The latest advances in the technology of conception

The quest for a baby is a booming business. The fertility industry in the UK is said to be worth more than £320 million, and this weekend The Fertility Show, a two-day event covering all things fertility, comes to London for the 10th year running. This year also marks the 40th anniversary of IVF, a pioneering fertility treatment that, four decades on, is rarely out of the news.

Earlier this week, NHS bosses were accused of “backdoor rationing” IVF by telling men seeking treatment to lose weight. A study by Fertility Fairness, the campaign group, found that local commissioners were imposing “arbitrary” rules around things such as male body mass index (BMI) as a way of rationing the costly treatment, despite the National Institute for Health and Care Excellence (NICE) paying no heed to male BMI in its rules over who is entitled to IVF.

The study also found that one in ten commissioning groups (the bodies who determine local spending) stipulate that men must be under 55 to receive IVF on the NHS.

Also, in a move that Fertility Fairness call “social rationing”, nine in ten commissioning groups prevent couples from having IVF on the NHS if one has a child from a previous relationship.

A recent investigation by the Victoria Derbyshire programme on the BBC also found that women over 34 are refused IVF treatment on the NHS in 12 parts of England, despite NICE guidelines stating that it should be offered to women up to 42.

All this probably explains why, according to the Royal College of Obstetricians and Gynaecologists, six out of ten IVF cycles in the UK are paid for privately by patients.

“Infertility is devastating – it causes depression, suicidal feelings, relationship breakdown and social isolation; removing the recommended clinical help or making it harder to access is cruel and economically short-sighted,” says Aileen Feeney, chief executive of the charity Fertility Network UK, who leads the team at this weekend’s show. “Access to NHS treatment should be according to medical need and not your postcode.”

Of the Victoria Derbyshire findings, Sarah Norcross, the co-chairman of Fertility Fairness, says the cut-off point of 34 “penalises women who take longer to find a partner or wish to put themselves on a secure financial footing before trying to conceive”.

So as the debate goes on, what else is happening in the world of fertility?

POLLUTION AND PLASTICS: THE IMPACT OF OUR ENVIRONMENT

“We know there’s something in our environment impacting on our fertility,” says Emma Cannon, a fertility and pregnancy expert, acupuncturist and author, who is speaking at this weekend’s show.

“Pollution has a lot to answer for and we know that poor air quality affects male sperm. Men who live and cycle in cities are at particular risk: in Brixton, legal air pollution limits for the whole year were reached before the end of January.”

Previous studies have found a link between polluted areas and lower fertility rates, including reduced sperm motility, and a report this week from the World Health Organization found that exposure to pollution in the womb can lower a child’s intelligence and increase risk of childhood cancer, obesity and impaired lung function. It also linked pollution to premature birth and low birth weight.

“Other environmental factors causing concern to fertility experts are our exposure to soft plastics, micro-plastics, mobile phone masts, mobile phone usage and certain medications such as antidepressants and contraceptive pills,” says Cannon. “Even if we don’t take these drugs we can be exposed to them through tap water.”

Studies show that bisphenol A (BPA), found in plastic food packaging, is an endocrine disrupter, which decreases sperm quality and sexual function by interfering with the release, metabolism and elimination of natural hormones.

Air pollution, and in particular nitrogen dioxide, has been implicated in reduced pregnancy rates among women undergoing IVF, and studies in the Czech Republic have shown that men living in areas with higher air pollution are more likely to have sperm with decreased motility.

So what’s the solution? Cannon says: “In order to maximise your chances of conception, reduce your exposure to soft plastics – found mostly in food packaging – pesticides, hormones and fertilisers by choosing locally sourced organic food. Use less toxic cleaning products, and where possible change your plastic food containers to glass or BPA-free ones.”

Also, be wary of Instagram. “A lot of people come to see me who are trying to get pregnant and who consider themselves very healthy,” says Cannon. “But more often than not, due to sites like Instagram, they’re over-exercising, cutting out food groups and at a body weight that doesn’t support fertility. I see women losing their periods through veganism.

“Instagram can also cultivate a culture of fear. Feeling fearful of our fertility before we’ve even started trying, or comparing ourselves to the edited versions of others, causes a state of low-level stress, as do constant notifications from Instagram or email.

“This causes our bodies to produce stress hormones, which isn’t helpful for fertility.

“To procreate, we need to feel safe and calm. A whole generation has been oversold the idea they can simply turn to IVF as a cure-all, but we need to educate them on the role of stress management and quieting our monkey minds – which swing from emails to Instagram and back again.”

Cannon also wants to see better awareness about “lifestyle, being smart about technology, and the environment around us. What we do to the environ-ment, we do to ourselves.”

MEN MATTER: THE ROLE OF MALE INFERTILITY

“The role of male infertility is seriously overlooked in the fertility world,” says Professor Allan Pacey, a senior lecturer at the University of Sheffield and leading expert on male fertility.

“It’s currently estimated that one in six couples have a problem conceiving, and while it shouldn’t be surprising, in half of these cases it’s due to the male partner.

“But women tend to lead the discussions around fertility because they presume the problem lies with them. When couples come along to The Fertility Show, it’s often the first time they’ve ever heard of male fertility issues.”

Prof Pacey says this is largely due to society’s attitudes. “If you look at sex education in school, there’s an assumption that boys are very fertile, and boys grow up teasing each other about their lack of sexual potency. Then we bash men later on for not opening up about their sexual health and fertility.

“Many men have sperm that’s the wrong size or shape to reach an egg, or abnormally shaped with two heads or two tails, or that can’t swim sufficiently. But there’s very little awareness of sperm health for men, whereas women are raised to be aware of menstrual cycles and so on.”

Because of this, Prof Pacey says, there are very few treatments for male infertility. But this is slowly changing: “In extreme cases we can surgically remove sperm from the testicles, identify hormonal disorders and give drugs to add back those hormones.

“But very often, we have to do the best we can with the sperm we have. Life- style changes can make a huge difference.”

Last year, a study in the journal Andrologia found a link between being overweight and abnormal sperm. “And we now know that wearing tight underpants is worse for male fertility than smoking,” says Prof Pacey.

“We carried out a study recently that looked at things like smoking, cycling, drinking and tight pants, and the biggest factor was tight pants. Men who do a lot of cycling and triathlons often have poor sperm, but it’s probably the Lycra rather than sitting on the saddle that’s the problem.”

FERTILITY JEWELLERY: WEARABLE TRACKERS GO MAINSTREAM

The wearable health tracker industry has taken off in recent years, and now the fertility equivalent is catching up.

“Fertility tech is a really interesting area: we’ve come very far in the last year or so but we have much further to go,” says Lea von Bidder, co-founder of the new Ava fertility bracelet.

“But really, we’re just scratching the surface of digital health.”

The Ava bracelet (£249, avawomen.com), which is worn at night, looks at nine physiological parameters including your heart rate and rate of breathing.

It then gathers millions of data points before sending them to your iPhone, which will then tell you in the morning whether that day is an optimal day to conceive or not.

In a recent study from the University Hospital of Zurich, published by the International Federation of Gynaecology and Obstetrics, the bracelet was found to be able to detect the 5.3 fertile days of the month with 89 per cent accuracy.

A woman can only become pregnant during ovulation, which happens during the 24 to 48 hours after one of her ovaries releases an egg.

Sperm can survive for five days in the body, and therefore there are just less than six days a month when a woman is able to become pregnant. Most of the new fertility trackers and apps rely on this information.

“We started Ava four years ago, and my two co-founders have a personal fertility story that partly inspired its creation,” says von Bidder. “We read every medical journal on fertility we could find on how to identify your fertile window, and then went into our first clinical study. When we went into it a few years ago, the area of women’s digital health was underfunded, overlooked and there wasn’t a huge amount of data.

“Tech is a very male-dominated industry, so trackers have tended to focus on areas like heart and fitness.

“But despite half the population being female, we were further behind on the fertility, menstrual tracking and menopausal side. These were almost stigmatised areas, with not a lot of data.”

But that is slowly changing. As well as wearable fertility trackers, nicknamed ‘Fitbits for fertility’, there are countless new apps on the market to help couples to conceive.

“These trackers are a fertility companion for couples,” says von Bidder, right. “When you enter the world of fertility, you often have little idea of what’s going on in your body. You have very little control and you often feel like there is little you can do to help yourself.

“Some of these trackers are so advanced, and the technology is improving all the time.

“This gives trying couples more data and control, which they can then take to their doctor or fertility specialist.”