clinic on 9976 5466.

A Mother Centred C Section

Are you needing to plan a scheduled Caesarean? Do you know someone who is? Are there ways to improve the experience for the physical and emotional wellbeing of mother and baby? Did you know you should have immediate skin-skin time with your baby after a C section? Watch these two excellent videos before you begin reading (and forward this to a friend):

• Mother Centre C- Section by Jentle ChildBirth Foundation:  https://www.youtube.com/watch?v=m5RIcaK98Yg
• Skin to Skin immediately after C Section: https://www.youtube.com/watch?v=0jCjk73Xpn8
    

With preparation and an open discussion with your doctor, you can prepare yourself for a planned or unplanned cesarean section. These more supportive procedures can help make you feel more involved in the birthing process, as well as improving breastfeeding and bonding with your newborn. Identify the following elements of a mother-friendly caesarean which most appeal to you, and ask your medical team about which of these are possible in your hospital.

Atmosphere

• Ask if room lights can be dimmed and theatre warmed a little to help mother and baby feel more relaxed, comfortable and allow a feeling of intimacy during the skin-on-skin time.
• Request theatre ‘chatter’ and noise be minimised to allow the focus on the special moment of birth and first contact for the family. You may, however, wish for the doctors to explain the process as it is happening.

 
Preparation & Practicalities

• Prior to delivery, practice breathing and relaxation techniques that you can use during the procedure.
• Decide what photos you would like taken and who will take them
• Ask the anesthetist to ensure you have at least one arm free to envelope the baby for easier skin-to-skin contact after delivery.
• Ensure your ‘theatre gown’ is removed or moved in preparation for complete skin-to-skin contact.

• Have your support people in with you. While policy prevents a crowd of bystanders in the theatre, the partner and a Doula are welcomed in a mother-friendly caesarean. A doula is valued as a support to both parents, especially the mother if the dad needs to go with the baby for extra attention.

• Request that the surgery be performed more slowly. (see Video 1.) The extra time taken to ‘walk the baby’s body out’ allows the uterus to squeeze excess fluid out of the lungs. (This process occurs during a vaginal birth and is important for healthy breathing after birth.) Once the baby’s head is out, the doctor may wait a couple of minutes before lifting the baby’s body out for this purpose.

• Request the screen to be lowered at the point of delivery, so you can watch your baby being born. The abdominal incision will remain hidden from view, but you will be able to see your baby being gently lifted out from your uterus. In a mother-friendly caesarean, time and care is taken to allow mothers to feel more involved in the birth process.

• Request a delay in cord clamping until it stops pulsing. The health benefits to baby are well documented and will be supported by your doctor if all is travelling well with the birth. 

• Ensure immediate skin-to-skin contact, as long as you and the baby are healthy. At a mother/family-friendly caesarean, skin-to-skin is a priority. As well as aiding with bonding, skin to skin immediately after birth has been found to regulate the baby’s body temperature & breathing and increase the likelihood of breastfeeding.

• Request the opportunity to breastfeed within the first half to one hour and have baby stay with you throughout your time in theatre and recovery. Breastfeeding within that first half to one hour increases your chances of successful breastfeeding, and is considered to be an important part of postnatal care. You are able to breastfeed whilst still on the operating table.

• The immediate minutes and hours post-birth are very important for mother-baby bonding. In a mother-friendly caesarean, the amount of time you spent separated from your baby will be limited. 

If you would like more information on C Section support or natural birthing preparation, call the clinic on 9976 5466.

Natural Skin Care

Skin care is a multimillion dollar industry but with so many products available it is hard to know what is best for you. Often the simplest products are the best for us to use. Have you ever taken the time to read over the ingredients list of your beauty products? Chances are that they will be filled with hundreds of chemicals.
Just imagine the collection of chemicals you are exposed to every day that come in beauty products- soaps, shampoo, conditioner, body wash, face wash, deodorant, moisturizers, perfumes, make up, hair spray. This is literally hundreds of chemicals each day! I encourage you to read each and every ingredient next time you have a shower and get ready for your day and just think about the magnitude of this chemical exposure if on a daily basis!
 
The Environment Working Group has set up a website called ‘Skin deep’ which allows you to search any product and find detailed information about the safety of the chemicals used. You can simply type in the product name and it will bring up information about the various health effects that the product may have. It grades your product, so you know if it contains low, moderate and high risk ingredients. It then lists all the ingredients found in the product with information about those chemicals and your health. I strongly urge you to use the website yourself and learn more about the products and chemicals you are using on your skin -http://www.ewg.org/skindeep/
 
The problem for many of us is that we don’t understand what the chemicals used actually are - you need to be a chemist to decipher the list! This in itself should be a pretty big warning sign that the ingredients are not safe.
Below lists the top 12 most toxic ingredients used in skin care - these ingredients may be cancer causing, neurotoxic, endocrine or hormone disrupting, toxic to organs or skin irritants. I suggest you scan your ingredients list of these products and ensure you’re not exposing yourself and your family to these highly toxic substances on a daily basis.

Luckily there are plenty of natural and chemical free beauty products available to use. The following lists some of my favourite brands, products and natural remedies that have been tried and tested both on myself and patients. Next time you are replacing a skin care product, take the time to find a cleaner alternative that will dramatically lower your chemical exposure.
 
Moogoo skincare products

This is one of my favourite natural skin care brands. For those of you with dermatitis, eczema, psoriasis or dry skin the ‘eczema and psoriasis cream’ is one of the best on the market and I have seen fantastic improvements in my patient’s skin health with this product. They have a huge range of products (including shampoo and conditioners and natural skin tanning products). They also make a good range of products for acne free skin. They don’t use any harmful chemicals and instead fill their products with ingredients that literally feed your skin with nutrients and herbs.
www.moogoo.com.au
 
Miessence deodorant range


It has taken me a long time to find a natural deodorant that actually works but this one is the best I have come across so far- and my patient’s agree. The deodorant contains just essential oils along with baking soda so it is completely natural. There are no nasty antiperspirant ingredients and no aluminium. The deodorant comes in a range of flavours but even the fragrance free works a treat.
www.miessence.com
 
Tea tree oil

Tea tree oil is an antimicrobial, antibacterial, antifungal and antiseptic. For this reason it can be used for a range of skin issues. Don’t use it directly on the skin as it is too irritating- it needs to be diluted. Use it on acne prone skin to reduce bacterial involvement after washing your face. The tea tree oil can either be diluted in some water splashed on the face or add a few drops onto a warm wet cloth or make-up wipe and wipe over the face. You can use it to reduce the risk of infection following a cut or scrape.
 
Lavender oil


Lavender oil is great to have on hand if you have any blemishes or redness as it takes the red colour out of the skin. This one can be used directly onto the skin and does also have antimicrobial activity. Use it for acne, breakouts, blemishes or rosacea.
 

Coconut oil 

This is a great alternative to moisturizer and is of course a completely natural product. Coconut oil is full of healthy fats that help to moisturize and soften the skin. It has some antimicrobial activity which also makes it great for skin prone to breakouts. It can soothe inflamed skin, reduce flaky skin, reduces wrinkles by plumping up the skin and is also high in antioxidants which mean it has anti-ageing effects. While coconut oil is solid at room temperature, it will melt with only a small amount of heat therefore the heat on your skin will be enough to allow it to spread nicely. Coconut oil can be used as a hair treatment for dry hair too. I always suggest using the coconut oil on the skin at the end of the day (before bed) with a shower in the morning to wash it off. This is because the smell of the oil can change once it has been exposed to the air for too long. It can also get onto your clothing so best to wear something comfortable to bed that you don’t mind ending up with a coconut smell.
 

If you would like more information on skin care products or what might be useful for your skin type, call the clinic on 9976 5466