NICE Try - The Impact of Policy / Calm Down Dear - The Impact of Stress

The Progress Educational Trust (PET)'s annual conference 'Fertility Treatment: A Life-Changing Event?' was an opportunity for experts in the fertility sector to debunk myths surrounding the impact of lifestyle factors on fertility and fertility practice. The first two sessions focused on the two big policy areas in fertility treatment (NICE and the impending reform to the NHS), and the impact of stress.

Peter Taylor, a healthcare policy adviser at the Cooperation and Competition Panel for NHS-Funded Services (an advisory panel to the Department of Health), kicked off the opening session 'NICE Try: The Impact of Policy' by explaining that he had intended to discuss the changes proposed in the NICE guideline. But, as it happened, the publication of the final guideline had been delayed and he would instead be discussing the changes proposed in the draft guideline published in May 2012 (see BioNews 658).

The proposed changes to the guideline (which is not mandatory) include changing how we define infertility and recommending earlier referrals for women meeting certain criteria. For couples with unexplained fertility (with no identified reason for not conceiving) it was proposed they should be allowed IVF after one year of investigation. In addition, the draft guideline would expand access to fertility treatment to women up to the age of 42 - currently the upper age limit is 39. All this is very encouraging for patients.

Taylor then considered the impending reform to the NHS and how it may affect fertility treatment. Two main difficulties arose. First, the idea is to make the treatment process easier for patients by putting the GPs at the centre, yet evidence shows that 75 to 80 percent of those on GPs' books never visit their GP. A reform agenda out of touch with reality is worrying.

The second problem is that ensuring fertility treatment is recognised by NHS commissioners can already sometimes be difficult. Taylor explained that it was 'sitting on a shelf getting dusty' before he got involved as a strategic health authority commissioner. Furthermore, treatments will now need to fulfil certain criteria to meet 'national outcome goals'. A good argument will need to be made for fertility treatment as it doesn't fit easily into these criteria.

Taylor's projection of the future for fertility treatment on the NHS was a mixture of optimism and caution. The session ended with a positive note that much had improved in the past five years, and there is high hope for the next five.

The session 'Calm Down Dear: The Impact of Stress' began with a presentation by fertility counsellor Tracey Sainsbury, who spoke about the impact of stress on fertility treatment from her experience with patients and highlighted the ramifications of negative and unrealistic thinking when undertaking treatment. She said it was a 'myth' that patients go through treatment with little or no stress. Patients who expect to stay optimistic all the time risk setting themselves up to fail.

Sainsbury said feelings of hope and expectation at the start of treatment can sometimes quickly give way to fear, embarrassment and depression. When patients are undergoing treatment they end up 'beating themselves with an emotional stick', but instead of moving up and down on the emotional scale, patients are often just going backwards and forwards because they believe it's not normal to feel worry or fear - they are constantly trying too hard not to be stressed.

She recommended that patients should therefore be more accepting of the emotional highs and low that are a normal part of undergoing fertility treatment. Although it is clearly present, it is unclear how stress affects patients' fertility. 

Zita West is the clinical director of the Zita West Assisted Fertility Programme, which is designed to help fertility patients manage their mindset towards treatment. The way it works is that before treatment each patient is given a questionnaire to explore their environment, relationship and lifestyle. West said the most important question she asked her patients was 'why do you think that you're not getting pregnant?'. More often than not the answer from women involves some form of guilt.

West posited that some couples may be turning to IVF prematurely - patients were anxious to achieve a pregnancy quickly before looking at their sex lives first. In West's experience negativity can quickly sink in around the uncertainty of fertility and GPs rarely have time to explore the reasons behind this. When patients have been trying for a year, panic sets in and makes the patients even more stressed. Sex then becomes mechanical, dysfunctional and doesn't happen often enough. West explained that some couples need to get their intimacy back.

West's non-medical view to combating stress was then followed by Jacky Boivin, professor of health psychology at Cardiff University. Professor Boivin presented a more research-backed view of psychological issues in fertility treatment. She explained that stress does not reduce fertility treatment success directly. However, stress can make people take up unhealthy habits such as smoking and drinking which do affect treatment outcomes. 

Professor Boivin also discussed other research which has shown that stress can result in people dropping out of fertility treatment before they have a chance of achieving a pregnancy.

The morning sessions were chaired by Professor Lord Naren Patel, and questions drew on and disputed parallels between West and Boivin's presentations. The session ended with Jackie Boivin noting that if there is in fact a stress-related mechanism for switching fertility off, then there must be a way to switch it back on.

PET
is grateful to the conference's gold sponsors, Merck Serono, silver sponsors
London Women’s Clinic and bronze sponsors Ferring Pharmaceuticals.