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BBC News recently reported that “more than 70% of NHS trusts and care providers are ignoring official guidance
on offering infertile couples three chances at IVF.” Several newspapers also covered this finding, which comes from a report by an all-party group of MPs who
looked at the availability of IVF (in vitro fertilisation) on the NHS.

The group sent freedom of information requests to 177 primary care trusts (PCTs) across the UK. Of the
152 that responded, 73% said they offered fewer than the three cycles recommended by the National Institute for Health and Clinical Excellence
(NICE). Five PCTs did not offer any IVF treatment at all. The report also said that some PCTs placed age restrictions on who was eligible for IVF. The
report’s authors point out that individual PCTs may have amended their level of IVF provision in the intervening months since their survey in March 2011.

NICE recommends that couples with fertility problems should be offered up to three cycles of IVF on
the NHS. To be eligible, the woman must be aged 23–39 at the time of IVF and the couple must have an identified cause for their fertility problems or have
been infertile for three years. These guidelines are currently under review.

Who produced the report?

The report was produced by the All Party Parliamentary Group on Infertility. This is a group of 22 MPs
from across all political parties. The group’s purpose was to “raise awareness in Parliament of infertility and the associated ill health that it causes and
to draw attention to the need to implement fully the National Institute for Health and Clinical Excellence’s clinical guidelines on the assessment and
treatment for people with infertility problems”.

The report aimed to provide
a snapshot of how IVF is provided across the UK and to assess the extent to
which NICE guidelines were being implemented in PCTs. The report was called “Holding back the British IVF revolution?”

What does NICE recommend for IVF treatment?

NICE was set up to provide evidence-based guidance for doctors on the most effective treatments and best
care for patients. In 2004, NICE published the guidance “Fertility assessment and treatment for people with fertility
problems”. The guidelines make recommendations about the criteria that people
should meet in order to receive IVF on the NHS, and also makes recommendations
for people who are concerned about delays in conception and tests for
infertility.

The guidelines recommend that:

• Up to three stimulated cycles of IVF treatment should be offered to couples
  where the woman is 23-39 years old at the time of treatment and who have
  an identified cause for their fertility problems or who have been
  infertile for at least three years.
• Alcohol, smoking, drinking caffeinated beverages and body weight can affect the
  chances of natural conception and reproduction procedures including IVF.
  Women should be informed that body mass index (BMI) should ideally be in
  the range of 19-30 before commencing IVF to increase the chances of a
  successful treatment. This advice does not affect a woman’s eligibility
  for IVF or place any restrictions on whether she receives the treatment.

The NICE website says that this guidance is currently being reviewed (February 2011).

What did the report find?

The report said that fertility problems affect one in seven couples in the UK. This is approximately
3.5 million people. Although the proportion of couples with fertility problems has remained the same, there has been an increase in the number of people
seeking IVF. Success rates have also improved, with the live birth rate for IVF treatments rising from 14% in 1991 to 24% in 2008.

In England in 2008, IVF was given to 39,879 people, 50,687 cycles were carried out and, as a result, 15,082
babies were born. The report says that there is increasing pressure on the NHS
to provide IVF.

What happens now?

The conclusion to the report said:

“There will always be limits on the amount of infertility treatment that can be given on the NHS. The
NICE guidelines achieve a fair balance between the needs of infertile couples and the limits that have been placed on funding. It is therefore vital that
PCTs adhere to them.”

The report collected
information through freedom of information requests to primary care trusts in
March 2011. The report’s authors highlighted that individual PCTs may have
changed the amount of IVF they provide since the survey was carried out. They
made no recommendations other than urging PCTs to follow the NICE guidelines.

What is Plantar Fasciitis?  Plantar fasciitis (also called ‘policman’s foot) means inflammation of your plantar fascia. Your plantar fascia is a strong band of tissue (like a ligament) that stretches from your heel to your middle foot bones. It supports the arch of your foot and also acts as a shock-absorber in your foot.

What are the symptoms of plantar fasciitis? Pain is the main symptom. This can be anywhere on the underside of your heel. However, commonly, one spot is found as the main source of pain. This is often about 4 cms forward from your heel, and may be tender to touch. The pain is often worst when you take your first steps on getting up in the morning, or after long periods of rest where no weight is placed on your foot. Gentle exercise may ease things a little as the day goes by, but a long walk or being on your feet for a long time often makes the pain worse. Resting your foot usually eases the pain. Sudden stretching of the sole of your foot may make the pain worse. For example, walking up stairs or on tip-toes. You may limp because of pain. Some people have plantar fasciitis in both feet at the same time
(Information from www.patient.co.uk/health/Plantar-Fasciitis.htm).

Plantar fasciitis is an inflammation of the fascia under the foot. It can be very painful on standing after sitting or sleeping but it gets better as the person moves.This is because the fascia is being pulled by usually overly strong muscles down the sides of the legs or the Achilles tendon, causing inflammation. This is made worse by the foot flopping forwards when at rest or in sleep. The best treatment is obtained from a podiatrist. Often there is a pronation of the foot, a rolling in or out of the foot, and this can be helped by using insoles to correct this rolling, which puts less stress on the external muscles of the leg, allowing less inflammation. This alone can help the problem be relieved over time. Often stretching exercises are also given. The next stage if this fails is strapping with fabric plaster, which keeps the fascia in place and allows the inflammation to heal. The next stage is the night splint which is sometimes made from a fibreglass plaster cut down the front and is tied on to the foot at night. This keeps the foot in the upwards pointing position all night, relieving the pulling on the fascia. This might have to be worn for 6 weeks or more. Lastly, there is the steroid injection into the fascia, which blocks the inflammation and relieves the pain.

From a reflexology point of view, treatment sessions may help over time as the manipulation of the foot may help release muscle tension, foot tension and the ‘adhesions’ that form when inflammation is present, allowing greater movement. The main advise is to see a podiatrist first and then to complement with reflexology treatments.

My name is Alison Clayton-Smith and I have been having
reflexology with Karina over the last few months. As someone who is managing a
chronic condition, taking time out for complete relaxation is hugely important.
Though I do regular yoga and meditation practice, there is something different
about receiving 1:1 attention from another human being.

When I first went to Karina I immediately felt relaxed in
her company and a sense of genuine connection. Her gentle, supportive manner
and humorous nature helped create a warm environment. Some years ago I tried
reflexology with someone else and we just didn’t seem to click. I didn’t have
that same sense of instant calm when I walked through their door.

The physical environment in which Karina practises supports
her approach. The room at the front of her house is full of light and yet
simply screened with natural blinds. I love this. Many times I’ve been for
treatments in other places and there are no windows, no natural light. Now ok,
normally you have your eyes shut so it shouldn’t matter, but it does. Even
through closed eyelids you can detect lightness.

Sitting in the reclining chair is also a different
experience to lying on a massage couch (which was my previous experience). In
the chair I feel supported, physically and mentally. And her choice of music,
often with singing in languages other than English, also helps soothe the mind.
None of the tweeting birds and sounds of ocean that you often get, though I
admit I have a fondness for the ocean sounds. Instead, rhythmic, beautiful and
ethereal sounds, that I haven’t heard anywhere else.

There’s a branch of psychology called Ecopsychology, which
focuses on the interrelationship between us and the natural environment. It
emphasises how much our wellbeing is affected by the environment we are in and
the more we can feel connected with the natural world, the more whole we feel.
The reason I enjoy going to Karina for reflexology is she manages to bring a
sense of the natural environment into her room. When I’m there, I become more
at peace and leave being more mindful of my impact on myself and the world
around me.

Alison Clayton-Smith
is a facilitator and writer with a particular interest in eco/environmental
psychology and sustainable living.

Email: info@growinginsights.co.uk

Website: www.growinginsights.co.uk