Tuesday, 26 May 2020

GOOD NEWS: ST JUDE'S HOSPITAL GETS THE HFEA NOD TO RESUME TREATMENTS


We are pleased to announce that St Jude's Women's Hospital have been granted approval by the HFEA to resume treatments. Worldwide suspension of fertility treatments was due to the Covid-19 pandemic. We have put in place stringent safe working practices for our staff and patients. We will now start to contact our patients who have been waiting patiently. See you all soon.

Mr J. Adeghe PhD, FRCOG.
Consultant - Gynaecology & Assisted Reproduction  


Wednesday, 20 May 2020

Vol.14, MAY 2020, Your Mind and Your Fertility Journey.

Your Mind and Your Fertility Journey

Author: Dr Osa Suzie Adeghe BSc, MSc, MBBS.

Anxieties surrounding your fertility journey may be amplified by the Covid-19 crisis that we  currently face. Having a healthy mind is just as crucial as having a healthy physical body. It is easier to neglect our mental health than we realise. This is Mental Health awareness week.
So…here are some tips that can help your mind feel healthy as you navigate this season:

1   Move your body!
Exercise has been proven to lift our mood and get those endorphins pumping. Go for a gentle walk, get hold of a skipping rope, or check out some home workout videos on YouTube. There are many free resources available to help you. The mind and body connection is extremely powerful. The increased blood flow to the brain will allow you to think with clarity, empowering you to focus on positive thoughts. 

List five things each day that make you happy
Visualising those positive things in your life will help you remain optimistic. Make a list of five simple things that make you smile: Our new freedom of spending more time outdoors, a new series on Netflix, or your favourite dessert!

Do one thing to make someone smile
The theme of this year’s Mental Health Week is ‘Kindness’. There is scientific evidence that acts of kindness boost our own mental and physical wellbeing. What can be more satisfying than putting a smile on someone’s face? Order a friend a new book if they are isolating alone, bake a neighbour some banana bread, or even spend time talking with an old friend over the phone.

      Allow yourself to have bad days
It is completely normal to feel overwhelmed. The current climate is tough and sometimes feels impossible to navigate. Do not feel bad for allowing yourself to retreat for some time and acknowledge your feelings. They are valid.

Congratulate yourself!
 As the saying goes…’You have survived 100% of your worst days’. I have great news for you – better days are coming. Do not underestimate the power of being able to bounce back after that negative pregnancy test, the loss of a pregnancy or as some may have experienced more recently; the delay to your long awaited treatment cycle.
You deserve to congratulate yourself for overcoming these challenges.
 I hope these tips will help you remain positive and keep your minds healthy.  Remember that there is support if you feel that things are getting too much. Pick up the phone and our friendly staff will offer you support and a listening ear.

Stay safe and remember ‘Your Mind Matters’.


Thursday, 7 May 2020

Vol.13, MAY 2020, Food and Fertility: What Women Should Eat When Trying To Conceive

A young fertile couple's chance of conceiving in the first month they try is 25%-30%. By the end of the first year, about 85% of couples achieve a success; the remaining 15% are diagnosed with infertility. 

Infertility has many known causes (eg, ovulatory defect, tubal occlusion, low sperm counts), and many factors lower the chance of pregnancy (eg, older age, lower ovarian reserve, endometriosis). There are modifiable and nonmodifiable risk factors for infertility or reduced fertility. Although some factors can't be altered (eg, age and ovarian reserve), others, such as body weight and lifestyle habits, are modifiable.

Patients frequently ask providers to offer them guidance on the ideal diet to improve their chances of conceiving and carrying a pregnancy to term. A recent review by Chiu and colleagues summarizes the available epidemiologic literature on the reproductive benefits of diets and dietary supplements.

Nutrition and Fertility: Review Findings

This article reviews the potential benefits of consumption of certain micronutrients, macronutrients, and dietary patterns. The following conclusions are drawn from this review:

Folic acid. Folic acid is important for germ cell production and pregnancy. The recommended daily dose to prevent neural tube defects is 400-800 µg. Women who take folic acid-containing multivitamins are less likely to be anovulatory, and the time to achieve a pregnancy is reduced. Those who consume more than 800 µg of folic acid daily are more likely to conceive with assisted reproductive technology (ART) than those whose daily intake is less than 400 µg.

Vitamin D. Vitamin D may affect fertility through receptors found in the ovaries and endometrium. An extremely low vitamin D level (< 20 ng/mL) is associated with higher risk for spontaneous miscarriage risk. Some reports suggest that women with adequate vitamin D levels (> 30 ng/mL) are more likely to conceive after ART when compared with those whose vitamin D levels are insufficient (20-30 ng/mL), or deficient (< 20 ng/mL). These findings, however, are inconclusive.

Carbohydrates. Dietary carbohydrates affect glucose homeostasis and insulin sensitivity, and by these mechanisms can affect reproduction. The impact is most pronounced among women with polycystic ovary syndrome (PCOS). In women with PCOS, a reduction in glycemic load improves insulin sensitivity as well as ovulatory function. Whole grains have antioxidant effects and also improve insulin sensitivity, thereby positively influencing reproduction.

Omega-3 supplements. Omega-3 polyunsaturated fatty acids lower the risk for endometriosis. Increased levels of omega-3 polyunsaturated fatty acids are associated with higher clinical pregnancy and live birth rates.

Protein and dairy. Some reports suggest that dairy protein intake lowers ovarian reserve. Other reports suggest improved ART outcomes with increased dairy intake. Meat, fish, and dairy products, however, can also serve as vehicles for environmental contamination that may adversely affect the embryo. Fish, on the other hand, has been shown to exert positive effects on fertility.

Dietary approach. In general, a Mediterranean diet is favored (high intake of fruits, vegetables, fish, chicken, and olive oil) among women diagnosed with infertility.

Viewpoint
A well-balanced diet, rich in vegetables and fruits, is preferred for infertile women and should provide the required micro- and macronutrients. It remains common for patients consume a wide variety of vitamin, mineral, and micronutrient supplements daily. Supplements should not replace food sources of vitamins and trace elements because of differences in bioavailability (natural versus synthetic), and inaccuracy of label declarations may result in suboptimal intake of important nutrients. Furthermore, naturally occurring vitamins and micronutrients are more efficiently absorbed.

With respect to overall diet, women are advised to follow a caloric intake that won't contribute to being overweight or obese. Obesity is on the rise among younger people, including children. Obese women have a lower chance of conceiving and are less likely to have an uncomplicated pregnancy. Proper weight can be maintained with an appropriate diet and regular exercise.

Finally, women must abstain from substances that are potentially harmful to pregnancy (eg, smoking, alcohol, recreational drugs, high caffeine intake).

References

1.      Zinaman MJ, Clegg ED, Brown CC, O'Connor J, Selevan SG. Estimates of human fertility and pregnancy loss. Fertil Steril. 1996;65:503-509. Abstract

2.      Practice Committee of American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril. 2013;99:63. Abstract

3.      Chiu YH, Chavarro JE, Souter I. Diet and female fertility: doctor, what should I eat? Fertil Steril. 2018;110:560-569. Abstract

4.      Kantor ED, Rehm CD, Du M, White E, Giovannucci EL. Trends in dietary supplement use among US adults from 1999-2012. JAMA. 2016;316:1464-1474. Abstract

5.      Carr AC, Vissers MC. Synthetic or food-derived vitamin C—are they equally bioavailable? Nutrients. 2013;5:4284-4304. Abstract

6.      Yetley EA. Multivitamin and multimineral dietary supplements: definitions, characterization, bioavailability, and drug interactions. Am J Clin Nutr. 2007;85:269S-276S. Abstract

7.      Practice Committee of American Society for Reproductive Medicine. Obesity and reproduction: an educational bulletin. Fertil Steril. 2008;90(5 Suppl):S21-S29. Abstract

Medscape
Peter Kovacs, MD, PhD.



Wednesday, 6 May 2020

Vol.12, MAY 2020, FERTILITY PRAYER


FERTILITY PRAYER

Children are the right of a marriage covenant with God (Deutronomy 28:11). Based on the word of God, we set ourselves in agreement with you that you will have the desire of your heart, a child of your own. The Lord perfects that which concerns you (Psalm 138:8)

Father, we desire to have a baby, and since your word says that children are a gift from you, we expect to have a normal, healthy baby. Since  …………………… has been redeemed from the curse, we expect her to carry her baby full term. Your word says you will bless the fruit of her womb, and your word says she will not lose her baby through miscarriage or be barren and that you will keep her safe through childbearing. Since she is no longer under the curse, she will be able to have this child the way you originally planned for Eve to have children --- free from pain and suffering and pangs and spasms of distress. So we expect this child to be brought into the world quickly and with no pain. We believe, according to your word, that she will have a beautiful pregnancy with no suffering during it.
Thank you Father for hearing and answering our prayers and for faithfully watching over your word to perform it. We know you have given your angels charge over us to accompany and defend and preserve us in all our ways.
Now, Satan, you hear the word of God. We speak it to you and command you to take your hands off us, God’s children, in the name of Jesus. We break all assignments you have put up against us and forbid you to hinder this pregnancy or childbirth in any way. We bind you, and the word of God declares that whatever we bind on earth is bound in heaven and whatever we loose is loosed in heaven. And we loose the peace of God to flood our hearts right now, in Jesus name.
Thank you Lord, for hearing and answering our prayers. We love you and we appreciate you and look forward to seeing this precious little love that you have especially picked out for us. AMEN.


Relevant Scriptures

• Lo, children are an heritage of the Lord and the fruit of the womb is his reward (Psalm 127:3)

• .. No good thing will he withhold from them that uprightly (Psalm 84:11)

• He maketh the barren woman to keep house and to be a joyful mother of children (Psalm 113:9)

• None shall lose her young by miscarriage or be barren in your land … (Exodus 23:26)

(Taken from Kenneth Copeland Ministries)


Monday, 4 May 2020

Vol. 11, MAY 2020, GOOD NEWS - Re-starting IVF treatment after Covid suspension


GOOD NEWS - Restarting IVF Treatment

The news came on Friday 1st May 2020, first by email from the HFEA to clinic PRs, and later in the day, the news headlined the weekly Covid-19 update by the health secretary Matt Hancock. Thus, after a period of uncertainty and stress, the proverbial light appeared in the tunnel. The HFEA had taken the decision that fertility clinics can apply to re-start treatment from 11th May 2020.

The good news is that St Jude's can soon resume our duties which is to help in making parenthood a reality. We can now put forward our Covid-19 safe working policies to the HFEA from 11th May 2020 for approval. Our policies will certainly be in tune with guidance from the government, professional bodies and the HFEA. Subject to satisfactory approval treatment cycles could start shortly after.

Luckily, St Jude’s is not a big centre. We are nimble on our feet. Our small size and our self-contained setting which is homely yet clinical, is well suited for a situation such as this. Well spaced appointment times, small size clinics, professional and personalised fertility care, are the core characteristics of our service. Safety and quality will continue to be our tradition.

We have a list of clients who have been waiting patiently, we will be in touch soon for next steps.

 

J. Adeghe PhD, FRCOG.

Medical Director






Sunday, 3 May 2020

Vol.10 May 2020: REPRODUCTIVE HEALTH EDUCATION -- Basic Fertility Physiology


REPRODUCTIVE HEALTH EDUCATION – Basic Fertility Physiology

Author: J. Adeghe PhD, FRCOG. Consultant – Gynaecology & Assisted Reproduction

 This is about knowledge of some basic fertility facts to boost the chance of achieving a pregnancy. Conception takes place when a woman’s egg is fertilised by a man’s sperm. For this process to be successful  both egg and sperm have to be of good quality, the egg has to be released (ovulation) into the fallopian tube, the fallopian tube has to healthy and patent (open), the sperm has to swim from the vagina, through the cervix and into the uterine cavity and then into the fallopian tubes. The sperm has to penetrate into the egg through the egg shell called Zona Pellucida. Finally, the fertilised egg develops into an embryo which implant in the uterine lining (endometrium). It is evident from the above that there are many steps in the fertility process. Generally, the more complex a process is, the higher the risk of malfunction. This applies to human reproduction.

Human reproduction is inefficient. The chance of a normal couple (with no fertility problems) becoming pregnant on a month to month basis is only 25%.  A normal semen sample produced during sexual intercourse contains an average of 22 million sperm with at least 40% swimming well. Yet it takes multiple sexual intercourse (ideally 2-3 times a week) over several months (average of 6 months) before one sperm fertilises one egg to achieve a pregnancy. Compare this with reproduction in some animal species where a single act of sexual intercourse results in the birth of multiple offsprings!. 

Normal female monthly cycle is between 27 to 32 days. An egg is released around mid-cycle which is 13 to 16 days from the start of the last menstruation. The egg is fertilised within 12 to 24 hours of being released. 

 At the risk of stating the obvious, the biology (basis) of male and female fertility are different.  A woman is born with a fixed number of eggs in her ovaries (about half a million) akin to having a set amount of money in a deposit bank account. The difference though, is that while money in a bank account may yield interest and increase your deposit, the number of eggs in the ovaries does not increase, on the contrary it actually declines in quantity and quality with increasing age. This is the reason for the decline in female fertility with age. This decline in fertility kicks in in the mid-30s and becomes significant from 40 years age. Pregnancy rates are very low after 44 years even with fertility treatment.

The male fertility system is centred within the testes where spermatozoa (sperm cells) are produced. The production and maturation of sperm within the testes (spermatogenesis) takes about 2 to 3 months and require a lower temperature, a few degrees below normal body temperature. This is why the testes are positioned in the scrotum, and not inside the body. The essence of spermatogenesis is that fresh sperm cells are produced every 2 to 3 months. Compare this to females where a 40 year old woman has eggs that that have been present from birth, meaning that the eggs are 40 years old!  I say this to emphasise the difference between men and women with ‘reproductive design’. It is not only that natural conception is less likely in women over 40years, the risk of miscarriage is higher and the risk of chromosomal abnormalities in the offspring is also higher. These fertility facts underline the disadvantages of undue delay in starting a family.


Vol.16, JUNE 2020, Recurrent IVF failure: What to Do

Recurrent IVF Failure - What to Do Mr J. Adeghe PhD, FRCOG.,  Consultant – Fertility & Gynaecology St Jude Hospitals & Clinics, ...