New research suggests that if you want to find out about outcomes from fertility treatment at a particular clinic, the best place to go is not the clinic’s own website. Researchers from Manchester University discovered that fertility clinics use a variety of different ways to present their data which makes it very difficult for anyone trying to compare one clinic with another. They found that clinic websites often use league tables which they construct themselves using their own parameters to compare clinics in their area and that these are “invariably constructed so that the comparison was favourable to the reporting clinic.”
If you do want to look at outcomes, it is worth bearing in mind that most clinics have broadly similar success rates and that relatively small percentage differences can be pretty meaningless and may have more to do with the patients being treated at any given time than anything else. The HFEA publishes outcomes broken down by age and this is by far the best place to go for information if you want to look at treatment outcomes as the figures are collected and collated the same way for all clinics across the UK
On Saturday, I’ll be speaking at the Fertility Show at London’s Olympia about what you need to think about if you are choosing a fertility clinic. If you are fortunate enough to have NHS-funded treatment, you may not have a wide range of clinics to choose from, and in some parts of the country there are fewer clinics than in others – but if you live in London or the South East and you are paying for your treatment, the choice can be overwhelming.
I’ll be explaining how to make sense of what can seem an overwhelming array of different clinics all claiming to be the best, and what factors you should take into consideration when making your choice. I’ll cover treatment outcomes – how to make sense of the IVF success rates published by the HFEA and why they may not be the only thing you want to look at when making a decision – and will look at a number of other issues that can affect which clinic might be right for you.
If you’re at the Show on Saturday, I look forward to meeting you – make sure you come and say hello!
If you are currently having fertility treatment, you are likely to be aware of the many different additions that are offered on top of the standard IVF from immunology treatments to time-lapse imaging. Yesterday’s Independent contained three articles on the subject; a news story, details of some of the treatments which may not be evidence-based and an editorial suggesting that clinics should not be offering unproven treatments. It is worth reading if you are thinking of having treatment.
It is to be welcomed that the Independent are exploring this issue – it is something which has been a concern to many of those supporting patients for some time as more and more additional treatments are offered in fertility clinics, just a few of which are listed in the paper. Patients are often worried that if they don’t pay for extras they will be reducing their chances of success, when there isn’t a strong evidence base to support this as the leading experts quoted in the articles explain.
I’m not entirely sure I agree with the editorial though, which seems to put some of the blame for this back at the door of fertility patients with the suggestion that “We also live in an age in which people do not like to take no for an answer. Some couples may be reluctant to face the fact that there may be no simple answer to their fertility issues. If one treatment does not work, the temptation is to demand another.”. Patients are not likely to demand different treatments if clinics don’t offer them, and it seems to me unfair to be blame patients for the fact that clinics are offering unproven treatments. In fact, the editorial does go on to say that “the onus lies on the clinics – not the patients – to be the voice of realism“. It also claims that only a quarter of women who have IVF conceive – this may be true of an individual cycle of treatment but cumulative outcomes are far higher – many of those who conceive after IVF treatment did not get pregnant in the first cycle.
If you are having fertility treatment and are being given the opportunity to pay for additional extras, it is really important to make sure that you are clear about the evidence. The best kind of evidence comes from a randomised controlled trial (an RCT) and it is always a good idea to ask whoever is treating you to point you in the direction of evidence in the form of an RCT to suggest that paying for an extra treatment is a good idea.
The latest statistics for fertility treatment from the HFEA show an increase in the number of IVF cycles, with more than 52,0000 women having more than 67,000 cycles of treatment – a 5% increase on the previous year. The overall success rate has gone up very slightly too, to 26% and the number of higher risk multiple pregnancies is continuing to fall
For the first time ever, the statistics include success rates for frozen eggs but despite all the publicity about egg freezing, in fact the numbers of women opting to do this are still very small – there were only 102 treatment cycles using frozen eggs and average success rate was just 14%. There are geographical differences in treatment with far more fertility patients being treated in London than in Scotland, Wales and Northern Ireland combined. The postcode lottery means that just 41% of cycles are funded by the NHS.
Another day, another survey – but this one is to help researchers who are keen to find out more about why success rates following IVF treatment aren’t higher. Embryo quality plays a role here, and when treatment doesn’t work it can be down to abnormalities in the chromosomes which carry genetic information and this can result in miscarriage.
Some fertility specialists believe that testing the embryos by removing few cells and analysing them (a process known as preimplantation genetic screening or PGS) to make sure they don’t carry any of these abnormalities could lead to higher IVF success rates – but more research is needed to show whether this will work.
The researchers would be very grateful if you could fill in a very short survey to help them with their project, and pass on their thanks in advance to anyone who helps them! You can find a link here
We’re often told that IVF is not a terribly successful treatment, that 75% of cycles won’t work – and this is sometimes cited by people who don’t agree that the NHS should fund fertility treatment. Earlier this week, I went to the event at Westminster organised by campaign group Fertility Fairness where there were some compelling arguments about the clinical and cost effectiveness of funding three full cycles of IVF as recommended by NICE.
One of the speakers at the event, Tim Child from Oxford Fertility Unit, presented some figures from his clinic for IVF success rates for the NHS patients they treat aged under 37 who were getting the three full cycles of IVF recommended by NICE. The statistics showed an 80% cumulative success rate over three full cycles. So, the majority of patients will be successful when NICE guidance is followed – which isn’t what we are often led to believe. What is sometimes forgotten when CCGs talk about funding for fertility is that they don’t need to pay for three full cycles for every patient – as more people get pregnant with each transfer, the number of additional payments needed diminishes – and yet calculations often seem to be based on the idea that every patient will need the three full cycles.
Infertility Network UK‘s Chief Executive Susan Seenan, who is also Co-Chair of Fertility Fairness along with Sarah Norcross, spoke about the realities of the impact of CCGs policies on fertility funding for patients. She told of one patient who was unable to access the treatment she needed because her partner had a child from a previous relationship. The “child” was in fact a 25 year old who lived abroad, but this still meant that the couple were denied treatment.
I’ve had a couple of questions recently from people about success rates at fertility clinics, and it is clear that one thing that sometimes gets overlooked when you are considering the relative merits of different places is the multiple birth rate. In fact, it’s just as important to look at this as it is to look at the overall success.
In the UK, clinics are actively trying to reduce their multiple birth rates as they recognise that this is the biggest health risk from IVF – the idea of twins can sound marvellous, but a multiple pregnancy can bring serious risks for both mother and babies. The overall multiple rate after IVF has gone down in the UK from one in four babies to one in six, and yet success rates have remained stable. This shows that by selecting the right patients for single embryo transfer, you can maintain good success rates while at the same time reducing the risks. If you want to know more, the One at a Time website is the best place to start.
Some clinics overseas do still routinely put back three or more embryos – I came across a young couple a while ago who’d had five embryos transferred. This isn’t a sign of a good clinic trying to help you to get pregnant, but rather of a clinic which may not have your interests at heart. Even within the UK, multiple rates can vary hugely, so do check them out and remember that a really good clinic will have a good success rate combined with a low multiple rate.
ICSI (intracytoplasmic sperm injection) is a form of IVF that was developed to help overcome male fertility problems by injecting sperm directly into eggs, but in recent years is often used far more widely and sometimes in cases where there isn’t a male factor problem at all. Patients are often told that ICSI improves the chances of success, but a new study from the States has found that this is not the case unless there is a male fertility problem. In fact, in cases where there is no male factor problem, ICSI is associated with lower rates of implantation and live birth than conventional IVF.
The research was a big retrospective study looking at more than 1 300, 000 IVF and ICSI cycles from 1996 to 2012. The use of ICSI in the US in this period had gone up from 36% of cycles to 76%, but it was not associated with improved outcomes.
The research is published by the Journal of the American Medical Association, and you can read the full findings on their website – http://jama.jamanetwork.com
The latest figures relating to fertility treatment in the UK have been released this morning by the Human Fertilisation and Embryology Authority (HFEA) and show a growing number of cycles of IVF with a total of more than 64,000 carried out in 2013. The number of cycles of donor treatment have more than doubled in the last five years, and there has been an increase in the number of same-sex couples having treatment. Success rates have gone up very slightly, but the multiple birth rate from fertility treatment has fallen.
The majority of women having treatment are under 37, and the average age of fertility patients is 35. The report shows that over a third of fertility treatment is carried out in London and the South East – and that in 2012, 2.2% of all babies born in the UK were conceived as a result of IVF.
There’s an interesting piece on the Guardian’s Comment is Free written by Barbara Ellen about a paper in the Lancet suggesting young women might freeze their eggs or ovarian tissue for future use. She is quite right to be concerned about the uncertainties around freezing as a solution – it is relatively new, expensive and comes with no guarantees – and yet having come across many women who are still unaware of the realities of their fertility I don’t think all women are aware of the way that fertility declines.
There may be endless screeching about this through the “media megaphone” as she describes it, and yet I regularly meet women in their forties who think that being fit and healthy and still having periods must also mean being fertile. I’m not sure where the disconnect is here, and whilst it is quite true that there are many women who may be unnecessarily anxious about their fertility in their early thirties, the realities of fertility in your forties still comes as a surprise to many others.
I’m not sure why this is – is it that women who are now in their forties didn’t get this message when they were younger? Is it that they are putting too much faith in fertility treatments to solve any problems? The realities of IVF success rates of less than 2% at the age of 45 combined with miscarriage rates rising to 93% at that age are still something too few women really appreciate.