Earlier this month, an Australian study was published which looked at whether acupuncture increases the likelihood of a live birth in women undergoing IVF (see BioNews 950). The lead researcher concluded that 'the findings do not support the use of acupuncture to improve the rate of live births among women undergoing IVF'. Arguments about the pros and cons of the study continue online.
This story emphasises the need for public debate about the merits of alternative approaches to fertility treatment. It is also timely for the Progress Educational Trust, which publishes BioNews, as we make the final preparations for our free-to-attend event 'From Acupuncture to Yoga: Can Lifestyle Choices Improve the Odds of IVF Working for You?', taking place in Glasgow on the evening of Thursday 14 June.
Since the world's first IVF baby was born in the UK 40 years ago, most fertility treatment has centred on a small number of key procedures: ovarian stimulation, egg retrieval and sperm collection, the process of fertilisation in vitro, embryo culture and embryo transfer.
However, there is more to being a fertility patient than simply undergoing these procedures. Patients are often told – by their clinic, by its partner organisations, by the media or by other figures – that what they eat, what they do and even what they think has an important role to play in the likelihood of their IVF treatment succeeding.
Fertility blogs and forums are full of people giving peer support and advice in this area. A message along of the lines of, 'All I know is I had X number of unsuccessful attempts at IVF, but when I tried Y my IVF worked and now I have my little miracle baby' can be very powerful.
To be eligible for publicly funded IVF, UK patients are often required to fall within a certain range of body mass index (BMI), to abstain from smoking and sometimes to abstain from alcohol as well. Such criteria are in place throughout Scotland and are justified with reference to research concluding that these factors can indeed affect the success of IVF.
But fertility patients also encounter high-profile claims about what they can do to improve their chances that go well beyond these criteria. Sometimes they are recommended courses of action that come at (additional) financial cost. And sometimes, these recommendations go beyond medicine as conventionally defined, and enter instead the realms of wellbeing or of complementary and alternative medicine (CAM).
Even in Scotland, which has the UK's most generous funding for fertility treatment, there is still a limit to publicly funded IVF. Patients will, understandably, want to do whatever they can to maximise their chance of those precious free cycles working. And alternative approaches may also help them deal with feelings of lack of control around their treatment.
Let's take yoga. Practising yoga may help some patients feel relaxed and generally good about themselves while undergoing a medical intervention such as IVF, and few would begrudge them that. But when a clinic lists yoga on its website as a treatment for unblocking fallopian tubes, it could be argued that this is a yoga pose too far.
Patients also have to contend with the fact that what is touted as good for you in one context, this week, can be characterised as harmful in a different context next week. Many people are familiar with the bewildering phenomenon whereby the same food can be claimed to be both good for you and bad for you, depending on what newspaper you read or what day of the week it is. This happens in discussions of diet and fertility as well.
Beyond diet, there are other examples such as the study last year which pointed to a possible connection between a common type of flame retardant material used in yoga mats and a lower pregnancy success rate in women undergoing IVF (see BioNews 915). That study was widely reported under headlines such as 'Yoga mat chemicals may mess with your fertility.'
In that instance, Professor Richard Anderson (who will be chairing our discussion in Glasgow), said: 'This carefully conducted study analysed chemicals from flame retardants in urine from women having IVF and found that the chemicals were detected in most. Worryingly, higher concentrations of these chemicals were associated with substantial reductions in the success of IVF, with a lower chance of having a baby.'
However, Professor Allan Pacey (who is a trustee at our charity) provided reassurance that the study 'only describes an association'. He added: 'Before men and women undergoing IVF throw away their yoga mats, I think we need a bit more data in larger populations and in various parts of the world.'
Our Glasgow event on 14 June, which we are producing with the support of the Scottish Government, will ask:
To what extent is fertility-related lifestyle advice simply part and parcel of promoting good health more generally? At what point should fertility patients become sceptical of such advice? Should they be willing to pay for additional guidance, therapies or supplements to optimise their chances of success?
When fertility clinics offer additional forms of support to patients that go beyond the straightforwardly medical, is this an enlightened and helpful thing to do? Or could it potentially be exploitative?
Approaches to fertility that fall outside conventional medicine are increasingly described as 'integrated' or 'integrative', or as addressing the 'mind-body connection'. Do such approaches offer an alternative to the mainstream fertility industry, or have they become an integral (and profitable) part of it?
Are patients who use assisted conception being singled out as targets for non-medical or quasi-medical advice and marketing? Or is it becoming the norm for all prospective parents to receive this?
Undergoing invasive medical treatment to fulfil a cherished hope, with no guarantee of success, can be a source of anxiety or stress. Is it accurate to tell patients – as some do – that their anxiety or stress may reduce the odds of their IVF succeeding, and that this problem therefore needs to be remedied in its own right (perhaps at additional cost)?
A common theme of much lifestyle/CAM advice is that modernity and mass production – whether in relation to food, work, electronic devices or some yoga mats – are associated with stress and toxicity. In contrast, anything which can be presented as 'natural', or which is derived from older customs, is presented as wholesome and helpful. Can this stance coexist meaningfully with IVF, which is by definition a medical intervention to bring about a pregnancy when nature will not oblige?