your great life

The Fertility Focus Telesummit is back for 2012

Sarah Holland's Fertility Focus Telesummit launches on the 12th of March. I spoke at last year's Telesummit, and listened to every one of the other speakers, so I believe I can vouch for this worthwhile event. Click here for more information about how you can register for the Telesummit.

This is how it works. The Telesummit is an amazing “virtual event.” It will feature fertility experts from around the world sharing their knowledge and insights on a wide range of fertility subjects. You can listen in to all the information-packed presentations either online or over the phone every day of the Telesummit, starting on March 12th.

Grab your place now to attend this exciting event for free and get fully informed about what you can do to improve your chances of having a baby. Click here for details of all the expert presentations, each covering a different aspect of infertility and all offering great advice, ideas and solutions to help you move further towards becoming a parent.

Are you taking these common painkillers while pregnant?

We all know that we shouldn't take medication while pregnant without a doctor's knowledge, in case it passes through the placenta to affect the baby, right? However, certain painkillers have become so commonly used that they may be wrongly thought to be exempt from this rule.  A study by the University of Montreal has found that the use of ibuprofen (in over-the-counter medicines like Advil) and naproxen (in Aleve) in early pregnancy could more than double the risk of miscarriage. The findings are significant enough to serve as a warning to take all due care when deciding to take medication during pregnancy.

Over-the-counter painkillers ibuprofen and naproxen  are both non-aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), a group that includes prescription medications diclofenac, celecoxib (Celebrex) and rofecoxib (Vioxx). In a study of 52,000 women, it was found that of the 4,705 women who miscarried before the 20th week of pregnancy, 7.5% had been given at least one prescription of these drugs during early pregnancy. The miscarriage rate among women in the study who had not been prescribed one of these drugs was 2.6%. It is possible that even lower-dose, over-the-counter medications present a significant danger.

While the study only used the prescription as a marker, and not actual usage of the drugs, and thus cannot prove a direct link, it may serve as a timely reminder that more care should be taken before prescribing and using painkillers in pregnancy. It is possible that some of the women who miscarried never actually took the prescribed medication and/or that some could have miscarried for other reasons.  It was emphasized that non-NSAID painkillers, like acetaminophen, are a better choice during early pregnancy. So, don't be complacent about the contents of your medicine cabinet and check with your doctor before taking any medication.

Links:

http://healthland.time.com/2011/09/08/common-painkiller-use-may-be-linked-to-miscarriage-risk/

The Canadian Medical Association Journal http://www.cmaj.ca/content/early/2011/09/06/cmaj.110454

Making up for lost time

I was just writing an article for Mindful Mum this morning about when to announce your pregnancy, and thinking about some of the positive news stories about pregnancy which I have heard recently.

• I was really thrilled to read that Amanda Holden has recently announced that she is more than 3 months pregnant. You may have read here about Amanda's devastating stillbirth earlier this year. It's never easy to decide who and what   to tell about a pregnancy that follows a loss like that, and especially when you are in the public eye the way Amanda is. I think she has demonstrated great courage and hope, and wish her well. 
• Lisa Wilkinson, who lost her husband Gareth to bone cancer 3 years ago, now has a 1-year old baby Jack, born of Gareth's sperm through a single cycle of IVF. In Lisa's open letter to Gareth in the Daily Mail, she recounts the decision they made together before he died, the hopes and fears she felt while pregnant and the emotional difficulties she faced during and after the emergency Caesarean birth.   Gareth had his sperm frozen prior to embarking on chemotherapy, as the treatment was likely to make him infertile. He and Lisa initially planned to have IVF once he had recovered from the cancer, but once he knew he was dying, he asked her to have their baby after he was gone.

Before agreeing to allow Lisa to undergo fertility treatment, doctors required Lisa to undergo psychological testing to ensure that she could cope emotionally with giving birth to Gareth's child on her own. While it seems from the article that Lisa resents this requirement to "prove her sanity" and the year-long delay that it caused, I agree in principle. It's important to determine that the reasons for giving birth to a deceased partner's child are sound and will not prevent a woman from healing from her loss, moving forward with her life in a healthy way or raising a baby who is wanted for themselves and not as a living memorial to his father. In fact, Lisa admits to having suffered post-natal depression and anxiety about having Jack on her own, however, she has recovered and is happily raising her now one-year old boy. He also brings joy and comfort to Gareth's mother, who helps out weekly with her grandson.

It's lovely to read about how people find the strength, resources and good fortune to overcome adversity. I"m grateful that people like Amanda Holden and Lisa Wilkinson are courageous enough to share their personal stories with us, as they will surely inspire someone else to meet their own challenges and move forward with their life.

End-of-summer news

Temperatures in England are cooling, everyone is returning from their summer holidays and there is a September mood of "let's get down to business" in the air.  Here's a little of what's in the news this week:

• I have a new, light-filled, private and cosy office in my garden which will be ready later in September for client sessions. I look forward to sharing it with you as soon as possible.
• Beyonce's having a baby!  The 30-year old global star, who totally rocked Glastonbury in June this year, has proudly announced her pregnancy.  It's so nice to hear some good news directly from the source, rather than the gossip magazines. I'm wishing her good health, happiness and an easy birth.
• Too posh to push? NHS North Yorkshire and York has banned elective caesarean sections on the basis that it costs twice as much (L 2,539) as a natural birth (L 1,324)and poses higher risks for mother and baby.  Currently, 1/4 of British births are by C-section. 
• Pre-implantation genetic diagnosis allows screening of embryos for genetic disorders.  One London couple, Jay and Ami Bharvada, went through 4 cycles of IVF to find an embryo that was both free of Wiskott-Aldrich syndrome, a rare genetic disorder, and a tissue match to their son Jivan who is afflicted by the disease.  Untreated, the boy would probably not live past age 10.  Eventually, the couple had a daughter through IVF whose umbilical cord will contribute stem cells vital to their son's recovery. She will then provide further life-saving aid through a bone marrow donation to her brother.  Now, the couple says that they will go ahead and give life to the remaining frozen embryos once their son's health improves.  Their religion, Jainism, has guided them in their decision not to destroy the surplus embryos.  They have launched a charity to raise awareness of storing stem cells from the umbilical cord and donating bone marrow:  Chance to Live.

Do you have fears concerning a vaginal birth that you would like to conquer?

Are you faced with a huge decision about fertility treatment, storing or discarding frozen embryos?

For information about how coaching and EFT can help you, email me directly: [email protected].

Bringing multiple births down

Sometimes the number of young twins I notice seems remarkable compared to the relative rarity of twins I knew from my own childhood. Double, and even triple, buggies seem to be everywhere. Both of my children have twin friends, and know a few others. Twins do run in families, usually a genetic predisposition from the mother's side. They are also more likely to occur in women of African descent. However, there are two additional reasons for the increase in twin births in the past 2 decades:

• First, women have been having children later than in previous generations. Twins occur more frequently as the mother's age rises at the conception of her children.
• Secondly, the increase in IVF and the implanting of more than one embryo per cycle has resulted in more twin births.

However, news reports this week have revealed that twin births are declining in the UK now.

You may wonder what difference it makes if women are having twins rather than single births. After all, it still has the novelty factor. Some parents may prefer to have twins and not go through a second pregnancy and birth experience, especially if it would involve another round of IVF. For convenience and cost, it might make sense. However, there are several disadvantages to multiple births that should be considered.

The Human Fertilisation and Embryology Authority (HFEA) considers multiple births the "single biggest risk of fertility treatment." The increased risks of multiple births, according to the HFEA, include:

• miscarriage and other pregnancy complications
• premature and/or low birth weight
• neonatal mortality: 19/1,000 deaths within the first month of life for multiple babies, compared to 3/1,000 live births for single babies
• cerebral palsy: HFEA quote 6.2/1,000 live births for twins compared to 1.7/1,000 live births for single babies
• of newborns requiring special neonatal care
• maternal pregnancy-induced high blood pressure (hypertension), pre-eclampsia, pregnancy diabetes, assisted or interventional delivery (e.g., a caesarean), and mortality.

Its aim has been to reduce that risk by encouraging the transfer of single, rather than multiple, embryos per cycle. The program is having a swift and definitive impact on the trend of multiple births. The first target level set in 2009/2010, required that fertility clinics have a rate of no more than 24% multiple births from assisted reproduction techniques. For 2010/2011, the target was lowered to 20%, and in April 2011 the target has been set to 15%, which UK clinics are expected to meet by this time next year. The ultimate aim is a multiple birth rate of no more than 10% each year.

So, what does this mean for you if you are currently trying to conceive? If you are having fertility treatment in the UK, are under the age of 35 and considered to have a high chance of successful conception, you may find your clinic unwilling to transfer multiple embryos. Up to the age of 40, the HFEA restricts transfer to 2 embryos. From age 40, the group which is least assured of success with IVF, a woman may elect to have up to 3 embryos transferred. Any additional embryos created in vitro can be frozen and used later.

If you require more information about elective Single Embryo Transfer (eSET), a good source of information is the One at a Time website, which is dedicated to "better outcomes from fertility treatment." The site includes information about the guidelines, best practice, the risks of multiple pregnancies and what is involved in carrying, giving birth to and raising twins and triplets.

Additional sources:

Elective Single Embryo Transfer: Guidelines for Practice British Fertility Society and Association of Clinical Embryologists - http://informahealthcare.com/doi/abs/10.1080/14647270802302629

Decline in multiple birth rate from IVF -http://www.nhs.uk/news/2011/05May/Pages/decline-in-multiple-birth-rate-from-IVF.aspx

Preparing for multiplebirths - http://kidshealth.org/parent/pregnancy_center/preparing_parenthood/multiple_births.html

What's on TV?

It's possible that you are feeling as bereft on weeknights these days as I am over the end of Masterchef and, dare I say it, Embarrassing Bodies. While I enjoy having it on while I'm preparing dinner, Great British Menu doesn't have the same sense of drama as Masterchef, the kitchen isn't as swish and the chefs/restaurant critics/judges lack the personality to make you want to watch every episode. For the first time, my daughter and I couldn't call a winner this year on Masterchef, finding merit in all 3 candidates (Tim, Tom and Sara).

On the opposite end of the spectrum, nothing comes close to the wierd, unattractive and, frankly, yucky aspects of our health and bodily welfare on Embarrassing Bodies, presented by the very likeable Dr Christian, Dr Pixie and Dr Dawn. While I sometimes have to watch with my hands over my eyes, I'm fascinated by the untreated conditions that people keep secret for years, only to show millions of TV viewers, including growths, excessive body hair, "moobs," fungi, bowel disorders and skin conditions. I would go for the privacy of an appointment with my GP any day over sharing en masse. Is it that people don't have confidence in their own doctor, but are comforted and emboldened by the approachable bedside manner of EB's 3 medical presenters?

I've learned quite a bit of quasi-medical information which will hopefully stand me in good stead over the years, including preventive care (not the UK's strong suit) but what fascinates me is the link between bodily function, appearance and self-esteem. What causes people to keep their conditions hidden, to their own detriment? Some have lived 10 - 20 years with discomfort, pain, bad odours, inconvenience and embarrassment that could have been cleared up if they had sought help. Others, unfortunately, didn't receive the best help when they did inquire and didn't seek a second opinion until now. Fear of what the offending body part might mean to their health is a factor, for sure. Shame also plays a big part. Some of the visitors to the Embarrassing Bodies Clinic visibly blossom after treatment; a huge weight lifted off their shoulders. My husband leaves the living room in despair when he realizes that I won't change channels for love or money. If you live in the UK and haven't seen an episode of Embarrassing Bodies (is that possible?) or if you want information about an aspect of your own health or body, go to http://www.channel4embarrassingillnesses.com.

Good news then, that this week there is some worthwhile TV viewing this week. Ha! I laugh, because it all comes at once. On Thursday, May 5th, you can pin your hopes on one of the remaining 5 contestants on American Idol (ITV2, 7:30 - 9 pm), marvel at how pretty judge Jennifer Lopez is, how gentle and sweet judge and former Aerosmith band member Steven Tyler is and wonder what Simon Cowel thinks of Season 11, the first without his input. If you prefer something more educational and fertility health-related, the alternative is 'Is Breast Best?' on BBC3 at 8 pm, exploring the debate over breast-feeding. I may have to do some channel-hopping!

Another dilemma at 9 pm that evening. 'Inside the Human Body,' on BBC1, promises us a view of the moment of conception and the sequence of events leading to birth. I'm hoping that they handle this subject well, because the more information people have about their fertility health, the better prepared they will be when they approach conception and pregnancy themselves. At the same time, on ITV1, is 'Long Lost Family.' This is the emotional tearjerker of the reality show season, reuniting long-lost siblings, adopted children with their birth parents, etc... It's lovely. I like a happy ending and they do it well. Hopefully, you know how to record a program (unlike me) and won't miss either. Happy viewing.

The loneliest girl: What desperation led a pregnant teen to give birth and leave her baby in a hotel room?

This morning's news brought a tragic story about a newborn baby found dead in a hotel in Hounslow, West London. Police have traced the mother; a 15-year old Canadian girl who had been visiting the UK on a school trip. She gave birth without anyone knowing that she was even pregnant, and returned home to Canada. Had anyone known, she surely would not have been allowed to travel to the UK at 40 weeks pregnant by her parents, the school or the airline. It isn't known yet whether the baby was born alive. I spoke to Jayson Mansaray, the presenter of the Lunch Show at hayes.fm radio, this morning about why a young woman would go to these lengths and how teens can access help if they think they may be pregnant.

It may be difficult to believe that a woman could go through 9 months of pregnancy without anyone knowing about it, but it does happen occasionally. Presumably, she knew that she was pregnant, but hid it well by gaining a small amount of weight, already being overweight when she conceived or wearing very loose clothing. The question is why she felt she needed to go through this alone. We can only speculate that she may have:

• feared the judgment of her parents, peers, teachers and neighbours for being sexually active and/or pregnant;
• not understood much about pregnancy and feared the changes in her body;
• worried that she would be excluded from school, a job, a sports team or a social group;
• been in complete denial that the pregnancy would result in the birth of a baby;
• feared the responsibility of having a baby; or
• feared the withdrawal of love and support from her parents or other family members.

It's understandable that a pregnant teen would feel scared, isolated, confused and overwhelmed. However, the danger associated with secrecy about the pregnancy is that she would not get the help she needs and which is available to her. The primary concern is for the pregnant teen's health and wellbeing. She needs to know, as quickly as possible, whether she is pregnant and how far into the pregnancy she is. Depending upon whether she decides to continue in the pregnancy or to terminate, she needs advice about how to proceed. She, or her partner, may also need emotional support and help with her decision-making. They can access help, confidentially, through helplines and walk-in, young people's, sexual health clinics.

Nationally, a great UK resource is the Ask Brook website.  Young people, under the age of 25, can access information and advice regarding their sexuality, body image, sexual health, contraception, pregnancy, sexually transmitted diseases (STD's) and termination of pregnancy. Additionally, there is a free, confidential Ask Brook Helpline, which operates 9 am - 7 pm, Monday - Friday:  0808 802 1234, and a confidential text service: 07717 989 023, which charges a standard SMS rate. Both the website and the advisors on the helpline can provide information about all the services that are available to a young person in their own area.

Locally, KISS is the name for the NHS sexual health services for young people up to the age of 25 in and around Hounslow. For more information about where you can go to access free and confidential pregnancy testing, advice and other health services, go to: KISS Young People's Clinics – Sexual Health Hounslow. (You do not have to live in Hounslow to use this service.)

An unexpected pregnancy may seem very overwhelming, but if you are in that position, it's important that you know:

• There are no stupid questions;
• The sooner you ask those questions that you have, the more you will understand and the better equipped you will be;
• If you are pregnant, the earlier you know, the more choice you will have about how to handle it (prior to 24 weeks for abortion);
• You will get the right medical advice and treatment for yourself and/or the baby at the right time;
• Telling someone confidentially on the helpline or at a KISS centre may make it easier for you to tell an adult who is closer to you, like a parent;
• The help is there for you...you are not alone.

My heart goes out to Amanda Holden and Chris Hughes, who have lost a second baby

A few, short weeks ago, I blogged about actress and Britain's Got Talent presenter Amanda Holden's decision to keep the news of her pregnancy private for the first six months. It happened that Amanda and her husband Chris Hughes were being particularly careful in announcing their pregnancy, because they had suffered a miscarriage in the 4th month of pregnancy earlier in the year.  At the time, Amanda was quoted as saying that the miscarriage had been utterly devastating, completely unexpected and the lowest point of her life. Tragically, their nightmare repeated itself this weekend.

There is news today that Amanda and Chris have lost their baby son, due in March, at 7 months. She gave birth this weekend to a seemingly perfect, but stillborn, son after going to hospital because she had not felt him kicking or moving at all during the day. A cause for the baby's stillbirth has not been released publicly and the couple has retreated to grieve outside of the glare of public scrutiny. Much like in the British singer Lily Allen's late miscarriage, there will be speculation about whether the demands of work in the entertainment industry was in any way to blame for Amanda's loss. I would stress here, as I did then, that these two women reportedly wanted these babies very much, had access  to excellent medical supervision and took every precaution to maintain and protect  their pregnancies. 

It is heartbreaking to lose a much-wanted baby at any stage of pregnancy, but must be multiplied a thousand times for the woman who felt that baby move inside her. The timing and vigour of that activity leads the mother to attach certain characteristics to the unborn baby, helping her to know him and await his birth with expectations of his personality and energy. It creates a special bond between mother and child during the second and third trimester, but also between other family members and the baby who witness and experience external signs of the baby's very real life in the womb.

For a woman who has miscarried previously, the signs of life in the womb carry even greater significance.  Until she feels the baby move, she may not trust the health and longevity of a subsequent pregnancy.  This was certainly the case with my full-term pregnancies, in which I felt jittery and lacking in self-confidence about the pregnancy until I reached the halfway mark. How could I trust my body to nurture this baby, when it had failed the others? I didn't dare to believe.

Like Amanda Holden and her husband Chris Hughes, my daughter was 4 years old when we had our son.  She was old enough to ask questions about why her friends had siblings and she didn't, why I was going to the Dr all the time (secondary infertility and IVF) and eventually about the baby in Mummy's tummy.  We had waited nearly 5 months to tell her our news, conscious of how confusing and sad it would be for her to expect a brother or sister who might never be born. Thankfully, in our case, my last pregnancy went full term and I was able to give my daughter the brother she wanted.  My heart goes out to Amanda and Chris, who apparently did everything they could have done to be sure of this pregnancy and to protect daughter Lexi in the same way, but to no avail.

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Last week, I was fortunate to be present at a talk given by Prof Lesley Regan, Director of the Recurrent Miscarriage Unit at St Mary's Hospital, Paddington, and the founder of Charm, The Charity for Research into Miscarriage.  It was an overview of the latest developments in the treatment of recurrent miscarriage, however, it was Prof Regan's discussion of late miscarriage that interested me most. Ironically, the audience was made up almost entirely of Orthodox Jewish women, who tend to start their families at very young ages, relative to the general UK population. Nevertheless, it was of great interest to me and my work with older women.

I don't suppose it will surprise anyone to hear that after the age of 35, fertility drops drastically and miscarriage rates increase.  Between 1994 and 2004, there was an enormous increase in the number of births in the UK to women in the age range 35 - 39 years old, and a 94% increase in the 40 - 44 year range. Now, 35% of the women seen by the Recurrent Miscarriage Unit at St Mary's now are over the age of 35 and 25% of them are over the age of 40.  Even though these women are conceiving and giving birth, many of the pregnancies and births aren't without complications, such as pre-eclampsia, restricted growth and premature delivery. Still, stillbirth is very rare; the UK rate being only 7.6 per thousand live births (2008).

As an older mother myself, I know the chances I was willing to take in order to have my own children. However, given the choice, I would never have been in that position. I married my husband at the age of 35, without any predictors for my miscarriages and secondary infertility. Had I been better educated back then about the difficulties and risks inherent in conception, pregnancy and childbirth after the age of 35, I may have chosen to become a mother earlier, through the use of donor insemination.  It's easier to think in hindsight, knowing several women now who have successfully gone down that route, that I might have been that courageous.  Now, however, I would recommend that a younger woman who is in a committed relationship and has a desire to have a family some day, seriously consider the implications of waiting too long for lifestyle reasons. This is one of the reasons I advocate that young women (young men too) be provided with fertility facts alongside their Sex Education at school.  Knowledge is power; it brings choices into perspective.

 

 

Amanda Holden's announcement of her pregnancy; and yours

Do you think that celebrities have a different privacy threshhold than the rest of us when it comes to their fertility and family-building plans?

Several newspapers and magazines have commented on the actress Amanda Holden's decision to keep her pregnancy a secret until her 6th month. It had not been made public until this week that she and her husband suffered a miscarriage in 2010, therefore the reason for their secrecy about this new pregnancy. What annoyed me was the question posed by some of the news sources; "should she" have waited 6 months to release the news?" Why is there a "should" involved? Essentially, a pregnancy is a woman's private business and it is her decision if and when to tell other people outside her family. I don't think that being an actress makes one bit of difference to that. Even if Amanda and her husband had not had a previous miscarriage, her pregnancy is no one's business until they decide to make it public.

After a miscarriage, a woman may feel very tentative about a subsequent pregnancy. She may be watching and waiting for something similar to happen, until she has passed the time frame at which the previous pregnancy ended. This isn't necessarily about being positive or negative. She may be worried that if she is too hopeful or excited, she will "jinx" her new pregnancy. Of course, logically, we know that can't happen, it's an understandable fear.

So, when should you announce your pregnancy? Even without the fear of miscarriage, many women wait until the end of the 1st trimester. After about 13 weeks, many women will begin to show their baby bump and won't be able to get away with keeping the pregnancy a secret. However, the timing should be entirely up to you and your partner. It truly is your private matter and you can only go by how comfortable you feel with everyone else knowing about it. There are no rules; you are in the control seat on this one.

What you can do to embrace a pregnancy that comes after a miscarriage: take it one day at a time and celebrate each passing day by recognizing it as a triumph... anything from lighting a candle, marking the day off on your calendar with a smiley face, or putting £1 (or $1) into a piggy bank for the new baby.  If you find yourself feeling particularly anxious on any given day, try some deep breathing exercises and visualize your healthy baby growing inside of you. Then, take that image and "grow" it until the baby is the size and appearance of how he or she will look at full-term and transfer the image of your newborn into your arms.  Make sure that you then celebrate the success of your pregnancy as of that day with a positive and nurturing reward for yourself: fresh flowers, a bubble bath, time with a good friend or a healing therapy session or massage.

 

Steering IVF patients toward adoption from the start

How would you feel, if on your very first visit to the doctor regarding IVF, you were given an information pack about adoption?

Last week, there was a news report that Tim Loughton, the UK government minister for children and families, announced an initiative to prime childless couples for adoption, rather than fertility treatment. Loughton is concerned that there are too many children in care and too few being placed with families. Only 70 babies were adopted in the UK last year. He has a point. Is it too obvious to state that it is preferable to give a child a stable, loving family environment than to have them grow up in orphanages or foster care? He has good intentions, and the need is present, however, I wonder whether you have thoughts about the method he intends to employ?

Loughton apparently wants to get to childless couples before they begin the medical process to attempt assisted conception. His reasoning is that "they are clearly committed to bringing up children." He may be right, but I think he's missing a step here. At that point, on their very first appointment, they are committed to having and bringing up their own children. I fear that his proposed leafletting might be damaging, both emotionally to the infertile couple and in having the counter-productive impact of sending potential parents running. 

First,  a couple that has just begun to wonder why it's taking so long to conceive is hardly going to think of themselves as childless...yet. They may just be coming around to the realization that they need medical help to have a child, and think that once it's sorted, they will go along their merry way and have the family they want.

Second, it's jumping the gun a bit to approach a couple about adoption, when they are just exploring how medical treatment can help them to have their own child. Children aren't commodities. It's not like going to the shops to place an order for a sold-out product, and being offered a returned item instead.  I believe that with the vast majority of patients, the highest priority will be placed on having their own biological child at that point in the process. They will only be seeking guidance and approval on how to go about it. Some will find this type of information premature and disregard it; others may take comfort that it provides them with a Plan B, while still others may find it hurtful, intrusive or insulting.

Third, for many infertile people, the idea of being like "everyone else" and having a child who joins them as a couple and has recognizable, family traits is the ultimate choice.  We are romantic beings, wanting to recognize in our babies a mother's eyes, a father's smile, a grandparent's colouring or  a sibling's mannerism. With the advent of sperm and egg donation making the experience of pregnancy available to those who would otherwise have missed out, adoption is still seen by many as a last choice. There is not necessarily an immediate leap of consciousness from "why haven't I gotten pregnant this year?" to "let's adopt."

Mr. Loughton, finding out that you are infertile can be very difficult. If medical science can overcome infertility and give a couple what they want most, why shouldn't they go down that route? Additionally,a couple may need to go through a grieving process for the child they will not be able to bring into the world. They will not be receptive to your information packs until they have dealt with their grief. Sensitivity, time and coaching or counselling may be required to achieve acceptance of their situation and mental clarity about what IVF would entail in comparison to adoption. At present, adoption is not all that simple in the UK.

 I suspect that the difficult adoption process is the reason why only 3,200 children a year are adopted. Some people won't even bother trying because they have heard how notoriously difficult, intrusive and judgmental the process can be. The upper age limit for potential adoptive parents ranges between the ages of 35 and 40. Ironic then, that it is being proposed as the preferable option to IVF when many of those seeking treatment will be women in precisely that age range, cutting their chances rather close. Because people are getting married older, and women's fertility goes into rapid decline from age 35, it is often not until this age that they will seek IVF as an option to help them conceive.

It should be pointed out that besides the current, upper-age limit on adoption, the NHS cuts off funded IVF treatment at age 40. We might conclude from this that the government position has been that women aged 40 and older should not become parents, but apparently that's more about cost-effectiveness of treatment for women who have few healthy eggs remaining because of their age.  I wonder if cost plays a part in Loughton's new scheme, as diverting younger couples toward adoption would help both the NHS and Social Services reduce the stress on their budgets.

Adoption is a wonderful thing to do for an unwanted or parentless child and can create families where there would have been none. Thankfully, Tim Loughton wants to address the difficulty of adopting as well as shepherding would-be parents in that direction. He is quoted in The Sunday Times as saying that "the major consideration is [whether there is] a stable, loving environment to bring up a child [now] in care. There shouldn't be a hard and fast age limit or BMI (weight) index. We have older foster carers and we should consider older families to adopt."  He proposes that the upper age limit be lifted.

Tim, I couldn't agree with you more. But, please don't shoot yourself in the foot by pouncing too early on infertile couples who dream of having their own child. I propose that:

• the restrictions on adoption in the UK be revised first, so that more people can adopt;
• Then, a public awareness campaign can reach out to those who previously thought adoption was out-of-reach for them.;
• Only then would I target couples seeking IVF, in the sense of offering them alternatives to explore;
• Perhaps a simple, non-judgemental leaflet and questionnaire sent after an initial medical consultation could encourage those who would consider adopting instead of going through IVF;
• Couples who are willing to explore the idea of adoption could be offered coaching to help them weigh the pros and cons of IVF v. adoption as they apploy to them specifically, find common ground with each other on their values and priorities and make a positive choice for one or the other.