Pathways to Parenthood - Q3 2023

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Agency, confidence, healthy relationships and financial resources are crucial to women and girls’ reproductive autonomy and owning their pathways to parenthood.

Each woman and girl wants to own her ‘pathway to parenthood’ — calling the shots about sex, marriage and childbearing. To have reproductive autonomy, we must have the requisite education and knowledge, decision-making and negotiation skills, healthy relationships and financial resources. Without these things, the contraceptive services offered nearby — no matter how close — will remain out of reach.

More

knowledge, more reproductive autonomy

From a young age, girls can learn about their bodies. Teaching girls about puberty, menstrual cycles, pregnancy and childbirth is integral to informed decisions about sex and reproduction. Women, too, can continue to learn about reproductive health, contraceptive options and where comprehensive sexual and reproductive healthcare is offered.

Confidence, agency and decision-making power

Women and girls must have the confidence to negotiate for what they want and hold fast to the decisions that are best for them. Keeping girls in school and ensuring women can have careers and hold leadership positions helps to reinforce confidence. Women can serve as role models to other women and girls, instilling in them the confidence and agency to stand by their decisions about sex, pregnancy and childbirth.

Men who support women

Things like forced marriage, teenage pregnancy, school dropouts and sexual violence are a direct result of misogynistic cultures found all over the world. Men must be expected to view and treat women as equals, be respectful partners in parenting their children and learn about women’s sexual and reproductive health, so they can contribute to informed decisions about childbearing.

A little money goes a long way

Without financial independence, there is little women can do on their own. She may know where to get the contraceptive pills she needs to prevent pregnancy, for example. However, if she has no money to spend on transportation to the clinic, the pills remain out of reach. We must support women in the workforce, women-led businesses and keeping girls in school.

We know these things because, at Pathfinder, we’ve helped millions of women and girls around the world gain reproductive autonomy — from girls in Jordan to Maasai women in Tanzania and newly married young women in India.

WRITTEN BY Tabinda Sarosh President, South Asia, Middle East, North Africa, Pathfinder

The safe way to get fertility treatment or find the right donor

Thanks to improved fertility treatment and laboratory practice over the last 30 years, pregnancy rates have increased, giving hope to thousands of people wishing to have a baby.

WRITTEN BY Julia Chain Chair, Human Fertilisation and Embryology Authority (HFEA)

The latest data from the Human Fertilisation and Embryology Authority (HFEA) — the UK’s independent regulator of fertility clinics shows that more people than ever before are having fertility treatment. Data also shows that around 55,000 patients have IVF treatment each year at UK-licensed clinics, amounting to almost 76,000 IVF cycles.

Reasons people have fertility treatment

Patients in same-sex relationships who wish to start a family may opt for fertility treatment. Some people want to freeze their eggs, sperm or embryos for use in the future. There are patients who have fertility treatment for medical reasons, such as lack of regular ovulation or poor-quality semen, endometriosis and polycystic ovary syndrome. Some patients have fertility issues that can’t be explained.

Donor conception helps people have families

Most fertility treatments involve patient and partner eggs and sperm, but a growing number of treatments are now using egg and/or sperm donation; in 2019, over 4,100 babies were born thanks to donor conception.

Some people will know that they need donor eggs or sperm before they start treatment, such as female same-sex couples and single patients. However, for others, using donor eggs or sperm may be the only — or best — possible chance of conceiving a child.

Finding the right fertility clinic

Egg and sperm donation is a complex area. We encourage everyone who chooses donation to use a HFEAlicensed fertility clinic, which offers important health and legal protections for the donor and recipient — and for the welfare of the future child.

UK clinics also offer expert advice, so the implications of donation are understood before patients make a decision. This is particularly important as most children — once they turn 18 — can access their donor’s full name, date of birth and last known address.

The HFEA is responsible for licensing, monitoring and inspecting fertility clinics to ensure everyone accessing fertility treatment receives high-quality care. Since the donor anonymity law changed in 2005, the Authority also offers the Opening the Register (OTR) service, through which it releases specific categories of information to donor-conceived people, their parents or donors. It also offers a wide range of free, clear and impartial information about fertility treatment; clinics; egg, sperm and embryo donation.

The HFEA’s Choose a Fertility Clinic tool helps patients search for, and compare fertility clinics, taking into consideration important factors such as location, professional and practical support provided, treatment success rates and cost. Find this and more at hfea.gov.uk

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Beyond reproductive health: how to ensure reproductive autonomy for women

Leveraging AI to empower IVF clinics from embryo management to lab monitoring

Embryologists are expected to meet increasingly challenging demands in the lab. AI is now ripe for helping IVF centres become more efficient.

EMBRYOLY, a CE-Marked Artificial Intelligence (AI)-powered SaaS platform developed by ImVitro, can help in-vitro fertilisation (IVF) centres ease challenging demands and welcome more patients. EMBRYOLY is helping IVF centres optimise and standardise their laboratory practices in a range of clinical scenarios as demonstrated in multiple peer-reviewed studies. It connects to the main timelapse systems (MIRI®, GERI®, EMBRYOSCOPE/+®) to help IVF centres in the following ways:

Save embryo evaluation time

ImVitro’s computer vision-based algorithms support daily embryo

assessments by automatically identifying key morphological traits and developmental events, helping embryologists save analysis time and feel more confident about their evaluation.

Shorten patients’ time to pregnancy

The morphokinetic algorithm also objectively ranks embryos in terms of pregnancy potential with the aim of minimising the number of failed transfers to increase first-cycle pregnancy success rates of the IVF centre.

Strengthen transfer and freezing decisions

ImVitro’s software personalises its algorithms with the clinical

characteristics of the patient and their treatment to give more precise recommendations about the chances embryos have to lead to a pregnancy, helping embryologists decide which to transfer or freeze.

Track KPIs to monitor your centre’s performances

IVF centres constantly look out for unexpected changes in their lab and fine-tune their practices to maximise chances of success. To monitor performances, they compute embryonic and clinical key performance indicators (KPIs) manually, which can be error-prone and time-consuming. The software automates this by generating objective conventional and AI-driven KPIs in real time to react more swiftly — from identifying training needs to adapting protocols.

Optimise communication and administrative tasks

It can be difficult for embryologists to regularly update patients. Using this software, they can focus on having meaningful conversations while giving patients secure access to detailed information about their treatment on a dedicated portal at any time. Embryologists can also grant colleagues access, including gynaecologists, giving them more visibility. This portal helps streamline administrative patient paperwork, also benefiting centres that lack timelapse systems.

to their physicians, providing them a 360-degree patient view of their current health. It also provides fertility insights as well as lifestyle and nutrition recommendations. With the data input by patients, physicians are given the ability to make data-driven decisions and come up with a treatment plan — based on real-time information.

WRITTEN BY Olga Chabr Grillova CEO, Leeaf

A medical female technology (FemTech) startup is developing a data-driven patient management software to improve treatment decision-making for in vitro fertilisation (IVF).

By translating available technological solutions and capabilities to the fertility sector, MedTech companies can contribute to the improvement of fertility treatments on a larger scale. These can come in the form of health software and tech-enabled products and solutions that support women’s health.

Data-driven FemTech supporting fertility treatment

Leeaf is a fertility health portal for physicians and white label-ready mobile app for patients offering a solution that ties together algorithms of patient data and oocyte evaluation technology. Patient data is based

largely on digital at-home hormone and lifestyle anamnesis (medical history-taking that can expand diagnostic possibilities).

The platform aims to elevate fertility diagnostics, streamline the IVF process and improve patient outcomes for clinics to level with the increasing global demand for fertility treatment. “FemTech and emerging medical solutions improve diagnostics and fertility treatment to solve infertility for future generations,” states Olga Chabr Grillova, CEO of Leeaf.

Empowering patients and physicians

Patients can store all fertilityrelated information within the mobile app and make it accessible

“We need to develop evidence-based solutions using solid patient data in order to advance fertility treatments,” explains Associate Prof Rita Vassena, PhD., member of the Leeaf Scientific Board.

Personalised treatment and human autonomy

The platform uses two types of algorithms — rule-based and ML-based — that work together to ensure scientific and clinical validity to provide hyper-personalisation. Holistic data collection in female health and thorough research on medical, lifestyle, environmental and genetic information will make it possible to cater to the unique predispositions of every single fertility patient.

“Our dedicated research study on biomarkers that affect the outcomes of ovarian stimulation for IVF contributes to closing the data gap in women’s health. It improves diagnostics and treatment selection for future IVF patients,” concludes Grillova.

Paid for by Leeaf

FemTech company enables data-driven fertility treatments

WRITTEN BY Prof Rita Vassena PhD Member, Leeaf Scientific Board

WRITTEN BY Alexandra Boussommier-Calleja CEO & Founder, ImVitro

Helping people plan better by enabling access to fertility facts

One in six people globally will experience challenges with fertility. Despite this, fertility journeys are still a taboo for many.

Asimple search online will tell you that laser eye surgery costs between £2k–4k or detail the exact process and timeframe for plastic surgery recovery. But while fertility is also an important therapy area, there is not enough open discussion about it.

Important fertility factors

Young people in particular, while living in an age of empowerment and career focus, are shielded from talk about fertility. However, it’s not true empowerment if we shy away from having conversations about fertility choices. Crucially, many young people are unaware that their lifestyle choices can impact fertility later (eg. alcohol, smoking, STIs, drug or steroid use).

Fertility trends with younger generations

This lack of open discussion and stigma is not going unnoticed. In Merck’s latest annual survey of over 7,500 19 to 36-yearolds across Europe, in the UK, 65% wanted more public awareness of infertility, and 61.2% want that stigma tackled.

Last year, the survey showed that 16% of UK women under 30 decided to postpone their maternity plans as a result of the pandemic. Knowledge is power, but timing is everything with fertility; women’s fertility and number of eggs drops from 2 million at birth to around 25,000 by age 37.

Age and IVF success rates

Taking IVF as an example, it can be a twoyear wait for eligibility, one to two for tests and another year or more for treatment. Women aged 30 have roughly a 20% success rate, and over 35, that drops to less than 10%. What does all this mean? It means it is a numbers game; this is a mantra we have heard from many patients in our years of fertility expertise.

At Merck, we are committed to empowering young people to know their options, especially with challenging NHS waitlists. We invest time and resources in sharing accessible fertility facts for all — both patients and healthcare professionals. We hope that by having more conversations about fertility, we can continue our mission to help create, improve and prolong lives.

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Female choice at the heart of a striking trend in fertility treatment

The Fertility Trends report shows that women taking charge of their fertility were powering all the biggest increases in the sector — by either choosing to freeze their eggs or become solo mums or duo mothers in same-sex relationships.

Earlier this year, the UK’s fertility regulator, the Human Fertilisation and Embryology Authority (HFEA), published its 2021 ‘Fertility Trends’ report. Fertility Trends is published every two years and is a summary of the fertility treatment undertaken during that period in the UK. This year’s report stood out for a striking reason — women are taking charge.

Recent trends in fertility treatment

When and why women seek fertility treatment

The HFEA’s Fertility Trends report also collates data on the age of women having treatment. It, too, makes for interesting reading. The average age of women freezing their eggs is 35 (with data showing most women freeze their eggs because of a lack of men prepared to commit to parenthood).

WRITTEN BY Doina Ionescu Managing Director, Merck Healthcare UK and Ireland

According to the HFEA’s

data,

there was a 64% rise in the number of women freezing their eggs in the hope of preserving their fertility; a 44% rise in the number of women choosing to become single mums and a 33% rise in female same-sex couples having fertility treatment to begin their families. It will be interesting to see whether these steep rises are replicated in future years.

It’s important to recognise the majority of these treatments will have been paid for by the women themselves. Egg freezing for social reasons is not funded by the NHS, while access to NHS-funded IVF for female same-sex couples and would-be solo mums is patchy and poor.

The average age of IVF patients is 36 — about five years older than women who get pregnant naturally. This difference isn’t surprising, considering how long a typical fertility journey can take. Female same-sex partners have the lowest age for fertility treatment –on average 32.9 years.

Does this suggest male reluctance about parenthood is impeding women’s desire to embrace it? Perhaps, this year’s Fertility Trends data is showing us what women will do instead.

WRITTEN BY Catherine Hill Interim Chief Executive, Fertility Network UK

Paid for by Merck

This year’s report stood out for a striking reason — women are taking charge.

The majority of these treatments will have been paid for by the women themselves.

Natural fertility medicine: how to increase chances of treatment success

Women looking to, or struggling to, conceive can benefit from Chinese medicine as a natural way to enhance fertility treatment.

Chinese medicine works by getting to the root cause of fertility struggles, offering a holistic approach based on a person’s energy being in balance — known as yin and yang. “When these energies are in balance, a person has a better chance of conceiving,” explains TCM Expert Lily Li Hua, founder of GinSen, which incorporates Chinese holistic medicine into natural treatments for women trying to conceive. “However, if there is an imbalance between yin and yang, it can lead to fertility problems.”

Natural fertility medicine promotes balance

Yin energy is more to do with hormone balance and nutrition. Yang is essential to warming the uterus to promote blood circulation. When seeing patients — many of whom are over 40 and who have had trouble conceiving or with multiple miscarriages — TCM Expert Li Hua investigates the root causes leading to the quality and quantity of eggs produced.

“I often see patients with low energy levels, stress and unhealthy lifestyles, which means the body is using up too much energy. When energy is low, it affects egg quality,” she says. Environmental factors such as pesticides, plastics and toxic air are also highly detrimental as they cause hormone imbalance, often manifesting in poor blood circulation, cold feet and tiredness. Any irregularity in temperature can affect egg quality and uterine lining.

There are mixed perspectives on miscarriage, and many people don’t know how — or hesitate — to discuss it.

Around one in four pregnancies ends in miscarriage. To many, that number might seem shockingly high. Others may see it as so incredibly common that it’s perhaps not worth mentioning, and life goes on. The combined effect of these perspectives can make pregnancy loss a very lonely experience.

Lack of support after miscarriage

For most people, the loss of a pregnancy — however early it happens — is the loss of their baby, their hopes, dreams and plans for a future family. Many experience it as a bereavement like any other, grieving for a tiny life that ended too soon. If others don’t understand or acknowledge what they are going through — physically and emotionally — they can feel isolated and unsupported.

Being able to open up

It’s time to break the silence around pregnancy loss, says Miscarriage Association National Director Ruth Bender Atik. “There are often feelings of failure, guilt and shame around miscarriage; and society’s silence, perhaps due to discomfort, can compound those. Breaking the taboo around miscarriage helps people to understand they are not alone in their experience and helps to validate feelings of grief and loss.

Vaginal health could be affecting your overall health, fertility and risk of certain diseases. A comprehensive screening test can help.

The vaginal microbiome is the gateway to your reproductive health and wellbeing and is comprised of a unique bacterial community. Some bacteria species are protective; some are neutral; and some are disease-causing. This means that certain people are more susceptible to fertility complications, diseases and infections while others are more protected.

How microbiome affects vaginal health

Essentially, the vaginal microbiome is like the doorway to your house. A less protective, imbalanced microbiome leaves you open to intruders causing infections or inflammation in reproductive organs. Meanwhile, a wellprotected environment keeps them out.

Risks of vaginal microbiome imbalance

• Miscarriage: Research shows people with imbalanced vaginal microbiomes are more likely to experience recurrent miscarriage and pre-term birth. The presence of ‘good’ bacteria protects against common miscarriage causes including genital infections and inflammation.

• IVF success: Women with unfavourable vaginal microbiome profiles were seven times less likely to become pregnant through IVF. The vaginal microbiome’s role in IVF is thought to be linked to a higher chance of successful embryo transfer.

• Unexplained infertility: Up to 30% of women who have infertility concerns are associated with having pathogenic bacteria and an imbalance in their vaginal microbiome.

Treatments lead to improved fertility

A total of 70% of people who undertake the treatments, which include herbal supplements and lifestyle advice, will see improved egg quality within a few months. “For example, one woman — who had recurrently miscarried — did acupuncture, herbal medicine and holistic treatments to improve her hormone balance and circulation for three months. She got pregnant and successfully carried the baby,” she explains.

Countless other cases are cited by TCM Expert Li Hua, including women in their mid40s conceiving naturally after a few months of treatment. “The great thing is there are no side effects,” she concludes. “Patients that stick rigorously to their diet and herbal medicine feel more confident and healthier, giving themselves the best possible chance of conceiving.”

Lily Li Hua Founder, GinSen

WRITTEN BY James Martin

“We’d like to see a world where people know that miscarriage happens and that it can be really distressing, where that loss is acknowledged and where people do not feel they have to go through it alone. That’s not to say that those who choose to keep their experience private shouldn’t — we just don’t want them to feel they have to.”

Acknowledging the loss

Bender Atik says offering support to anyone affected by pregnancy loss doesn’t need to be complicated. “The most important thing you can do is acknowledge what has happened. Sometimes, people don’t know what to say or are worried about saying the wrong thing, so they say nothing at all. The trouble is that this can make the person who has miscarried feel very alone or that their loss isn’t seen as important … A simple, ‘I’m so sorry,’ is often enough.”

• Infection and disease risks: Recurrent UTIs, bacterial vaginosis (BV), thrush, STDs and infections indicate low levels of ‘good’ bacteria to fight infections in the vaginal microbiome. The absence of ‘good’ bacteria promotes inflammation and infection.

• Uncomfortable vaginal symptoms: This includes dryness, itchiness, pain during sex, inflammation and abnormal discharge.

Checking your vaginal health

About 84% of people with vaginal microbiome imbalance experience no symptoms. Testing provides comprehensive insights into whether vaginal health is impacting your fertility, increasing the risk of disease, infection and more. The ScreenMe gold standard kit is a comprehensive vaginal microbiome test, which includes: 100% of bacterial species present screened, 100% of yeast species present screened, 99.9% accuracy, a free 1:1 intimate health expert and online consultation, as well as a bespoke action plan with nutritional and lifestyle advice.

By understanding your vaginal health, you can help promote overall health.

WRITTEN BY Dr Golnoush Golshirazi CEO & Founder, ScreenMe

WRITTEN BY Ruth Bender Atik National Director, Miscarriage Association

Vaginal health: help improve fertility, tackle miscarriage, infections and more — today

INTERVIEW WITH

TCM Expert

When these energies are in balance, a person has a better chance of conceiving.

Miscarriage support: how to break the silence and offer solace

WRITTEN BY Dr Raj Mathur Chair of the British Fertility Society and Spokesperson for the Royal College of Obstetricians and Gynaecologists

Access to fertility treatment: how to understand all options and costs

More people than ever are accessing fertility treatments. Around one in six couples will experience fertility difficulties and may need help to conceive through in-vitro fertilisation (IVF) or donor insemination (DI).

The Human Fertilisation and Embryology Authority (HFEA) is the UK regulator for fertility treatment and research. According to their 2021 data, around 55,000 patients had IVF or DI at a licensed fertility centre. In 18 to 34-year-olds, around two-thirds of IVF was privately funded.

Where to get support after being affected by baby loss

Pregnancy and baby loss affects people from all backgrounds and communities. Currently, 13 families a day in the UK suffer from the heartbreak of losing their baby before, during or shortly after birth, and at least 15% of all pregnancies end in miscarriage.

WRITTEN BY Jen Coates Director of Bereavement Support Services, Sands

Everyone seeking fertility treatment should have access to impartial and reliable information about the treatment options and costs, as well as transparency on additional costs from any tests or add-ons offered alongside routine treatment.

Ways to enable access to IVF

No baby should have a higher risk of dying because of their parents’ postcode, ethnicity or income. Shockingly, for some, it is more likely to happen. According to MBRRACE-UK, babies from the most deprived families are 1.6x more likely to die than babies from the least deprived families.1

Getting the right support after baby loss

Accessing

fertility treatment information and options

People should be able to access information about what is available in their area and understand the evidence behind various treatment options. They should also know the potential costs of treatments to enable better planning.

Accessing NHSfunded fertility treatment remains a ‘postcode lottery.’ There is variation in waiting times and in what treatments are funded across England and Wales. GPs can provide information on local funding and hospital waiting lists.

Transparency in costs and extra testing fees

For people who access treatment privately, the average cost of one cycle of IVF is around £5,000, excluding additional costs such as storing eggs or embryos, medication, diagnostics tests or clinic add-ons.

The Women’s Health Strategy for England highlighted the need to address the unequal access to fertility services. They are committed to working with the NHS and HFEA to do this. This also saw the Government commit to making IVF more accessible for female same-sex couples.

A year on from the women’s health strategy, a new tool has been added to the gov.uk website, enabling people to see the provision of IVF provided by their local Integrated Care Board (ICB). This is a positive first step to making the variation in access to NHSfunded IVF more transparent.

The HFEA website also publishes useful information on choosing a clinic. The Royal College of Obstetricians and Gynaecologists is calling for all ICBs in England and the Health and Social Care in Northern Ireland to ensure equitable access to fertility services and offer three, full NHS-funded cycles of IVF.

If you have been affected by baby loss, Sands are here for you. Call our helpline on 0808 164 3332, email helpline@sands.org. uk or visit sands.org.uk/ support

Rowena Pailing, Head of Bereavement Support Services at the charity Sands, says: “We are here to support anyone who has been affected by pregnancy or baby loss. While we recognise that some groups are more likely to experience this, we know that individuals from those same groups may also find it more challenging to access or seek support. That’s why we are constantly reviewing what we offer to ensure it is inclusive and welcoming for all.”

Accessible resources for various experiences

Support is available for everyone, including dedicated support pages on the website and safe spaces held in online monthly support meetings and webinars for bereaved Black and South Asian parents. These spaces help bring communities together to address important topics. Many of Sands’ support resources have been translated into multiple languages. Some of the key materials are also available in EasyRead format, which some parents may find more accessible.

The Voices of Baby Loss podcast was also developed by the charity to explore the impact of pregnancy and baby loss. Audiences hear from parents of different ages, ethnicities and genders — including single people, opposite sex and same-sex couples.

Workplace training for bereavement support

Those who are not bereaved themselves may also need support. Sands’ specialist Bereavement in the Workplace training helps managers and colleagues to understand pregnancy loss and baby death. It helps them find the right words to ensure that supportive workplace environments are available for bereaved parents returning to work.

Reference 1. MBRRACE-UK Perinatal Mortality Surveillance Report UK Perinatal Deaths for Births from January to December 2020

In 18 to 34-yearolds, around twothirds of IVF was privately funded.

It’s time to break the silence around pregnancy loss.

~Ruth Bender Atik, National Director, Miscarriage Association