Demand for fertility treatment is rising with an increasing number of couples experiencing problems conceiving.

Published on Monday 22 March 2010 21:44

MAKING the decision to start a family is never easy. The financial impact, effects on careers and worrying about childcare are among the many issues that need to be considered. But for some couples, deciding is the easy part – the road to becoming pregnant is much more difficult.

Cecilia Tymkewycz-Fife never thought that having a baby would take so long. She and husband Andy battled for eight years, going through rounds of in-vitro fertilisation (IVF) and spending 20,000 in the process.

Now, sitting with baby Oscar on her knee, the battle has been won. But the 43-year-old knows that, despite the many problems she has faced, she has been lucky – for some, the many rounds of expensive treatment come to nothing.

Demand for fertility treatment is rising, as more couples experience problems conceiving. But with access on the National Health Service limited to those meeting certain criteria and with waiting lists long for those who make it, many are pushed into the private sector to fulfil their dreams.

Yesterday saw the opening of Edinburgh's first private fertility service, based at Shawfair Park. It will probably not be short of customers, no matter what the cost.

Mrs Tymkewycz-Fife, of Craiglockhart in Edinburgh, was 35 when she decided she wanted children after meeting husband Andy in Spain.

"I had been single. I'd never been married, never met the right person, and then I met Andy. As soon as I met him I wanted to have a child," she said.

Mr Fife has two grown-up children from a previous marriage and had had a vasectomy. To have children, first this had to be reversed – a process that took more than two years and eventually saw the couple having to go private.

After trying to conceive naturally for about a year after the reversal, they were referred to the fertility services at Edinburgh Royal Infirmary. They had to pay for the treatment themselves as they did not qualify for IVF on the NHS.

In October 2006, they went through their first round of IVF treatment, using a process known as ICSI (Intra-cytoplasmic sperm injection), where a single sperm is injected directly into an egg to fertilise it and create an embryo. These embryos are then implanted in the woman's womb.

Unlike many women, Mrs Tymkewycz-Fife, then aged 40, got pregnant on the first attempt. "We were delighted," she said.

"At the seven-week scan we found out it was twins. I was extremely happy. Then, just before Christmas 2006, I went for a scan at 13 weeks and found out one of the twins had died.

"I was devastated, but they assured me that the other twin was OK. We continued to about 19 weeks and then the second twin died as well."

Mrs Tymkewycz-Fife had to go through labour and give birth to her dead baby – a process she described as "horrific".

But they continued their quest to have a child, with another cycle of treatment using frozen embryos in June 2007. This time she did not get pregnant, leading to another attempt using fresh eggs in October the same year.

"They told me it was a positive result, but my hormone levels were very low and they were sure I'd have a miscarriage and it would not be a viable pregnancy," she said.

As expected, the pregnancy failed and they had their fourth attempt in August 2008. Again, they were not successful.

"Then we were in a situation where I really did not want to do any more," Mrs Tymkewycz-Fife said.

"Emotionally, financially and physically I'd just had enough. I felt I could not do any more, but we still had the frozen embryos from the last two cycles. So we had eight frozen embryos in the freezer.

"I couldn't imagine not using the frozen embryos. I could not imagine destroying them, and the longer they sat there, the more I could not move on with my life. Eventually we said, 'Let's have another go and use the other embryos and then that will be an end of it and we could move on'.

"I was miserable and everything was on hold going through IVF."

In March 2009, the clinic took three embryos out to be thawed and be implanted.

On their way to the hospital, a nurse phoned Mrs Tymkewycz-Fife to say the thawed embryos could not be used and asking for permission to unfreeze the final five that were left.

"I said go ahead and thaw all of them. Out of them there were two reasonably good ones and the rest were not suitable," she said.

"I found out two weeks later I was pregnant, and Oscar was born in December 2009.

"It was an extremely anxious pregnancy. Every scan we went for I was just a nervous wreck."

Mrs Tymkewycz-Fife said after a difficult pregnancy, the birth was relaxed, with a Barry Manilow CD playing as she had a Caesarean.

"I had been anxious for the whole nine months, but as soon as he came out I could hear him screaming, I knew he was fine. I relaxed completely."

Mrs Tymkewycz-Fife is among a growing number of couples seeking help conceiving. According to the Human Fertilisation and Embryology Authority (HFEA), there were 32,626 patients who had IVF in 2005. By 2007, this had gone up to 36,861.

Caitlin Delaney, the lead embryologist at the new IVF Scotland service based at Spire Shawfair Park Hospital, said demand for fertility services would continue to grow.

"Infertility is on the rise," she said. "The main reason is female age. We are leaving it later. We are putting career and travel and other things first. The average age women get married has increased now."

With cycles of treatment costing around 5,000 in the private sector, some couples seek help abroad.

Others face long waits for NHS treatment. Figures last year revealed something of a "postcode lottery" across Scotland, with waiting times for NHS cycles of IVF ranging from six months to three years.

Professor Richard Fleming, of the Glasgow Centre for Reproductive Health,

said the NHS should be doing more to help infertile patients, with long waiting times damaging their prospects of success.

"Over the age of 37, every six months you have an absolute chance of successful outcome declining by about 2 per cent," he said. "It starts off at about 35 per cent and it goes down 2 per cent every six months over the next five or ten years."

Prof Fleming criticised the NHS for making patients wait so long for help.

"That is the opposite of infertility treatment," he said. "That's actually damaging your chances of success. If you put someone on a waiting list over the age of 37, you are damaging their chances of success."

He said people needed to be aware that having children younger could spare them pain of infertility.

"What people don't realise is how early the decline in female fertility starts. It is actually at the age of 31," he said.

Mrs Tymkewycz-Fife knows she is one of the lucky patients, whose IVF battle has ended with a baby.

"Oscar is just a joy. He's lovely," she said. "But I know people who have tried many times and never get the happy ending. It is heart-breaking."

THREE DECADES OF CREATING FAMILIES

FERTILITY treatment has come a long way since the first "test-tube baby" was born more than 30 years ago.

Louise Joy Brown was born in July 1978 at Oldham and District Hospital in Greater Manchester, weighing 5lb 12oz.

Since this breakthrough, many thousands of babies have been born, using a variety of assisted reproduction techniques.

The most recent figures reveal that more than 13,600 babies were born in the UK in 2007 following IVF treatment, with many thousands more born every year around the world.

But there is no doubt that an even greater number of couples in the UK could be helped to conceive if more funding was available.

The majority of cycles of IVF are carried out privately as there are restrictions on what NHS health boards will fund – in many cases the health service will not fund treatment if the woman is over 36, when the likelihood of success decreases. Other factors, such as whether one of the would-be parents already has other children, are also considered.

It is estimated that infertility affects about one in six or seven couples in the UK – some 3.5 million people – at some point. While the majority will become pregnant naturally after some time, a significant minority will not, leading many to seek IVF treatment.

In the UK, fertility clinics are regulated by the Human Fertilisation and Embryology Authority to make sure that certain safety standards are met. However, clinics used by British couples overseas may not be as closely regulated.

Some patients have been driven overseas by a shortage of sperm and egg donors in the UK.