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.

What is premature ovarian insufficiency?

We know that around one in every hundred women under the age of 40 will experience what is known as premature ovarian insufficiency (POI), which is sometimes known as premature menopause. POI is actually a more accurate description as the condition isn’t exactly the same as a menopause women go through at the usual age of around 51 because it isn’t always final as hormones can fluctuate. It can happen to women who are still in their teens. If you are over forty but under 45 and go through the menopause, this is usually known as early menopause rather than POI.

The Daisy Network offers information and support to anyone experiencing POI and aims to provide a support network where members can share experiences. The Network also helps to raise awareness of the condition. You may be interested in this story from Grazia  by a woman who shares her experiences.

Feeling fed up with January?

If you’re fed up with people DOING things for January – whether it’s Dry January, joining a spin class or taking up tap dancing – you may like to read Lesley Pyne’s latest blog post. I’ve known Lesley for a long time and have witnessed her building up her support network to help other people who are experiencing involuntary childlessness – she offers lots of support and inspiration for anyone living without children, and has helped many people through their own difficult times. You can sign up for regular emails from Lesley which offer tips and advice. What’s more, she’s right about January and people doing things – it can be exhausting to be faced with other people’s bouncy enthusiasm when you’re just trying to get through things yourself.

I didn’t make any new year’s resolutions this year – I’ve come to the conclusion that if you try to give things up, you just feel more focused on them and have a sense of being deprived when you can’t have them. And when you don’t feel you HAVE to go to the gym or go running, it can make exercise seem much more attractive.  I know it may be my strange logic, but it works for me…

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.

Getting the balance right

Happy New Year everyone – and welcome to 2018. I hope it is a successful and happy year for you all, and that you can strike a balance between doing all you can to help yourself with your fertility problems and making life start to be difficult and miserable.

It may sound odd, but anyone trying to conceive is keen to do all that they can to make a difference to the outcome of treatment and there are many things you can do which are entirely sensible and likely to be beneficial – eating healthily, taking exercise, trying to take care of yourself as much as you can. What is not so likely to be beneficial is making strict rules for yourself which are incredibly difficult to follow and leaving yourself feeling constantly guilty if you don’t quite meet the mark – and then blaming yourself for your fertility problems. I’ve seen so many people recently who are following strict dietary rules and other guidance from therapists and complementary practitioners which can make life start to feel like a military exercise – and it really can start to become counterproductive if it is making you stressed. The truth is that being overweight, eating unhealthily and drinking too much alcohol can affect your fertility, but an occasional glass of wine or piece of chocolate is really not going to ruin your chances of fertility treatment working.

So for 2018, be kind to yourself – try to be as healthy as you can, but don’t forget to think about what makes you happy too!

Happy New Year

Thank you to everyone who has read the Fertility Matters blog over the past year – it has been great to have so much interest and I wanted to wish you all a very Happy New Year.

I know that when you are trying to conceive the start of a new year can feel tainted with the sadness of another year passing when you haven’t managed to conceive – and another year when the number of friends and family members who don’t have children seems to have dwindled even further after having to deal with endless pregnancy announcements and putting on a cheerful face.  It’s better – if not always easy – to try to put that behind you on Dec 31st and to look forward to the year ahead, to see it as a fresh start with new challenges but possibly new happinesses too.

If you are thinking of making new year’s resolutions, don’t set yourself difficult targets that you will struggle to reach – perhaps think more about being kinder to yourself, looking after yourself and focusing on doing more of the things in life which make you happy. They so often disappear when you’re trying to conceive and all you can focus on is that one seemingly unattainable thing – but try to think about the things that you enjoy and make sure you do more of them whatever they may be from walks in the country to going to the cinema. Set yourself some dates to look forward to in your diary – book something you know you’ll enjoy and you can give that some focus. Whatever it is you’re planning, take care of yourself and have fun!

Goodbye to Juliet

I don’t often put personal posts on this blog, but today I did want to say thank you to Juliet Tizzard who is leaving her role as Director of Strategy and Corporate Affairs at the regulatory body for fertility treatment, the HFEA.  If you’ve been to the Fertility Show in the past, you may have seen Juliet speaking there about how the Choose a Fertility Clinic pages on the HFEA website can help if you are trying to decide where to have treatment. She’s driven some of the exciting steps forward for the HFEA such as the new website where patients can find lots of helpful information about different clinics and can give feedback after they’ve had treatment. Juliet is moving on today to the Health Research Authority where she will do a fantastic job – but she will be missed!

Miscarriage support at Christmas

For anyone with fertility problems, a miscarriage can seem the most devastating double blow – and it can make Christmas feel a particularly difficult time. The Miscarriage Association is a fantastic charity offering advice and support and they have a page on their website with information about where to find support over Christmas and about a remembrance page which may be helpful at this time.

If you’ve been affected by this, do take care and use all the sources of support out there as it can really help.

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