Currently rated as amber by the Human Fertilisation & Embryology Authority, the UK’s IVF regulator, the value of IVF add-on endometrial scratching has come under the spotlight in recent months.

Endometrial scratching is rated amber by the HFEA because there is conflicting evidence from randomised controlled trials (RCTs) in terms of its effectiveness in improving the chances of conception for those undergoing fertility treatment.

What is endometrial scratching?

Endometrial scratching is termed as a fertility treatment ‘add-on’ as it is performed in conjunction with in vitro fertilisation (IVF). It is used in preparation for a round of IVF with your fertility doctor ‘scratching’ the lining of the uterus known as the endometrium. During the first stage of conception, an embryo attaches to the endometrium in a process known as implantation.

By ‘damaging’ the endometrium, the body’s natural healing process is triggered and an inflammatory response is produced, releasing growth factors, hormones and proinflammatory cytokines.

It is a quick, simple, low-cost procedure performed without anaesthetic. It can cause some discomfort and bleeding, but more serious risks such as infection or uterine perforation are very rare.

Some studies have suggested that endometrial scratching makes the uterus more receptive to implantation. However, as indicated by the HFEA, other trials into endometrial scratching have found no evidence that it increases the chance of conceiving through IVF.

The latest research into endometrial scratching

Published in the journal Human Fertility in December 2021, were the results of a new survey of fertility doctors in the UK, Australia and New Zealand into their perception of endometrial scratching value.

“We don’t have good evidence that endometrial scratching helps people to have a baby from IVF, and it’s a painful procedure associated with a cost for the patient too,” explains one of the study’s authors Sarah Lensen, postdoctoral research fellow at the University of Melbourne.

The study’s authors believe that earlier studies that found value in endometrial scratching lacked randomised controlled trials and were too small scale. Later larger, high-quality studies have cast doubt on these, meaning there’s no conclusive evidence that it boosts your chance of conception.

Yet, many fertility clinics continue to recommend this add-on. As identified in the study, many fertility specialists believe that it is valuable for patients who have unsuccessfully undergone more than one IVF cycle with good-quality embryos due to implantation failure.

“The idea of the scratch is that it might help these women who could theoretically have suboptimal endometrium, to achieve pregnancy,” Sarah says. “Secondly, people who have had multiple embryo transfers without success are often looking for something new to try that might help them to conceive.”

For more advice on endometrial scratching, call 0203 263 6025 to arrange an appointment with Dr Amanda Tozer at Aria Fertility Clinic.

Infertility and its treatment can affect all aspects of people’s life and can cause frustration, anxiety, depression, guilt, and feelings of worthlessness.

In a 2016 study into the impact of fertility treatment carried out by Fertility Network UK, respondents felt on average sad, frustrated, and worried nearly all the time and 42% experienced suicidal feelings as a result of fertility problems and/or the treatment they are undergoing. The study also found that 70% reported some detrimental impact on their relationship.

The Human Fertilisation and Embryology Authority (HFEA), the UK’s fertility regulator  acknowledge the importance of counselling being attended before you donate eggs, sperm or embryos or have treatment with donated eggs, sperm, embryo. It is a mandatory requirement that fertility clinics offer access to counselling when embarking on any fertility treatment.

Tracey Sainsbury Fertility Counsellor at Aria ClinicAt Aria, we work closely with Senior Fertility Counsellor Tracey Sainsbury who provides implications counselling for individuals and couples around all fertility issues. Implications counselling aims explore the psychological as well as the social, legal, and ethical implications around your treatment.

“I am not a tick box type of counsellor – I like to take my patients on a journey,” Tracey explains. “And every person’s journey is different – usually because experiences from the past can be triggered.” It’s estimated that 80 to 90% of people undergoing fertility treatment experience anxiety and depression.”

Managing the emotional rollercoaster of IVF

The IVF process can be a highly emotional time for both the individual and the couple, marked by highs and lows and alternating feelings of excitement, hope, disappointment or uncertainty.

“Often people have a fantasy around how they had hoped to conceive, it rarely includes assisted conception. There can be a grief response to the loss of fantasy around embracing assisted conception, even when they are keen to get started.” Tracey clarifies. “For couples, they will usually have put life on hold, telling themselves I’ll stay in this job because of maternity leave or we won’t book that holiday because we may be pregnant.”

“For women, in particular, we live in a prenatal world and suddenly everyone around them seems to be pregnant and that can feel persecutory. Then, they arrive in clinic and they are hopeful but maybe annoyed that they even have to be there in the first place. They may also feel relief because someone else is now going to take charge.

“Fertility treatment can be very traumatising and the thing with trauma is that we can be retraumatised. So, anything relating to family, hopes, dreams can bring up past trauma even from a very long time ago.”

Managing stress during your fertility treatment

“Sometimes the greatest risk to mental health is social media as it promotes this sense that you should be zen-like and positive, but fertility treatment is very stressful, Tracey explains. “So, we say be stressed but learn how to manage it well.”

Tracey promotes patient autonomy and there is no prescribed amount of fertility counselling that she recommends. For some patients this can be an initial appointment to discuss strategies for managing any stress you experience during your treatment journey. However, fertility treatment can bring to the surface long-buried trauma and emotions or put pressure on relationships and some patients – either as couples or individuals – may have weekly sessions throughout the many weeks and months that they undergo treatment.

Tracey offers a reduced fee for counselling appointments for people exploring or progressing fertility treatment with Aria. The cost is £50 per appointment, appointments are always provided online via Zoom or Teams and last around 50-60 minutes. Patients do not have to register with her private practice, and she has access to their notes, so she is aware of their fertility journey so far.

Call +44 (0) 203 263 6025 to find out more about the support we can offer at Aria Clinic.

A new study has identified new genetic risk factors in the development of polycystic ovary syndrome (PCOS). PCOS is the most common endocrine disorders affecting women and it can lead to difficulty getting pregnant.

Published in the journal Human Reproduction, genome-wide association studies were conducted by researchers at the Institute of Genomics of the University of Tartu to search for these variants in PCOS.

Polycystic ovary syndrome is often diagnosed through irregular periods, high levels of androgen hormones or enlarged ovaries known as polycystic ovaries, but the exact causes of PCOS remain unknown.

The study’s author analysed the genetic data of over 233,000 women from Estonia and Finland. Triin Laisk, Associate Professor at the Institute of Genomics, determined that PCOS “is a multifactorial condition, meaning both genetics and environmental or lifestyle factors increase the risk”.

The study found two new rare genetic variants that increase the risk for PCOS, which will probably affect the gene CHEK2. CHEK2 has been also linked to ovarian reserve and variation in age at menopause.

PCOS and fertility

One in five women in the UK suffer from PCOS and it can be a common cause of female infertility as it affects how the ovaries function. Although polycystic ovaries contain small antral follicles with eggs in them, the follicles often do not mature properly so there is no ovulation. Cysts can form instead.

Women will often experience irregular menstrual cycles and gradual worsening of excess facial and body hair growth as the result of high testosterone levels. Although the infertility rate can be high with PCOS, the good news is that the chance of getting pregnant using fertility treatments is good.

Women with PCOS usually require ovulation induction to conceive. Fertility treatment options include the use of medication such as Clomid or Letrozole. IVF is one of the most common fertility treatments for those suffering from PCOS and has a good success rate. The initial stage is taking medication to stimulate ovulation and then injections are given which will help the body to release an egg before they are harvested for fertilisation.

For more advice on PCOS and fertility treatment, call +44 (0) 203 263 6025 to arrange a consultation at Aria Fertility.


New research has found that mosaic embryos, currently ruled out for IVF selection, could self-correct and lead to healthy pregnancies.

During embryo selection, a test known as preimplantation genetic testing for aneuploidy (PGT-A) is used to screen aneuploid embryos which have an incorrect number of chromosomes. This is performed to reduce the risk of miscarriage.

Embryos with the correct number of chromosomes are called euploid and have a higher chance of leading to a successful pregnancy than those with the incorrect number of chromosomes or aneuploid embryos.

What are mosaic embryos?

Previously, embryos were categorised as normal or abnormal, but in the mid-2010s, embryologists discovered that blastocysts aren’t necessarily 100% euploid or 100% aneuploid: sometimes they’re a mixture.

The term mosaic embryos were coined to describe embryos that have a mix of normal and abnormal cells. Data suggests that mosaic embryos account for up to 20% of all PGT-A-tested embryos.

Mosaic embryos can have different proportions of normal and abnormal cells and there is a criterion ranging from low-level mosaic where 20 to 40% of the cells are abnormal to high-level mosaic.

What did the study into aneuploid embryos find?

Scientists at the laboratory of synthetic embryology at Rockefeller University, New York found that some aneuploid embryos can self-correct. They transferred embryos that had failed the PGT-A screen into women who’d given their consent. Genetic tests performed a few months later found there were no longer any signs of aneuploidy.

The next stage of the study was to understand how the ‘faulty’ embryos developed. Using human embryonic stem cells, they generated artificial human embryos and studied their development. They found that the proportion of the aneuploid cells decreased and the aneuploid cells that remained were in the outer layer which eventually becomes part of the placenta.

As this research shows, the science behind embryo selection continues to evolve and PGT-A is one tool to help us choose which embryos to transfer. Throughout the process, we provide you with all the information you need to make these important decisions.

For more advice on IVF and embryo selection, call +44 (0) 203 263 6025 to arrange a consultation at Aria Fertility.

Globally, we are starting families later than ever. Although most couples do get pregnant within the first 12 months of trying, it is estimated that one in seven couples may have difficulty conceiving.

Though the latest data from the Human Fertilisation and Embryology Authority (HFEA) reveals that the rate of successful IVF treatments continues to rise, it also noted that the chance of having a baby after one treatment cycle for women under 35 years of age is 31.3%.

Fertility clinics are increasingly focusing on the biopsychosocial dimension of fertility and, using a unique and cutting-edge approach, Aria’s Laboratories are conducting an innovative study to investigate how non-invasive data could be used to tailor and maximise IVF treatments.

Mr Stuart Lavery, Consultant Gynaecologist and a Founding Director of Aria Fertility, explains: “Aria Fertility was born through the vision of leading clinicians and embryologists who have combined their experience and vision to deliver truly market-leading fertility care, whilst combining the latest technological advances and pioneering research in the field of embryology.

“Using a unique and cutting-edge approach, Aria’s Laboratories are conducting an innovative study to investigate how non-invasive data could be used to tailor and maximise IVF treatments.”

The Safe Assessment of Embryos (SAFE) study aims to integrate information on individual’s sleep quality, lifestyle habits, laboratory and clinical data, together with non-invasive genetic information and the most advanced algorithms for embryo selection using artificial intelligence (AI).

Embryo selection explained

Once embryos are created in in vitro, embryo selection is a decisive stage in IVF treatment. The healthier the embryo selected, the higher the chance of a successful pregnancy result.

There are several methods embryologists use to select for the best embryo. One method used in routine practice involves looking at the appearance of the cells which make up the embryo (morphological assessment). Another method involves tracking the growth of the embryo in a special incubator that records images over time (morpho-kinetic assessment).

One emerging method to score embryos involves AI, which can be used to rank the embryos most likely to become a baby. Even though all methods are valid, there are currently discrepancies between IVF laboratories when it comes to their criteria, use and implementation.

Currently, genetic data from the embryo is obtained through a biopsy of the embryo, where some cells are removed and sent for analysis. Although being invasive, preimplantation genetic testing of aneuploidies (PGT-A, formerly known as PGS) is considered the gold standard technique to check embryos for abnormalities in the number of chromosomes – key factor for successful pregnancy.

Chief Investigator and Laboratory Manager at Aria, Xavier Viñals Gonzalez explains why the SAFE study is unique. “The SAFE study proposes to use the culture medium, which is the nutrient fluid that embryos are placed in to grow, to gain genetic information in a non-invasive manner. Embryos gain their nutrients from the culture medium to grow, and they then secrete certain markers into the medium. Previous studies have connected these with embryo’s genetic makeup.

“In routine treatment, the culture medium is discarded after the embryos have been transferred or cryopreserved. Our laboratory will measure these markers in the medium to see whether they are predictive of a live birth.”

Sleep and fertility

Previous studies have shown that sleep quality and length to be associated with variations in fertility hormones, number of eggs collected during fertility treatment, egg maturation, and quality of semen.

Dr Sara McNeillis, Sleep Medicine and Anaesthesia Consultant, joins Aria’s study to investigate the vastly unexplored area of sleep disorders and infertility. With the aid of a smart watch, individuals sleep quality and patterns will be measured and further complemented with sleep questionnaires. Also, participants will be encouraged to record information on lifestyle habits while they are enrolled in the study.

Joining the fertility study

To be eligible to participate in this study, individuals must be between the ages of 18 and 44 and planning to have IVF with a single embryo transfer. Given its non-invasive nature, being part of the SAFE study will not impact individual’s treatment in any way. Results from this research could be the biggest game changer not only for how we analyse data to predict successful outcomes in IVF but also for patients to understand their options during their reproductive journey.

To find out more about our study and the work of the Aria embryologists, call us on +44 (0) 203 263 6025 to speak to one of the team.

Although IVF has become the best known fertility treatment since its introduction in 1978, in vitro fertilisation is actually one of several assisted conception techniques.

Intracytoplasmic Sperm Injection or ICSI is performed as part of IVF and addresses sperm-related barriers to successful conception. One in 7 UK couples will have difficulties conceiving and it’s estimated that male infertility is a factor in 30 to 50% of cases.

Am I suitable for ICSI?

Intracytoplasmic Sperm Injection is not suitable for all patients undergoing fertility treatment. If male factor infertility has been identified or you have undergone previous unsuccessful IVF cycles, then ICSI may be recommended to improve your chances of conceiving. Issues that ICSI can address:

  • Low sperm count
  • Poor sperm motility
  • Sperm is abnormally shaped
  • There are high levels of antibodies in the semen (antibodies that are produced by the man’s body and may inhibit sperm function)
  • Sperm has been frozen
  • A medical condition or vasectomy means surgical sperm retrieval is required
  • Embryo testing is being performed
  • Previously failed IVF cycles

What happens if we opt for ICSI?

ICSI is performed as part of in vitro fertilisation, so every stage is the same as a conventional IVF treatment, but a different fertilisation technique is used in the laboratory.

To fertilise an egg, the sperm must penetrate the egg to reach the cytoplasm and during conventional IVF, the sperm and egg are mixed in culture media within a petri dish and left to naturally fertilise. However, if the sperm has poor motility, which refers to its ability to move efficiently, or an abnormal shape, then it can fail to push through the hard outer layer.

With ICSI, we select the healthiest sperm and directly inject it into the egg. Embryos are then left to develop as normal while being monitored by our embryologist before the best is chosen for implantation in the womb.

Are there any risks to ICSI?

The risks of ICSI are the same as IVF. The risk of birth defects is slightly higher than of a natural pregnancy but similar to conventional IVF. It is highly likely that males conceived with ICSI may inherit genetic male fertility issues, but research is limited currently as ICSI has only been used since the early 1990s.

What are the success rates of ICSI?

This is one stage of in vitro fertilisation, which can improve the chance of conception with IVF in couples where male factor infertility is an issue. But success rates are still linked to the overall success rate for IVF. The Human Fertilisation and Embryology Authority (HFEA) don’t publish separate statistics for IVF with ICSI.

To find out if you’re suitable for ICSI as part of your IVF treatment, call us on 0203 263 6025 to arrange a consultation at Aria Fertility Clinic.

Almost two years of living with COVID has resulted in ‘heartbreaking’ delays to fertility treatment, according to a survey of nearly 400 patients by the UK’s national fertility charity.

Last week was National Fertility Awareness Week, led by Fertility Network UK, to raise awareness of all aspects relating to fertility, from fair access to NHS-funded treatments, the emotional impact of male infertility, through to encouraging donor donation. The charity also reviewed the devastating impact the COVID pandemic has had on those waiting for fertility treatment.

Although clinics were officially given the green light to resume treating patients in May 2020, the backlog is still affecting many patients receiving fertility treatment through the NHS.

New research found that 58% of respondents had experienced delays being able to access treatment and a quarter had not been able to access counselling. Delays had affected both diagnostic testing, including semen analysis and blood tests, and surgical procedures with interruptions to treatment ranging from months to up to two years. Tests were often out of date and needed repeating.

Going it alone

Another upsetting aspect has been the impact on face-to-face services. In some instances, male partners were unable to attend fertility appointments and often patients had to receive devastating news over the phone.

The impact on mental health

Patients reported increased levels of stress, anxiety and depression as a result of delays. Counselling was also affected with many unable to access emotional support.

Gwenda Burns, chief executive of Fertility Network UK, said: “Our survey shows the devastating reality of delays to tests and treatment for fertility patients. It is clear the delays are ongoing and that many are concerned about how this will impact their chances of having a family. We are particularly concerned for those who haven’t been able to access counselling and would remind anyone affected by this that we are at hand to offer support.

“We are particularly concerned about the impact on fertility patients, where we know that age makes such a difference to outcomes. Time really is of the essence for fertility patients. Research from Aberdeen University earlier this year showed the impact that delays of six months or a year may have, and we know this is now a reality for many patients.”

One result of delays to NHS fertility provision has been more couples or individuals seeking treatment at private clinics.

Aria Fertility Clinic was developed during the height of the pandemic, receiving its license from HFEA in 2021. “We have managed to remain open throughout, providing consultations, investigations and the full range of treatment services, whilst always prioritising the safety of our patients,” Rob Smith, Clinic Director. Find out more about COVID and fertility treatment at Aria or call us on +44 (0) 203 263 6025 to speak to one of the team.

Made in Chelsea star Ollie Locke has revealed his surrogacy heartache on the latest series of the reality TV programme. He had recently announced on Instagram that the first round of IVF that he and his husband Gareth underwent with a surrogate hadn’t worked.

Ollie wrote. “We wanted to share an update with all our amazing supportive followers who have been with us on our surrogacy journey.

“I’m sorry I have been quiet, sadly we found out last week our first attempt at IVF hasn’t worked and after the heartbreaking news we have come to terms with the situation and are now looking forward to getting out to go for a second attempt very soon.”

Celebrity stories – from Ollie to Tom Daley and Kim Kardashian – have brought surrogacy into the spotlight and now a new UK study has shown that the number of parents using surrogates in England and Wales has quadrupled over the last decade.

Increase in parents using surrogates in the UK

Kent University scientists reviewing the data found that 413 parental orders were issued last year, indicating that almost four times as many parents in England and Wales are using surrogates now compared to ten years ago. In a new report published in collaboration with My Surrogacy Journey, a non-profit organisation in the UK supporting surrogates and intended parents, Dr Kirsty Horsey of Kent Law School found more parents were having babies through surrogacy. Research also revealed that two thirds of the applicants were mixed-sex couples in their 30s and 40s.

‘It is great to see such positive reporting on surrogacy in the mainstream media,” Dr Horsey commented, “particularly as the Law Commissions are currently reviewing the law on surrogacy, which I have long argued is out of date and in need of reform. It is to be hoped that reports such as this will feed into public and parliamentary debates on how any new law should look and enable progressive law reform to take place.”

Reality TV star Kim Kardashian opted for surrogacy after suffering placenta accreta, a serious medical condition that can be fatal for mother and child. She has now had two surrogate pregnancies: “I always knew surrogacy was an option — now it’s my reality. Whatever is meant to be will be.”

Celebrities being open about the surrogate experience is one of the driving factors in increased interest in this procedure. Yet, as Ollie Locke and his husband have revealed, surrogacy is not without its challenges.

Get in touch to discuss this in more depth with our fertility experts or read our pages on surrogacy for same-sex and mixed couples.

A new study has revealed that men may not have quite as long as they think to start a family. You may think that the biological clock is something only women need to worry about. However, the findings of this latest study show that there may also be a time limit on male fertility.

So, when can you expect male fertility to start to drop? Let’s look at what the study revealed…

Male fertility starts to drop in the mid-forties

Scientists from the Genea IVF clinic in Australia carried out the latest study, reviewing over 40,000 sperm tests. It was discovered that male fertility starts to drop in the mid-forties. By the age of 55, fertility deteriorates dramatically.

After studying the sperm samples, the two likely causes are reduced sperm mobility and DNA information damage. However, there are a lot of other potential causes too. Understanding the factors that can contribute to poorer male fertility can help you take preventative measures.

Why does male fertility reduce?

There is a vast range of factors that can cause male fertility to reduce. Some of the main things to factor in include:

  • Medical issues
  • Medical and environmental history
  • Lifestyle choices
  • Age

Certain medical issues such as illnesses, chromosomal defects, and anatomical issues, can all impact male fertility. Therefore, if you are experiencing fertility problems, it’s important to check that there isn’t an underlying medical issue.

Your medical and environmental history can also play a role. This includes any medications you might be taking or surgeries you may have undergone in the past. Environmental factors that could impact fertility include overexposure to radiation, industrial chemicals, or heavy metals.

It is also known that modern lifestyles have greatly impacted male fertility. Poor sperm mobility and lower sperm counts are becoming a worrying problem for modern men. This is said to be down to a poor western diet, excessive alcohol use, smoking, and illegal drug use.

Finally, age does play a role in fertility. While they may not experience the same level of age-related fertility issues as women, men still need to be aware of their own risks.

Undergoing a fertility assessment

Due to how prevalent male-related fertility issues are, it is important to test the fertility of both partners when couples are struggling to conceive. At Aria Fertility, we carry out extensive fertility assessments to identify any issues.

A range of tests will be carried out, and the results will be discussed with you to give you a clear picture of your fertility. The male fertility assessment involves looking into your BMI, carrying out a sperm analysis, and screening for infections. Depending upon the results, you may be recommended to undergo more extensive medical tests.

Fertility problems in men are becoming more prevalent in Western society. An Israeli study in 2017 that received a great deal of media attention found that sperm counts among men in the West have more than halved in the past 40 years and were currently falling by 1.4% on average per year.

Couples who are struggling to get pregnant can undergo an extensive fertility assessment to determine the cause and identify potential treatment options. Get in touch to find out more.

Last month, we wrote about managing IVF in the workplace which struck a chord with many of you. One interesting development from the COVID pandemic is that it seems to have accelerated the trend for fertility treatment benefits as employers prioritise employee wellbeing.

We take a look at the fertility treatment benefits starting to be introduced by employers.

What fertility treatments are being offered by employers?

Perks within businesses are certainly nothing new. However, up until now they largely consisted of free gym memberships, company cars, or additional days off.

In recent years, however, employers have started to realise the importance of employee wellbeing. For employees who are going through fertility problems, it can greatly impact their wellbeing and their performance. That is why several UK groups have started to offer fertility-related benefits.

Large UK employers such as NatWest and Clifford Chance, have introduced fertility benefits totalling up to £45,000 per employee. These include offering to pay for IVF or surrogacy. Other benefits include providing time off for appointments, counselling, and miscarriage leave.

Rarely did employers get involved with the outside lives of their workers? So, what’s changed?

The pandemic and its impact on employee wellbeing

Employee wellbeing was already starting to become a priority before COVID hit. However, the toll the pandemic has taken on the population has forced businesses to accelerate their efforts.

There has also been a huge increase in the number of employees leaving their jobs as people revaluate what is important in life. With a record number of job vacancies available, employers are having to pull out all the stops to keep hold of their existing workforce.
According to research, 49% of employers have introduced new benefits for their workers since the pandemic began.

Our contribution to fertility treatment benefits

Aria Fertility works alongside Carrot Fertility to provide fertility benefits to employees through their employers. Flexible plans are available to suit businesses of all sizes. Just some of the benefits companies can opt to include are:

  • Fertility medications
  • Pregnancy support
  • Family planning and care
  • Adoption benefits

The fact businesses are starting to help employees with fertility issues is fantastic. However, it is still only select businesses that have introduced these benefits. As time goes on, more HR professionals are realising the importance of fertility-related benefits. At the very least, workers who are experiencing fertility troubles can ask for more flexible working hours.

There is no denying that fertility issues can greatly impact employee wellbeing and performance. Employers who prioritise their workers mental and physical health such as offering fertility treatments are going to also reap the benefits. Get in touch to find out more.