Dear Professor Winston
I am 39. I am having ivf as my partner has had a vasectomy. My first cycle of ivf just failed. I had 6 grade 1 embryos – four frozen. My BMI is normal. I had acupuncture, took supplements, gave up alcohol & caffeine. My cycle went perfectly apart from mild OHSS after egg collection. I am having a frozen cycle next. I am paying privately but am very happy with my doctor & nurses. I dont have a child and would love to be a mum. What else can I do to help the process? from Z.
Dear Z,
Let me be blunt. Whilst there has been huge publicity given to taking supplements and having acupuncture as an adjunct to IVF, there have been no properly done trials which show that having these treatments is of any advantage whatsoever. They do not appear to do any harm, but the claims made for both dietary supplements and acupuncture have not been substantiated in serious research trials. As it happens, I am particularly interested in this area and am intending to undertake a randomised controlled study of acupuncture in IVF patients in the fairly near future. Unfortunately, the results of such a trial will not be particularly helpful to you because I think it’s going to take at least a year to get really valid results.
You mentioned the grade of your embryos. There is no standardised grading of embryos so it is difficult to say whether what you have been told is in any way meaningful. What I can definitely tell you is that the grade of an embryo is generally not informative with regard to the chances of a pregnancy. I often think that it is a bit like looking at somebody’s face and saying to oneself ‘that person looks intelligent’. I think looking at an embryo down the microscope is about as reliable.
You also mention caffeine and alcohol. I have to tell you that I am very unconvinced that caffeine in moderate amounts has any effect on the outcome of IVF or indeed any aspect of female fertility. In fact, having an occasional cup of coffee might even be of benefit if you are somewhat gently addicted, as so many people are. With regard to alcohol, I also believe that the negative press given to alcohol in pregnancy is not truly justified. Many years ago in the very early days of IVF, for a bit of fun and to bond with my patients, I actually did a randomised controlled trial testing a glass of red wine or a glass of white wine at the time of embryo transfer. The pregnancy rate was about 4% higher in people who had a glass of red wine with me at the time of the embryo transfer. Neither the dose of red wine all white wine made a significant difference from the overall pregnancy results we were getting at the time in under treated IVF patients! Burgundy was slightly better than Bordeaux. It is also worth bearing in mind that for a long time alcohol was used therapeutically during pregnancy to control uterine contractions in people undergoing premature labour. There is no doubt that this was quite effective as a treatment, but the problem with it was that the dose of alcohol that was required was so great that it made many women feel rather ill and sometimes sick. This treatment fell into disrepute in consequence but it does underline the point that minor drinks or small doses of alcohol probably do very little harm and may actually have a calming influence. This was my idea of giving alcohol at the time of embryo transfer because I recognised that this was a very anxious time for many of my patients and it was a good way of ensuring they felt a bit more confident. Also, in the very early days of embryo transfer, putting embryo back into the uterus was quite a fraught process, and if the surgeon also had a glass of alcohol, this tended to control the natural hand tremor that all people may get when they feel anxious.
Forgive this slightly light-hearted response to your letter. But in summary, I have to say that I do not think you can do much to improve your chances of pregnancy and embryo transfer, nor can you do a great deal to reduce those chances either. In a good unit, a frozen embryo transfer will have an average chance of around 15% pregnancy rate but this may depend on a whole range of different circumstances of course.
Whatever you decide, going to your treatment feeling optimistic and calm if you can. I feel for you and very much hope that you will be successful.
All best wishes
Robert Winston