In this episode I chatted with Professor Geeta Nargund, an inspiring woman putting women first Medical Director at Creative Fertility about Natural and Mild IVF and getting the same success as conventional IVF with reduced treatment Burden, reduced complications and improved outcomes for babies.
Before I started chatting with her, I wanted to let her know that I've been interested in what Create Fertility has been doing for a long time. It makes such a lot of sense to work with the body, to give a little nudge rather than the pressure physically and emotionally of the numbers game in IVF.
You may not know about Mild/Natural IVF, along with so much so many don’t know about fertility generally.
Mild/Natural IVF produces the SAME success rates as conventional IVF, while reducing the treatment burden, side effect, complications, injections and costs. So its a win win and hard to understand why its not the norm in more clinics.
We chatted about the benefits, research based evidence and this may open more opportunity for fertility for so many listeners.
Professor Narunds passion for women’s choices, rights and the desire to gain gender equality in fertility treatments is clear and inspiring. Ensuring the safety and welfare of the women is as important as success with informed choice, which as you may know is a key part of what i speak about.
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Create Fertility - what makes it different, and how it started.
I have been personally been always interested in the vision to help women and promote women’s interests including protecting their health safety and welfare in healthcare and as part of that I started researching how to make IVF treatment healthier, easier and better for women in order to reduce their treatment burden, complications particularly their risks of a condition called ovarian hyperstimulation syndrome, and to give them the best health outcomes they deserve and also the best health outcomes for their babies. And as part of this and my research into natural IVF which I did when I was a research fellow and published the first paper of the role of natural cycle IVF and particularly reducing the costs and its success rates and cumulative success rates with natural cycle IVF and that paper was received extremely well in the scientific world. And in fact, it was also publicised by the journal of Human Reproduction, that was published at that time by Professor Robert Edwards, as you know, was the pioneer. He supported my vision to make IVF safer, healthier for women and for babies and through my extensive research in this field. And also, I have to say my personal commitment and passion to help women I decided to start Create Fertility and Create Fertility is all about reducing treatment burden for women reducing the risk of ovarian hyperstimulation syndrome, making the journey a lot easier for women and it's a woman centred IVF, and I'm very proud that.
Ovarian hyperstimulation syndrome, which is a risk factor and something that I've seen with some of my clients going through IVF because the conventional IVF that I'm sure many of the listeners will know about is that it's about numbers. It's about push, push numbers, numbers of eggs, numbers of embryos, and also about stopping the cycle starting a medicated cycle. So can you expand and tell us more about the benefits of mild IVF and natural IVF and maybe what what's involved listeners might not know about.
So mild IVF is about giving lower dosages of stimulation for a shorter period of time in a woman's natural cycle. The aim is to achieve mild response from the ovaries. So, the aim is quality not quantity when it comes to eggs and embryos, and it actually helps to protect the lining of the uterus when the response is mild. So, it is a win, win situation not only for the quality of eggs, but also the quality of embryos for implantation. So, you mentioned about suppressing what you call a long, normal stimulation cycle which is where essentially a woman receives suppression hormones for up to two weeks where she's been temporarily menopausal then followed by giving higher dose of stimulation in conventional IVF. That doesn't happen. So, it is actually conducted within a woman's natural cycle. And the spontaneous ovulation is blocked by what we call antagonists instead of using the long protocol where hormones are suppressed So overall, mild IVF is aimed at mild response from the ovaries. That doesn't mean that they we always receive a mild response, of course, polycystic ovary or polycystic ovary syndrome, where we have a very high egg number, you can get more eggs. But you are aiming to achieve a mild response, you’re aiming to achieve best quality in other words, maximising quality over quantity.
So, that was the main difference. The aim is to conduct in the women’s natural cycle. Not suppressing the hormones to cause a temporary menopausal status before stimulation. The aim is to reduce the stimulation dose and in mild IVF it can also be combined with tablets not always injections and some women can be maybe suitable just to have tablets for stimulation. So overall, injection dosages are reduced per day and overall duration is reduced and what we're essentially trying to do is aim for higher quality of not only the eggs and embryos but also higher quality of the lining for implantation. And you know, the evidence has shown that the treatment burden is reduced. You know Kat, there is a huge physical and emotional burden of treatment, and you know, since you're asking, clearly it is so important to reduce treatment burden.
Remember, IVF was invented to help women whose fallopian tubes are blocked or damaged but look now what IVF is doing. IVF is helping so many people, women, single women, same sex couples, where there's a male factor problem.
Other reasons like tubal factor, unexplained infertility and also there are more healthy women undergoing IVF treatment. And we have an increased responsibility now to ensure that our treatment protocols take care of women's health and safety and reduce the treatment burden so that they can get on with their lives while having IVF treatment and achieve the success they deserve.
But success and safety are two sides of the same coin. We aim for achieving both are just one.
Quality over Quantity
I often think about when we're looking at IVF, conventional IVF I'm going to call it but it is a numbers game. I've said that already and clients that I'm working with. it's how many eggs will I get how many embryos will I get? We lose that aspect of quality. I work with women over 35, approaching 40 and beyond. And this aspect of egg quality is really really key, isn't it? And also, if their AMH isn’t optimal, they can't always access conventional IVF because they're not going to get the numbers. So how would that work with mild IVF someone with a lower egg reserve or maybe an egg reserve that's normal for that age?
First of all, more is better is not true when it comes to eggs and embryos. It is the quality isas you yourself said. The important thing is mild IVF should be equally effective in success in regard to pregnancy success and live birth rates to conventional IVF but also what one IVF does is also reduce the risk of ovarian hyperstimulation syndrome, reduce treatment burden, actually reduce the cost as well because you know Kat, these drugs are quite expensive. So, it can be a win, win situation in the sense that it will not only achieve equal success rates to conventional IVF but also reduce the burden of treatment, financial burden. And so, in that sense, I think about a woman with high reserve, normal reserve and also low Reserve and the evidence is now huge about the equal success rates of mild and conventional IVF. We have produced and we have published papers in this field extensively. And, as the president of the International Scientific society for mild approaches to human reproduction, we will continue to conduct educational sessions and conferences where we teach and educate in this field. Also, women with very low reserve, women who are older can also have natural IVF or natural modified IVF which can give equal success to conventional IVF. Simply, as you said, when women have very low egg, reserve, when women have very low AMH if you give highest stimulation, it doesn’t mean they are going to produce more eggs because you can't run a marathon when there aren’t any runners. So, in some ways it is extremely important that we do not unnecessarily give high dose stimulation, when the egg reserve is low. So physiologically and biologically the egg is of higher quality when you don't use high stimulation, and you do not increase oestrogen levels too high in a woman’s blood, so the lining of the uterus is also healthier, happier for implantation. So, we want to care about the seed and the soil in an IVF cycle, in order to achieve that less is more.
I often talk about the egg and the nest and how we overlook the nest with the uterus being the nest, but I love that as an analogy with the seed in the soil because it has to have that nourishment. Something I think about with IVF, is when you look at vegetables and particularly I'm talking about, well it's a fruit, Rhubarb. When rhubarb is allowed to grow naturally it grows, but if it's forced, which is for mass production. It changes the quality of the rhubarb. I've gone a little bit off topic there, but that's a real analogy in my mind that we're not forcing something. We're just almost giving it a little nudge in its own environment with the mild IVF for sure. Now, something that I talk about a lot is inflammation and reducing inflammation and with IVF there is a huge amount of inflammation. There's treatment burden in conventional IVF and women even if they don't get ovarian hyper stimulation syndrome often have an awful lot of bloating, soreness or tenderness, so your treatment can yes reduce the inflammation also when it comes to transferring the embryo, do you freeze all embryos and that is something that I really wanted to talk to you about because by freezing the embryo in my mind, one of the big aspects is that the body can recover ready for the next round. What's the theory behind freezing? Can you explain that?
Essentially, in mild IVF we're using less drugs so that there's less interference in the quality, that we have already explained. And that is clear, and the evidence is now so strong that I really believe why give women more drugs when we can achieve the same success with less drugs, it’s as simple as that. I also believe why should women suffer in fertility treatment when men don’t. Women go through IVF treatment even if there is a sperm problem, even if they are perfectly healthy and fertile, and it is hugely important for us to ensure that we don’t put them through unnecessary drugs, unnecessary treatment burden and unnecessary complication risks, and you know that when ICSI is required because of a sperm problem, women have to undergo treatment, I actually feel very strongly that reducing drugs and reducing complications, reducing the duration and reducing cost are fundamental when it comes to the way forward in IVF.
When it comes to a question about freezing. I am not a supporter of freeze all for all cycles. It's completely unnecessary. There is a place for freeze all embryos, if there is overstimulation, if oestrogen levels are very high and a very high number of eggs are collected. In other words, there is over stimulation, then yes, freezing can help to reduce the risk of ovarian hyperstimulation syndrome and also to help the health of babies created from embryo transfer. In other words, you segment the two cycles. In that case, you use a different trigger injection, and then you collect eggs, you do collect a high number of eggs when women are over stimulated and their levels of oestrogen are high, then you freeze those embryos and then allow the woman to recover. Then you transfer in an unstimulated cycle. It is helpful for implantation, in other words, it's helpful for the health of the baby as well because if you do a fresh embryo transfer in cycles with women where oestrogen levels are very high, where a high level of eggs are collected, then there is an increased risk of creating babies that are premature and underweight so it that not only affects the woman but it can affect the babies created from cycles with fresh embryo transfer where higher response has happened. But it is not necessary to freeze in all cycles. There's absolutely no need.
This is why mild IVF is important because if you do reduce the stimulation, if you achieve a mild response, it is not only that you’re achieving the number of eggs and embryos that are optimal but also you are achieving an optimal condition for the lining of the uterus and you use the word inflammation in your question. All I'm saying is overall, you’re aiming to achieve optimal environment for implantation and therefore there is no need to freeze and also don't forget by freezing on every single time you're not only increasing the cost, because there's a cost of freezing , storage, frozen embryo transfer and also you're letting the woman go without an embryo transfer. So, it is an incomplete cycle.
There is a role for freeze all where there is overstimulation and what we tend to do with natural and natural modified cycles when women have very low reserve, where time is of the essence because they are losing eggs every single cycle, these women would like to accumulate a few embryos when their eggs are disappearing very fast. That's where we freeze. In other words, we do we do consecutive cycles, we freeze embryos, and then we'll put back in afterwards because their eggs are disappearing faster, they'd like to accumulate a few embryos and then put back in fresh frozen embryo transfer cycle. So that's a different concept and we have actually published. peer reviewed scientific papers that have shown that the three-cycle package with a natural/natural modified cycle in women with low reserve can achieve higher success compared to a single cycle because women would like to accumulate their embryos when their ovaries are running out of eggs.
I had a client a few years ago who came to create and because she wanted a more natural cycle, and she couldn’t get it in Nottingham. so, she went to Create and she had consecutive cycles to gather more embryos, so that’s where that reference for me came from. Also, when you said its not necessary in just a one cycle of natural or mild, but it does bring into question for me once again in conventional IVF, it might not e OHSS, but we are massively stimulating the ovaries. It just shows me that this milder method is much gentler, much more Intune with the body and allows as you say for a woman to recover and maybe not notice the symptoms as much?
Not only experience of our own clinics across the country but also the experience of many centres practicing mild IVF across the world that women do experience less treatment burden, less side effects and feel they can get on with their work and have this treatment. There is also scientific evidence about reduced treatment burden as well. To me it is the smartest way forward.
Putting Women First
I just feel, as somebody who would like this treatment to be woman centred, we are treating a lot of women, who are healthy women, we have an obligation to make sure that no healthy woman where possible is made ill as a result of fertility treatment, because they are healthy people. We have to protect their health. Fertility treatment/ IVF is going to be here to stay, women are freezing eggs for the future now, so its so important for us to make sure that we reduce their side effects, we reduce their costs, we reduce their injections where possible and give them the best outcomes.
As a young woman in India, I used to write in newspapers about women's rights, choices, equality. That’s my background. This is my background, this is not about fertility by the way, overall equality, gender equality, women's choices, women's rights is what I have been writing about, speaking about from school days, and what I do now in IVF, is just an extension of giving women that choice, is an extension of achieving gender equality in IVF treatment. It's an extension of making life easier for women in fertility treatment.
Create Fertility Centres
We have In London, at Wimbledon, at St Paul's, near St Pauls Cathedral in the City. We have in Birmingham, Bristol, Manchester we also have several satellite centres in Liverpool, in Hertfordshire, in Oxford, in Cardiff, we are starting a new big centre in Leeds and then we are taking a lot more satellite centres across the country in the next few months. So, we have several centres across the country. And we also provide treatment for NHS through CCG contracts so women can also access our treatments on the NHS, but they need to check which region where they are eligible for NHS funding with us. But also of course, self-funded treatment in all our centres. We also have a centre in Copenhagen, Denmark we will be expanding because I really believe that giving women this choice is important and I truly care about it because I believe safety and success have got to be part to be part of assessing success because when we are looking at the success of IVF, it’s not Just about pregnancy rates and live birth rates at any cost, it is about achieving a healthy full term baby with minimal health risks to the woman and the cost is reduced at that the child we create is as healthy as possible and full term, not premature or underweight. This is my mantra this is what I truly care about. to just produce success rates and live births, clinical pregnancy rates is to me not complete it is short sighted. How to increase the success must include the safety, cost, complications and burden of treatment. Only then you have the full picture of success.
And it is a limiter for a lot of women that you know don't want to have IVF, because they dont want to d that to their body or they've had a round of IVF and they don't want to do again. This provides such an option for them. I really, really feel quite passionately about that. How can people find out more.
Finding out more
How can they get in touch with Create?
Are they best to Google and find the contact details that way?
Mild IVF is not about reduced success Mild IVF is the same success as conventional IVF and it has advantages.
So people can find out there is a webinar that I do and sometimes if I am away, there is a recorded webinar anyway, every Tuesday there is a webinar for create fertility they can join in, listen to webinar, join the Q&A session, they make an informed decision or they can go on the website look in the information, they can email, they can call, but the webinar is a good platform for them to join. Listen to the scientific evidence, listen to the background information, participate in the Q&A and also through other sources that we have just mentioned as well. But the important thing is to make sure that they make an informed decision because the reason why a lot of women like what we do because women would rather not take injections if we could. It they could reduce that or stop it.
I've come across many women in my career where women some women didn't have IVF simply because they have a needle phobia and they don't know that they can take tablets, you know they don't have to take injections all the time. So there are options available for women. And it is about giving them that option. It's giving them the choice. Choice is so fundamental, access is so fundamental. And mild IVF can be accessed as a treatment as well.
It's not about numbers. It's about quality. And when we look at that, different numbers but the same success, and I think that is very compelling point about it. The same success, but you're not pushing the body and that treatment burden is much reduced and I love the fact that the woman is at the heart of this
And the important thing for me is women to know that if you can achieve the same success with mild IVF as with conventional high stimulation IVF but with advantages of, reduced side effects and reduced cost.
Natural and natural modified IVF for women with low reserve where drugs have had no added benefit, whereas naturally selected egg can perform and that is important. And we want to freeze eggs to reduce their treatment burden and to give them higher quality eggs, this is woman centred IVF, we will continue to publish scientific literature in this field because it's quite important that the long term vision is about reducing treatment burden for women without compromising their success. And that is where my vision is and my commitment to women's choices gender equality, what has led me into do this.