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/

Lessons from a neonatal intensive care unit

images-21When I talk about choosing a fertility clinic, which I have done each year at the Fertility Show, I can always see some people switching off when I come on to the risks of multiple births and why it is so important to check that a clinic doesn’t have a high multiple birth rate. After all, most of us know twins who are perfectly happy and healthy and wouldn’t it be great to get two children from one treatment cycle? The reality – as this article from Psychology Today (titled The Dark Side of Fertility Treatments: Lessons from a Neonatal Intensive Care Unit) explains- is often very different.

I have seen at first hand some of the tragic endings from what has felt like a joyful story of successful IVF with a multiple pregnancy, and they are heart-breaking. IVF is a wonderful thing, but people who need fertility treatment should not be put at risk of more devastating upset by clinics putting back more embryos than clinically advisable. Responsible clinics have good success rates and low multiple pregnancy rates, and this is something worth remembering if you are choosing where to have your fertility treatment.

Fertility drugs online

images-18One of the most frustrating things about going through fertility tests and treatment can be the waiting – and so it’s not surprising that people are sometimes tempted to take matters into their own hands.  If that’s a matter of chasing up funding for treatment, going to visit different fertility clinics or seeing a complementary therapist it can be a positive thing.  Buying fertility drugs online, however, is not a good idea under any circumstances.  The problem is thought to be so widespread that the website Netmums is carrying out a survey looking into the issue. 

Clomifene citrate, or Clomid, is a drug which can be used to help women who have problems with ovulation – and which is apparently now widely available on the Internet for people who have decided to take it without medical support. I think part of the reason for this is a general misunderstanding about what Clomid is and what it can do – it’s sometimes described as a fertility-boosting drug, leaving people under the misapprehension that it will boost anyone’s fertility. In fact, this is really not the case at all as if you ovulate normally it may make you less fertile rather than more fertile because it can thicken the cervical mucus.

Women who are taking Clomid should be carefully monitored to make sure that they are not at in danger of a multiple pregnancy – twins may sound ideal, but multiple birth is the biggest risk from fertility treatment, and it would be awful to lose a pregnancy because you’d bought drugs online, which is a very real possibility.

Finally, there are restrictions on how Clomid should be taken with no more than six cycles recommended because of a possible link with ovarian cancer.

What’s perhaps more worrying is that you don’t actually know what you’re buying when you purchase drugs online – they may be out of date and they may not be what they claim to be at all.

If Clomid is the right treatment for you, your doctor or consultant will prescribe it – please, please don’t buy it online.