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#1
One of the central themes of A Journey Through Male Infertility is that men and women often process loss, trauma, and emotional pain in very different ways. While the book is written through the lens of infertility, its message about communication, understanding, and navigating adversity together resonates far beyond fertility challenges alone.
The post below comes from a reader who has not experienced infertility but was struck by the parallels between the experiences described in the book and the profound loss he and his wife endured following the death of their son. His insights highlight how differing responses to grief can create distance and misunderstanding, yet also how patience, support, and open communication can help couples find their way back to one another.
The following post reinforces a key message of A Journey Through Male Infertility: when couples seek to understand—not judge—each other's way of coping, they are better able to face life's greatest challenges StrongerTtogether.
His post is as follows:                                                                                                                 "I have been trying to make time to read this, and making slow progress. It is a fascinating read and what strikes me more than anything is the simlarities in the relationship between my wife and me when our son killed himself. Of course it was unbearable for both both of us but this was manifested different ways. I had to be "strong" and rational about how this effected us both, while she was overtly emotional and blamed me a great deal. So my efforts to be strong merely made her more accusative. It took 2 to 3 years for us to reach an even keel. Our two daughters were even more distraught at first, but after a while they calmed down and their support helped us all to come together again. I shall continue with the book it's rather wordy, but it is enlightening".
#2
One of the central themes of A Journey Through Male Infertility is that men and women often process loss, trauma, and emotional pain in very different ways. While the book is written through the lens of infertility, its message about communication, understanding, and navigating adversity together resonates far beyond fertility challenges alone.
The post below comes from a reader who has not experienced infertility but was struck by the parallels between the experiences described in the book and the profound loss he and his wife endured following the death of their son. His insights highlight how differing responses to grief can create distance and misunderstanding, yet also how patience, support, and open communication can help couples find their way back to one another.
The following post reinforces a key message of A Journey Through Male Infertility: when couples seek to understand—not judge—each other's way of coping, they are better able to face life's greatest challenges StrongerTtogether.
His post is as follows:                                                                                                                                                                                                                            "I have been trying to make time to read this, and making slow progress. It is a fascinating read and what strikes me more than anything is the simlarities in the relationship between my wife and me when our son killed himself. Of course it was unbearable for both both of us but this was manifested different ways. I had to be "strong" and rational about how this effected us both, while she was overtly emotional and blamed me a great deal. So my efforts to be strong merely made her more accusative. It took 2 to 3 years for us to reach an even keel. Our two daughters were even more distraught at first, but after a while they calmed down and their support helped us all to come together again. I shall continue with the book it's rather wordy, but it is enlightening".
#3
As set out in our review, one important pathway through which a father's health can affect both pregnancy outcomes and the infant's health is through sperm health.
Factors such as age, the father's nutrition, whether he smokes, is overweight or obese, has an unhealthy alcohol intake, experiences stress and his level of exposure to pollution or chemicals can all influence so-called non-coding nucleic acid (RNA) signals carried in sperm. These signals can affect how genes act in the early stages of the baby's development, which can subsequently impact long-term health outcomes in children.
For example, one study of over 500,000 couples found higher odds of birth defects (including cleft lip, digestive tract anomalies and congenital heart disease) when fathers reported drinking alcohol before pregnancy.
Older father's age (particularly those who conceived a child after the age of 35) is also linked with both risk of birth complications as well as a child's likelihood of being diagnosed with autism spectrum disorder. These links are stronger than those seen with a mother's age.
Research involving millions of fathers and children has additionally shown that depression in fathers is linked with higher risks of depression in their children.
Some research even suggests that experiences earlier in life may play a role. For example, studies have linked nutrition and environmental exposures such as food shortage or abundance during boys' pre-teen years with health outcomes in the next generation.
But biology is only part of the picture, as described in our review.
Men also influence pregnancy through their relationships with their partners. Supportive partners are consistently linked with healthier pregnancies. Women who feel supported are more likely to attend antenatal appointments, avoid smoking or alcohol, maintain healthier diets and experience lower levels of stress and depression during pregnancy.

Supportive partners are linked with healthier pregnancies.Hananeko_Studio/ Shutterstock© The Conversation UK
These factors matter because a mother's mental health and wellbeing during pregnancy are closely linked to children's emotional, cognitive and physical development.
Another pathway is through parenting. A father's mental health, stress levels and childhood experiences can influence how he interacts with his children after birth.
For example, men who experienced adversity growing up – such as poverty, neglect or trauma – are more likely to experience anxiety or depression later in life. This can affect family relationships and parenting.
This means that experiences during a boy's childhood can have ripple effects decades later, shaping the environment his own children grow up in.
What this means for families
Taken together, the evidence from our review shows the importance of shared responsibility for pregnancy and parenthood.
Improving men's health before pregnancy benefits not only men themselves but also their partners and future children. Yet most health advice about preparing for pregnancy still focuses almost entirely on women. In many countries, there is little information or support available for men who want to prepare for fatherhood.
Raising awareness is an important first step. Research shows that many men want to be involved in planning for pregnancy and supporting their partners – but they often don't realise how their own health may influence outcomes.
For men who hope to become fathers, general health guidance needs to be followed: avoid smoking, limit alcohol, maintain a healthy weight, manage stress and seek medical advice for ongoing health conditions. Just as important, strong and supportive relationships between partners can help create healthier environments for future parenthood.
Our review suggests it's time to rethink how we approach preparing for pregnancy. Instead of focusing only on women before pregnancy, a more effective approach should involve supporting the health and wellbeing of both boys and girls throughout their lives.
This includes addressing wider social factors such as education, mental health support, economic stability and childhood adversity. Experiences early in life shape later health behaviour and relationships, influencing the next generation.
Most healthcare systems are also simply not designed to support father's involvement in preparation for pregnancy and parenthood. But men need to be included in conversations about reproductive health and couples should be supported to approach pregnancy preparation together.
More research is still needed to better understand the biological and social pathways linking men's health to pregnancy and child outcomes. But our review makes one message clear: the health of the next generation does not begin with pregnancy – it begins much earlier, in the early lives and wellbeing of both parents.
Keith Godfrey receives funding from the National Institute for Health and Care Research (NIHR Senior Investigator (NF-SI-0515-10042) and NIHR Southampton Biomedical Research Centre (NIHR203319)) and the Wessex Medical Trust, Gerald Kerkut Charitable Trust and Rosetrees Trust.

#4
"Yes, a patient can transport frozen eggs (oocytes) or embryos from the UK to the USA, but it's a highly regulated process requiring coordination with specialist couriers, compliance with both UK (HFEA) and US (FDA) rules, proper cryo-shipping in liquid nitrogen tanks, and specific infectious disease testing. The process involves the UK clinic, the receiving US clinic, and an expert courier managing documentation, customs, and maintaining the cold chain for the samples.
Key Requirements & Steps:
1.   FDA Compliance (US Side): The primary hurdle for US entry is that donors must have completed specific FDA-required infectious disease screening (HIV, Hepatitis, Syphilis, Chlamydia, Gonorrohea) at an FDA-certified US facility at the time of donation.
2.   HFEA Compliance (UK Side): The UK clinic must follow Human Fertilisation and Embryology Authority (HFEA) regulations for exporting gametes, ensuring donor consent and proper quality standards.
3.   Specialist Courier: You need a licensed courier (e.g., Embryoport, Greenplace Healthcare, Biocair ) specialising in cryogenic transport (using LN2 dewars) and handling international paperwork.
4.   Clinic Coordination: Both the UK exporting clinic and the US receiving clinic must work together to arrange the transfer and paperwork.
5.   Documentation & Customs: The courier manages the extensive documentation, permits, and customs clearance.
Process Summary:
•   Frozen eggs are placed in specialised liquid nitrogen shippers.
•   A specialist courier transports them directly from the UK clinic to the US clinic.
•   The receiving US clinic verifies the FDA-compliant testing results.
In short, it's possible but complex, requiring expert logistical and regulatory support from your clinics and a specialised courier. "
#5
Patient experience - "Theoretically, this is possible and we have both imported and exported to the States. They would need to be registered with an American clinic and have had a consultation there. There's usually consent and admin charges that would need to be paid to the UK clinic before they would be happy to send information over. The UK clinic would need to send freeze details, consents and virologies, but the American clinic would also have to provide information on their accreditation, quality management and traceability and this would have to meet HFEA guidelines to be able to export there. If these cannot be met, they could apply to the HFEA for special directions, but they may not grant this. Regulations between the countries vary and they would not be able to use the eggs for anything that is illegal within the UK, the most common being sex selection."
#6
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Fertility Blog
Blog originally published by American Society for Reproductive Medicine (ASRM)
The United Kingdom's fertility regulator, the Human Fertilisation and Embryology Authority (HFEA), is updating its guidance on exporting eggs, sperm and embryos for surrogacy. It means that U.K. intended parents who wish to transport their gametes or embryos to clinics in the United States to conceive with a gestational carrier will now be able to arrange export much more straightforwardly.
Although export from the U.K. for the purposes of surrogacy has never been illegal, there are some complex regulatory rules which U.K. fertility clinics are obliged by law to follow which have in practice caused a block until now. To arrange export (without needing specific advance permission from the HFEA), U.K. fertility clinics must show the export falls within the rules of the HFEA General Direction on export. The General Direction creates a list of tick-boxes which, as well as confirming the safety and quality standards at the receiving clinic and patient consent, requires clinics to satisfy themselves that the treatment planned overseas would not be "unlawful" in the U.K.
This has long been a sticking point in surrogacy cases. U.K. law prohibits profit-making surrogacy agencies from operating in the U.K. and encourages the payment of no more than reasonable expenses to surrogates (although paying compensation is not illegal, and, in reality, the family court has the power to authorise surrogate compensation when awarding parentage and routinely does). As a result, many U.K. fertility clinics have been hesitant to export embryos or gametes overseas where "commercial" surrogacy is planned, fearing that this would breach the requirement in the General Direction about unlawfulness.
Previously, the HFEA guidance to U.K. fertility clinics added to the concern, since the HFEA advised that, before exporting gametes or embryos for surrogacy, U.K. clinics should ask patients whether the intention was to involve a commercial surrogacy agency or to compensate the surrogate. Although the HFEA was not clear about the implications of an affirmative answer, the fact that such questions were required was taken by most U.K. clinics as confirmation that export was not permitted where "commercial" surrogacy was planned.
In 2020, the pandemic threw a brighter spotlight on the problem, since intended parents who would have previously travelled to the U.S. (and elsewhere) for surrogacy, were suddenly not able to get there in person. More looked to U.K. fertility clinics to help them ship their sperm or embryos to the U.S. instead to enable them to conceive through gestational surrogacy. The confusion around the export rules, and the block this created in practice, suddenly became much more obvious and problematic.
This author's fertility law firm, NGA Law, and U.K. surrogacy organisation, Brilliant Beginnings, therefore made a joint approach to the HFEA to challenge its legal interpretation and ask them to clarify that clinics could export under the General Direction even if "commercial" surrogacy abroad was planned. We set out our case that, although the law in the U.K. prohibits professionally arranged surrogacy in the U.K., the parameters of unlawfulness are narrow and only catch the activities of surrogacy agencies operating for profit in the U.K. The arguments made were that there is no unlawfulness around fertility clinics offering treatment, surrogacy agencies operating commercially outside the U.K., or intended parents/surrogates themselves making or receiving payments. Therefore, we argued that the General Direction requirement not to export for "treatment services" which would be unlawful in the U.K. was not breached if intended parents from the U.K. wanted to engage in commercial surrogacy overseas.
HFEA Chief Executive, Peter Thompson, responded in October 2020 that, having reflected, and taken legal advice, the HFEA agreed with our interpretation. It was not in fact unlawful for clinics to provide treatment services for surrogacy where there was a wider commercial element (even in the U.K.), and therefore U.K. clinics also could export gametes and embryos for surrogacy in compliance with the General Direction rules without needing to ask patients about whether any commercial elements were involved overseas.
The wider context here is that attitudes toward commercial surrogacy have evolved in the U.K. over the past 15 years. International surrogacy is now an established and accepted way of building a family for U.K. parents, and one routinely authorised by the family court. Around half the parentage orders made in the U.K. in surrogacy cases now involve children born overseas through "commercial" surrogacy – around 200 cases a year – and there are no cases where the court has refused to award parentage to U.K. parents who have used a professional agency or compensated a surrogate. International surrogacy was even recently endorsed by the U.K. Supreme Court which (in awarding damages for negligence to cover the cost of surrogacy in California) ruled explicitly that international commercial surrogacy was no longer contrary to U.K. public policy, provided that the country in question had a well-established system which properly safeguarded the interests of all involved. Although the update to the HFEA guidance is a clarification rather than a change of policy, it is in line with this wider trend.
Going forward, U.K. fertility clinics will now be able to export eggs, sperm or embryos for patients wishing to pursue surrogacy under the General Direction rules. They do not need advance permission from the HFEA and there is no need for them to ask whether their patients plan to involve a paid surrogacy agency or a compensated surrogate. They just need to liaise with the receiving clinic overseas to confirm they meet all the right quality standards and confirm that the patients consent to the export, something which should be straightforward in most cases involving U.S. fertility clinics.
Although it will take some time for the HFEA to review and update its formal published guidance on export, HFEA Chief Executive, Peter Thompson, has explicitly confirmed in his letter to NGA Law and Brilliant Beginnings that the change is of immediate effect. This is good news for patients wishing to export their eggs, sperm or embryos overseas for the purposes of international surrogacy, who can now be confident in their ability to do so in the midst of a pandemic even if they cannot travel themselves.
Guest Author, U.K. Solicitor, Natalie Gamble, is the principal of NGA Law, which represents and advocates for clients building families through ART and surrogacy, and a founder of Brilliant Beginnings, a non-profit surrogacy agency known for its policy and campaigning work and support of U.K. parents engaging in surrogacy in the U.K., U.S., and Canada.
#7
Hi all you Mensfe readers

Its MENS DAY

Not sure what that means other than the media hopefully high profiling men's issues: We have just put a Guide Book together which will be published (1-12-2025) via Amazon it's called:

A JOURNEY THROUGH MALE INFERTILITY
Stronger together
A BOOK FOR MEN THAT WOMEN SHOULD READ

It's 21 chapters that address all aspects of the emotional weight of Infertility, including: Male and Female Ideology - Redefining Gender Roles - The Treatment Pathway - Diagnosis - The Significance of Fatherhood - Need for Change - Rediscovering Joy, to name a few.

Primarily, it is a support guidebook for you, by you.




#8
General Discussion / Childless
Last post by mensfe_admin - 2025-07-20 09:49
Hi Mensfe readers - we do not normally post the following request however the following may be of interest to some of you.
Good luck to your production and informative support on this very important subject: P. Mensfe.

I just wanted to let Mensfe know about Empty, my play about unwanted childlessness, which is getting an airing at the Cockpit on 7 September at 5.30pm. A two-hander, it's being performed as part of the London theatre's New Stuff programme. It would be lovely if you were able to give it a mention or, even better, come along to see it - and offer support! I'll probably be quaking in my boots! The theatre is near Marylebone Station.

It's actually a 40-minute extract taken from the complete play, which is an hour and a half long. As Empty is still in the development stage, it will be a rehearsed reading – that is, the two actors will be acting but will have the script to hand. I am so honoured that Empty has been chosen for performance, along with a second play by another playwright the same evening.

And I'm so lucky to have two wonderful actors playing the roles of Amy and Dave – Melanie Dagg and Tim Treloar, both childless. I can't wait to hear them get hold of my words and give them some heartfelt Geordie and Welsh energy.

Here's the post on the Cockpit website:

https://www.thecockpit.org.uk/show/new_stuff_september_0

It's where you can buy tickets for the princely sum of £3! After the play there will be a Q&A session and a more informal one in the bar at the end of the evening.

A shorter extract from Empty will be performed at Storyhouse Childless on the evening of 13 September.

All best wishes,

Robert



My latest book, 'I Always Wanted To Be A Dad: Men Without Children', is now available in hardback, paperback or as an eBook from Amazon, my website (robertnurden.com) or from bookshops.

Website: robertnurden.com
#9



Comment
The following letter has been sent to Peter Thompson, chief executive of the Human Fertilisation and Embryology Authority (HFEA).

Dear Peter,

Thank you for your recent communication and the interim publication of Choose a Fertility Clinic (CaFC) metrics on 29 May. We acknowledge the challenge of presenting meaningful outcome data in a rapidly evolving clinical landscape, and we appreciate the HFEA's intent to offer patients more timely information.

That said, we must raise serious concerns about the continued use of live birth per embryo transferred as the headline measure.

Focusing on live births per embryo transferred, rather than per cycle started or per patient, omits key aspects of the treatment journey.

This metric can unintentionally:

Favour clinics that selectively transfer only high-quality embryos, often after multiple freeze-all cycles where embryos of average quality are not even given chance and discarded, thereby inflating apparent success rates.
Allow exclusion of patients with poorer prognoses, including those whose cycles are cancelled or result in no embryos for transfer – particularly common in low ovarian reserve.
Create space for clinics to implicitly attribute success to adjunctive treatments or add-ons (such as PGT-A, IVIG, or immune testing), when in fact their reported outcomes benefit from methodological artefacts rather than evidence-based efficacy.
The statement on the HFEA website that differences are due to 'chance' is misleading in this context.

The data being published from highly heterogeneous populations and practices.

Clinics do not all treat the same mix of patients; they can (and do) differ in their:

Patient age profiles.
Use of donor gametes.
Use of PGT-A.
Patient selection (poorer prognosis patients may be shifted into 'natural IVF' category allowing to remove this group of patients from denominator).
Clinical protocols (multiple cycle banking for patients with poor reserve).
Inclusion or exclusion of certain types of cycles in reported denominators.
To suggest that differences of a significant percentage points are simply 'chance' without mentioning that systematic biases in patient selection and reporting drive these differences is non-scientific and risks misleading patients.

The mixing of different subpopulations into one 'success rate' is a serious methodological flaw.

Reporting an aggregate 'live birth per embryo transfer' without appropriate stratification:

Rewards clinics who heavily filter patients pre-transfer.
Hides poor performance in the stimulation, fertilisation, or embryo development phases.
Fails to account for the fact that many patients (especially older or poorer prognosis) never reach embryo transfer.
The current system ignores the fundamental problem of:

Denominator manipulation – by excluding failed cycles and those who never reach embryo transfer, a clinic can appear to outperform others simply by being more selective.
The PGT-A disclaimer is insufficient and misleading.

While the website does mention that PGT-A may influence success rates, the current wording is not enough to prevent patients from perceiving that PGT-A clinics are 'better'.

Critically, it fails to mention that:

Many patients are excluded from reported success rates entirely if their embryos are deemed 'abnormal' and no transfer occurs.
PGT-A outcomes should be reported separately and transparently (as per latest good practice recommendations), with success rates per cycle started or per patient, not just per embryo transfer.
Without full transparency on how many cycles never result in transfer, the success rates can appear artificially high.

We urge the HFEA to consider the following immediate steps.

The presentation of data in current format needs to be suspended.
Live birth rate needs to be reported per cycle started (multiple pregnancy rate still can be assessed in this setting).
Clearly separate PGT-A cycles and donor egg treatments in all outcome data, with transparent labelling by age group.
Aim to develop reporting on cumulative live birth rate per cycle started. While we understand that cumulative live birth rate per cycle started is a more complex metric to present, it remains the internationally accepted gold standard – already adopted by SART/CDC (USA), CARTR+ (Canada), ANZARD (Australia/New Zealand), and endorsed by ICMART. These systems recognise that the patient journey begins with a cycle start, not with an embryo transfer, and that fair reporting must reflect the full scope of that journey.
These concerns are not new. For well over a decade, clinicians and academics have pointed out that current reporting frameworks – including the continued reliance on embryo-based metrics – allow for distortion, selective exclusion, and confusion. Multiple studies and professional commentaries, including from members of our own team, have outlined how such practices undermine the original goals of the HFE Act: to inform, protect, and empower patients. Yet despite these repeated calls, meaningful reform has lagged behind international best practices. With the current update to CaFC, the Authority has a rare opportunity to address long-standing weaknesses and restore confidence in how outcomes are reported and understood.

We also welcome clarity on the upcoming consultation process.

Will clinics, patients, and independent experts be able to contribute formally?
Will the consultation explicitly address the use and abuse of elective freeze-all cycles and multi-cycle commercial packages?
We note that the HFEA's 2025–2028 Strategic Plan includes strong commitments to transparent, patient-centred information and to reducing inequalities in treatment outcomes. We are concerned, however, that the current CaFC metrics – in particular the continued focus on embryo-based success rates – may not fully reflect those strategic priorities in practice. We hope the forthcoming consultation will be an opportunity to bridge this gap and bring CaFC into closer alignment with the Authority's vision.

We believe this is a critical moment. How the HFEA reports outcomes will influence not only patient choice, but also clinical practices and commercial models across the UK fertility sector. Inaccurate or overly simplified metrics carry real risk of harm and perpetuate inequity. Transparent, cycle-based reporting – underpinned by clear definitions and cumulative success data – is essential if CaFC is to become a truly trusted tool for patients.

We thank the Authority for recognising the weight of this responsibility and remain committed to supporting the development of a fairer, more clinically accurate system of reporting.

Professor Dusko ILIC, MD PhD
Professor of Stem Cell Science
King's College London Faculty of Life Sciences and Medicine
School of Life Course and Population Sciences
Department of Women and Children's Health
Person responsible for the HFEA clinical license 0102
Assisted Conception Unit, Guy's and St Thomas' NHS Foundation Trust

Dr Julia Kopeika, MD PhD, FRCOG
Consultant Gynaecologist
Head of Assisted Conception Unit, Guy's and St Thomas' NHS Foundation Trust
Lead For Fertility Preservation
Sub specialist in Reproductive Medicine and Surgery

Professor Yacoub Khalaf, MD, FRCOG
Professor of Reproductive Medicine and Surgery
King's College, London Consultant in Reproductive Medicine and Surgery
Guy's and St Thomas' NHS Foundation Trust Medical Director of the Assisted Conception Unit and Centre for PGD

Tarek El-Toukhy, MSc MD MRCOG
Consultant Gynaecologist
Senior Lecturer, King's College London
Subspecialist in Reproductive Medicine and Surgery
Assisted Conception Unit, Guy's and St Thomas' Hospital NHS Foundation Trust

Professor Caroline Mackie Ogilvie, BSc DPhil OBE
Guy's and St Thomas' NHS Foundation Trust

Professor Ying Cheong, MD, FRCOG
Professor of Reproductive Medicine
University of Southampton

Some of the issues discussed in this open letter will be explored at this year's PET Annual Conference, What Does Genomics Mean for Fertility Treatment?.
#10
Films of all six events can be watched below. We believe that you will find them informative, as the UK Government considers rolling out this approach for all newborns. And the team at PET looks forward to holding further public discussions, as this work proceeds.

1. What Should Be Looked For? What Should Be Fed Back?

If you can't see the film embedded above, you can watch it on YouTube.

2. Consenting Adults, Sequencing Babies

If you can't see the film embedded above, you can watch it on YouTube.

3. What Research Can, and Should, Be Done with a Baby's Genome?

If you can't see the film embedded above, you can watch it on YouTube.

4. Genomic Data: A Resource from Cradle to Grave?

If you can't see the film embedded above, you can watch it on YouTube.

5. Workforce Implications for Healthcare Professionals and Beyond

If you can't see the film embedded above, you can watch it on YouTube.

6. Implementing the Generation Study

If you can't see the film embedded above, you can watch it on YouTube.