It's not often you come away from an event thinking 'wow, that could really save lives.'
The Progress Educational Trust (PET), in partnership with the Scottish Government, produced an online event entitled 'IVF and Women's Health: What Do We Know? What Do We Need to Find Out?'. PET's director Sarah Norcross opened the event by mentioning some of the key issues, including the prevalence of misinformation and the challenge of raising awareness without scaremongering.
Jenny Kurinczuk, Professor of perinatal epidemiology at the University of Oxford, opened the discussion by outlining some of the key surveillance data on maternal deaths from the UK's Confidential Enquiry into Maternal Deaths. As expected, mortality rates have declined considerably since the 1950s – from 90 deaths per 100,000 to 9.7. But interestingly the numbers have plateaued since the lowest figures in 2013. She explained some reasons for this: the average age at pregnancy is increasing, obesity is more prevalent, assisted conception is more common, and we live more socially complex lives.
The point that really struck me during this talk, was the importance of pre-treatment assessments for those with cardiac risk factors and older women considering fertility treatment. Professor Kurinczuk emphasised this by giving a harrowing account of a woman with a history of cardiac disease who became pregnant through IVF and died shortly after giving birth. The postmortem showed evidence of heart disease and stroke. Despite the woman having multiple risk factors, there was no assessment of her medical problems or discussion of their implications prior to IVF. This really shocked me as it felt as though this was a tragedy that could easily have been avoided.
This led directly into the next presentation where Professor Catherine Nelson-Piercy, a consultant obstetric physician at Guy's and St Thomas' NHS Foundation Trust and at Imperial College Healthcare NHS Trust, talked more in-depth about the burden of cardiac disease and risk factors.
I was surprised to hear that cardiovascular disease is the leading cause of death in pregnant women and many women are not even aware they have an underlying heart condition. Professor Nelson-Piercy went on to show a detailed slide of the European Society of Cardiology's classification of risk for pre-existing cardiac conditions. It's aimed at helping clinicians assess risks for women with pre-existing cardiac conditions who are seeking fertility treatment.
Professor Nelson-Piercy pleaded with the responsible people in the audience to use these guidelines and carry out some simple interventions that can highlight women at risk and reduce morbidity and mortality. She also mentioned the importance of counselling woman that the COVID-19 vaccine is safe – something Norcross agreed with and said 'it's important to keep getting the message out there'.
The penultimate speaker, Dr Melanie Davies, consultant obstetrician and gynaecologist at University College Hospital, spoke about an emotive subject that generates a great deal of media attention: IVF and cancer.
She asked if it was plausible that IVF could cause cancer, and listed some of the hypothetical mechanisms. She then addressed these by summarising data from an ongoing study of 2.2 million women who had fertility treatment in the UK from 1991-2010. The take-home message was that breast cancer risk is generally unaffected, endometrial cancer is associated with anovulation, and ovarian cancer is associated with endometriosis.
Dr Davies' tone was reassuring and she was careful not to overinterpret the data, which fitted well with the need to inform women about risk without being alarmist.
Professor Siladitya Bhattacharya – head of the School of Medicine, Medical Sciences and Nutrition at the University of Aberdeen – ended the discussion with a broader overview. It was fascinating to hear about his research, and the fact that Aberdeen is in a unique position to study women's health and IVF because almost everyone in the region is treated through the same service.
One of the most interesting findings from observational studies was that IVF does not appear to significantly increase maternal complications when comparing subfertile women with or without IVF. Professor Bhattacharya concluded that it's likely women bring the risk with them rather than the complications being a direct result of the treatment.
With this in mind, he mentioned some ongoing research on modelling risk and how these predictive tools might help couples make more informed decisions. He also raised an important final point, saying that we need to take a more personalised prognosis-driven approach to subfertility.
In PET tradition, the second half of the event consisted of a lively audience Q&A. There were several questions concerning menopause and potential harm caused by egg collecting. Dr Davies was very direct and clear in reassuring the audience that IVF does not impact menopause. Professor Bhattacharya added that the impact on the ovary when collecting eggs is minimal especially if the number of cycles is kept to a minimum.
As well as questions about the ethics of financial arrangements, influence of diet and lack of data for different ethnicities, there were several questions about the safety of the COVID-19 vaccine. Professor Nelson-Piercy acknowledged that misinformation around the use of the vaccine during pregnancy has caused much confusion and fear. To address this, she gave a very clear message – 'COVID can kill you in pregnancy full stop' – and urged women to have the vaccine if possible.
Overall, and considering the breadth of the topic, the event tackled some of the most important misconceptions regarding IVF, pregnancy and women's health. The speakers gave presentations that complimented each other well, resulting in a thoroughly informative event.
PET is grateful to the Scottish Government for supporting this event.