IVF success rates

I’ve just been reading about an overseas clinic which claims an IVF success rate of more than 90% per IVF cycle started, including frozen embryo transfers. I could understand why this would seem an incredibly attractive prospect to anyone who needs fertility treatment – not only is IVF cheaper than it would be in the UK, it also appears to be far more successful. But is it? Does any clinic really have a success rate of 90%?

One of the main differences for the apparent discrepancies between outcomes at clinics here in the UK and the rates some overseas clinics claim is the way that they are presented. Here in the UK, you can check validated IVF outcomes on the HFEA website. These are accurate figures for live births over a set period. Some of the amazing rates you see on overseas clinic websites are not for live births but for positive pregnancy tests, and as we know that one in four pregnancies ends in miscarriage, it is not surprising that live birth rates are always lower than pregnancy rates.

The figures you get from the HFEA will also show you the outcomes for women of different ages. Birth rates after IVF in the UK range from  2% to 33% depending on the woman’s age. The HFEA figures show you outcomes over a set period – a specific year, or a three-year period. If you are running a clinic elsewhere and happen to have a month where you have very good outcomes and lots of women get pregnant, followed by a month where no one does, what’s stopping you from using your good month as your “success rate”?  So a success rate may be for a short period, for younger women and it may be pregnancy rather than live birth – and all of these things make a huge difference. What’s more, sometimes the figures are simply wrong. I’ve read some crazy claims for totally impossible success rates, particularly for older women using their own eggs. The truth is that IVF is less successful as we get older, and miscarriage presents a greater risk.

Many overseas clinics offer very good fertility services, but if you are thinking about treatment abroad do be careful about hyped figures and unrealistic claims about outcomes. Know what is likely and what is possible, and be wary of clinic websites claiming successes which are totally out of kilter with anything you’ve ever seen elsewhere, especially for successes for older women using their own eggs, as this may suggest a clinic which is prepared to be somewhat economical with the truth.

The cost of private fertility treatment

New research has found huge discrepancies in the prices people are charged for IVF and for many extras such as blood tests or drugs as reported here in the Times. It can be difficult if you need treatment as you don’t always feel you have time to shop around – but this shows that it is at least worth making a few calls to see whether anywhere closer to you may offer treatment at a lower price. If you do this though, you do need to make sure that the price isn’t lower because not everything is included in the cost you are being given  or because the treatment is not the same. It is also important to be aware that the headline costs on clinic websites often have little to do with the real costs that you will end up paying as a patient.

It’s not just the treatment itself where costs can differ but also the prices paid for any additional treatments which some patients are now considering. When I was looked into this, I was surprised at how big the differences were in the charges for add ons. For example, some clinics were including embryo glue in the cost of an IVF cycle whilst others were charging for it and the costs ranged from £75 to £350. It was a similar picture with endometrial scratch, which you might be able to get free at some clinics across the country by taking part in a clinical trial or which could cost you up to £450. I looked at a small sample of clinics and even in those, found these wide price discrepancies but it does show that it is worth at the very least asking why your clinic is charging what it does if it is much more than others.

Finally, don’t forget that the cost is one part of the equation. If you are having to travel a long distance to the clinic – or if it is overseas – this in itself adds costs both financial and in terms of stress. You will also want to check out the clinic details on the HFEA website to see the latest outcomes from treatment and to see how it is ranked by inspectors and other patients. There is a section in the patient ratings about cost which is particularly relevant as it shows whether people ended up paying more than they expected for treatment at that particular clinic so make sure you have at least considered these things before committing yourself.

New report from the HFEA

The HFEA has  launched its first-ever “state of the sector” report yesterday, providing an overview fertility treatment in the UK, including the success in reducing multiple birth rates to just over 10% of all IVF births.

The report, which brings together previously separate reports on incidents, inspection findings and patient feedback, records how fertility clinics and research laboratories performed in the financial year 2016-17 across a range of criteria. It is designed to give both clinics and patients a rounded view of the health of the UK’s fertility sector.

It shows that through working with the UK’s licensed clinics, the HFEA has reduced the national multiple birth rate from 24% in 2009 to 11% today, a fantastic achievement which has increased the safety of IVF for mothers and their babies and reduced the burden on NHS ante- and neonatal services. This has come without a reduction in birth or pregnancy rates, with the latter rising from 24% in 2008 to 32% today.

The report also shows that in 2016-17 there were 132 treatment and research clinics working under licence in this country, of which 34% are privately run, 29% are in public/private partnership, and 22% are NHS only (the remaining 15% are research only). During that same year the HFEA carried out 81 inspections as part of its yearly inspection cycle.

There is also specific focus on how patients experience treatment, and the new ways being developed to receive patient feedback and pass it on to clinics. A new star rating system has recently been launched on the HFEA website, giving patients the chance to rate their clinic directly and which has already been used over 700 times.

Sally Cheshire CBE, Chair of the HFEA welcomed this new report as a sign of open and healthy governance, and a continuing commitment to improving patient care:

“This report shows the full range of work, undertaken by both us and clinics, that lies behind the more than 76,000 treatment cycles performed in the UK each year, and outlines the importance of us working together to ensure patients, donors and the donor-conceived get the highest possible quality care.

“It is particularly pleasing to see that the multiple births rate has fallen consistently across the vast majority of the sector and is now very close to the 10% target we set for clinics some years ago, without a reduction in births. And it is heartening to be able to discuss with clinics real examples of patient experiences. It’s so important that patients have a voice, and I hope that the UK’s clinics will listen to what is being said.”

The report also details non-compliances, including adverse incidents, and areas for improvement. In many ways, there has been good progress, with fewer than 10 instances of non-compliance identified by inspectors in 14 main areas of the Code of Practice across all clinics in 2016-17. And of the 299 reported non-compliances overall (a slight rise from the previous year), almost all were resolved within the deadline set. This shows a sector that is open to constructive feedback and continuous improvement.

However, performance wasn’t all positive and the report reveals some areas for concern. The number of reported incidents increased from 497 in 2015 to 540 in 2016. Of these, 325 were categorised as ‘grade C’, 176 were classed as ‘grade B’, with one ‘grade A’ incident – the most severe.

Sally Cheshire CBE urged clinics to consider the impact incidents have on patients, and ensure Britain’s IVF sector maintains the highest standards:

“While the number of incidents and non-compliances must be placed in the context of the many thousands of treatments being performed in the UK each year, the fact is that all incidents, whatever the category, can be very upsetting for patients and must be avoided wherever possible. Non-compliances risk undermining the hard-won reputation for quality and rigour that the UK’s fertility sector has established over the last 25 years.

“In line with our commitment to open, frank and constructive regulation, we will continue to work with all our licensed clinics so that they strive to continually improve and maximise the chances of success for patients seeking their much longed-for families.”

The full report can be read on the HFEA website: https://www.hfea.gov.uk/

Free IVF cycles

Since 2009, the Lister Fertility Clinic has been offering a small number of free IVF cycles each year to try to help people who are unable to access NHS-funded fertility treatment. The cycles are offered in conjunction with the charity Fertility Network UK and there are some criteria for entering into the draw for the free cycles.

You have to be a UK resident under the age of 42, with a cause for your fertility problems. Your BMI must be in the normal range and you can’t have any children from your current relationship. You can’t have been sterilised in the past and you can’t have had a free cycle at the Lister before. There are also some restrictions on the type of treatment you can have, which can’t include egg donation.

You need to send your entry to Fertility Network UK – and you can find the details here

 

Fertility milestones

In support of National Fertility Awareness Week, the HFEA or Human Fertilisation and Embryology Authority which regulates the fertility sector, has published data which reveals some new milestones for UK fertility treatment.

More than 300,000 children in total have now been born in the UK from licensed fertility treatment since 1991. Fertility treatment has grown markedly since 2010, with almost a third of all IVF and DI babies since 1991 arriving in the last six recorded years (2010 to 2015).

The total number of treatment cycles carried out in UK clinics also passed a significant milestone in 2015, breaking through the million barrier. The overall number of treatments carried out since 1991 is 1,034,601.

The new data – drawn from The HFEA Register, the oldest and largest fertility database in the world – also reveals that fertility services are used mainly by younger women. The average age of women having fertility treatment is 35 years, which has remained largely static over recent years.

Treatments involving women aged 18-34 remain the largest single group, accounting for 43% of all treatments, while treatments for women aged 40 and over account for just 20% of all treatments with very few treatments being provided to women over 45.

Looking at the different regions in the UK, the data shows that most treatments continue to take place in London and the South East of England, accounting for 42% of all cycles. However, there is a strong representation of large northern clinics in the figures, with the North West now providing more treatments per clinic than any other region, including London. Total clinic numbers vary according to region, ranging from three in Northern Ireland to 22 in London.

HFEA Chair Sally Cheshire CBE welcomed this new data as a sign of a thriving and successful fertility sector: “The figures we have released today show that the UK’s fertility sector continues to be one of the most vibrant and successful in the world. Families using assisted reproduction services across the UK are better served than ever before, and we will continue to encourage all who work in the sector to offer the highest quality support for patients who are both successful and unsuccessful.”

Susan Seenan, chief executive of patient charity Fertility Network UK said “We welcome the publication during National Fertility Awareness Week of the new IVF milestones from the HFEA. The extraordinary growth of IVF in the last six years shows the pressing need for practical and emotional support and advice for the many people facing fertility issues. It is also significant to note that this data underlines that fertility services are used mainly by younger women – aged under 35 – who will have been trying for a baby for at least two years and often more. National Fertility Awareness Week is about challenging perceptions and we hope this helps to dispel any misconceptions about IVF and female age.”

IVF funding situation is “shocking”

The latest figures released by Fertility Fairness earlier this week about funding for IVF treatment have been described as “shocking” by the President of the Royal College of Obstetricians and Gynaecologists, Professor Lesley Regan.

Commenting on the fact that so few clinical commissioning groups (CCGs) are currently following national guidance and that the number which have completely removed NHS IVF has almost doubled in the last year, Professor Regan said “These figures are shocking and it’s very disappointing to see even fewer CCGs following NICE guidance and providing full access to NHS fertility treatment. Current access to treatment is a postcode lottery and these health inequalities people face are unacceptable. Infertility can have a devastating effect on people’s lives, causing distress, depression, and the breakdown of relationships. IVF treatment is cost-effective and should be available on the NHS. The RCOG is committed to working with UK commissioners and healthcare providers to support them in following NICE Fertility Guidelines.”

Thank you Hannah, thank you Sophie…

Thanks to television news presenter Hannah Vaughan Jones for her brilliant article about her experiences of fertility problems and treatment. I’ve linked to Hannah’s tweet so that you can read the full article which is behind a paywall – and it is something we should all read as a reminder that things haven’t changed, that people are still feeling isolated, lonely and ashamed about their fertility problems, that people are still having to be brave, to pretend they are fine when inside it feels so bleak and desperate. It’s so wonderful when people in the public eye like Hannah and her husband, ITV news presenter Lewis Vaughan Jones, are able to be open about their fertility problems. It makes such a difference to those who are struggling with their own difficulties to know that it isn’t just them, that it can happen to anyone.

Also this week, BBC reporter Sophie Sulehria began a three-month series on PM on BBC Radio 4 charting her experiences of fertility and treatment. She and her husband Jonny have had a long journey involving endometriosis, premature ovarian insufficiency and unsuccessful IVF treatment. It’s really worth listening to Sophie’s story here – she is just so brave to do this in public and it will make such a difference, not just in terms of raising awareness of what it’s actually like to have fertility treatment but also in helping others who are going through fertility problems and treatment themselves. Sophie’s recording of her experiences of a cycle, of embryo transfer, of the two-week wait and a pregnancy test will resonate with anyone who has been there themselves.

Thank you Sophie, thank you Hannah – you are brave and brilliant and we thank you for being able to talk about this and wish you all the best for the future xx

Have you reviewed your fertility clinic?

If you’ve had fertility treatment recently or are currently having treatment at a UK clinic, did you know that you can give a review of your clinic’s services on the HFEA website? Your reviews are used to create a patient rating for the clinic which other people can then see on the website along with the outcomes from treatment there and a ranking from the HFEA inspectors.

It’s good to do this if you have a spare moment – and it really won’t take long – as it helps to build up a picture of the clinic for others who may be considering having treatment there.  You will be asked a series of questions about the clinic such as

  • How likely are you to recommend this clinic to friends and family if they needed similar care or treatment?
  • To what extent did you feel you understood everything that was happening throughout your treatment?
  • To what extent did you feel you were treated with privacy and dignity?
  • What was the level of empathy and understanding shown towards you by the clinic team?

You will also be asked about cost for those who had to pay for treatment and you will be able to say whether it was more, less or about the same as you’d been anticipating. Finally, you are able to add any further comments about your experiences which will be seen by the regulator but will not appear on the website.

Choosing a fertility clinic is not easy, particularly if you live in London and the South East where there are so many clinics to choose from, and the views of other people who’ve been to a clinic can be useful.

Why you might not want to bother with that fertility “MOT”…

eggFertility clinics have been promoting “fertility MOT” tests for some time as a way of checking your future fertility by testing the stock of potential eggs in your ovaries, known as your ovarian reserve, to see how “fertile” you are. New research published in the Journal of the American Medical Association suggests that these MOT tests may have no value in predicting how likely you are to get pregnant.

Ovarian reserve tests do have a use for people who are having fertility treatment as they can give some idea of how your ovaries might respond to the drugs used in the course of the treatment, but this study shows that the tests have no value in predicting your chances of getting pregnant naturally.

The researchers looked at a large group of women who had been trying to get pregnant for less than three months, and following them up for a year found that the results of the tests had no relation to the chances of the women getting pregnant.

The cost of these “fertility tests” can vary hugely. The articles covering the story suggested that they might cost around £100, but a quick google reveals that some clinics are charging more than £400 for MOT tests. The researchers were quite clear that their findings “do not support the use” of these tests to assess natural fertility – so be warned before you decide to part with any money. If you are concerned about your fertility, your first port of call should be your GP rather than a clinic charging for tests.

Fertility funding

The news of cuts to funding for fertility services has made depressing reading over recent days, with more and more areas cutting IVF in order to save money. As many people realise, cutting funds for IVF is a questionable way to save money in the longer term – you end up with dejected, unhappy people who are far more likely to need medical help for depression and related illnesses (we know from a Fertility Network UK survey that the majority of people with fertility problems have experienced depression and that more than 40% have had suicidal feelings as a result of their fertility problems).

People struggling to fund their own treatment often end up going overseas where IVF can appear cheaper, but where there are not always the same measures in place to reduce the numbers of multiple pregnancies, which is the biggest health risk from IVF.  It doesn’t need many sets of prematurely-born triplets conceived after multiple embryo transfers overseas to wipe out any savings from cutting IVF funding here in the UK.

What was more depressing was the reaction to the news about the cuts from some quarters – people with absolutely no understanding or knowledge about infertility who felt the need to try to grab centre stage by offering ill-informed opinions. We all know that not everyone agrees with the NHS funding IVF treatment, but most of those who think this way have the good grace to recognise that infertility is tough and that anyone experiencing it deserves some empathy. Not so one person writing in the Independent who suggested that fertility treatment “only serves to fulfil people’s whimsical obsession with baby-making”, that the NHS should not pay for people to become parents “if they fancy it” and that there is no justification for treatment “just because it will make some people feel more fulfilled in their life”. It was quite breath-taking to read such a glib and insensitive dismissal of a medical problem. Right back to biblical times, the huge impact of infertility has been understood with Rachel, who was unable to get pregnant, crying “Give me children, or else I die”. Infertility is recognised by the World Health Organisation as an illness, and NICE says that IVF is a clinically and cost-effective treatment.

I’m not adding a link to the article in the Independent, or addressing the poorly researched claims as to why we shouldn’t fund IVF one by one. Suffice to say that a few hours after the piece appeared, the person who wrote it tweeted “So I’m about to go on Newsnight. No big deal, right? RIGHT?!?!”… The tweet explained everything about the lack of empathy, understanding or any shred of human kindness in the piece. This article was never meant to be a thoughtful response to a social problem, but was all about trying to create the sort of stir that gets you noticed and on television. It’s just a shame that the media desire for controversy and debate means that ignorance often gets to masquerade as valid opinion.