Professor Lisa Jardine, who very sadly died last week at the age of 71, was Chair of the Human Fertilisation and Embryology Authority from 2008 to 2014. I will always remember how, soon after her appointment to the HFEA, she arrived like a whirlwind at National Infertility Day, an event organised by Infertility Network UK, and whizzed around chatting to everyone in her wake. She was a truly dynamic woman who had achieved so much in so many different fields. Reading her obituaries, the incredible breadth and range of her appointments and interests is extraordinary, and she had been a leading academic, historian, biographer and broadcaster. She will be very much missed.
I’m delighted that the HFEA Chair Professor Lisa Jardine has taken to the online pages of BioNews to clarify that the decision to remove the possible sanctions for clinics which breach the multiple births target doesn’t mean a change of heart on the policy itself.
There appeared to be a complete misunderstanding of what was actually going on in much of the coverage at the time as it was widely reported that clinics would no longer be expected to continue to reduce multiple births – which isn’t the case at all. As Lisa Jardine explains, the reasoning behind the change came after two years of legal wranglings with just two fertility clinics who argued against the licence condition that no more than 10% of their births should be multiples. It was felt that it would be wrong to continue to spend large sums of money fighting the challenge in the courts, and that it was also unfair to all the other clinics that just two of them should be treated differently.
In fact, the One at a Time policy has been very successful, with an overall reduction in the multiple birth rate after fertility treatment down from 24% to 16%. Successful clinics are heading towards the 10% rate now set as a target by the HFEA.
It’s fertility patients who can help push things in the right direction, by asking clinics about their multiple rate or checking this on the HFEA website – and by continuing to remember that a clinic with a high multiple rate should set alarm bells ringing. A really good fertility clinic will have a good success rate and a low multiple pregnancy rate, while a clinic with a high multiple rate is not focused on the future health of patients and their children.
You can read what Professor Lisa Jardine had to say here
If you haven’t already, do listen to this interview with the outgoing Chair of the HFEA Professor Lisa Jardine which was broadcast on BBC Woman’s Hour yesterday. It’s a great shame that Professor Jardine is standing down as Chair of the regulatory body as she has had a positive impact during her term and has been a visible figure for patients. Here she makes the point that we really don’t address what happens when IVF doesn’t work.
I was apprehensive when I heard Woman’s Hour were covering the topic, as sometimes this debate slides into a them and us battle which paints a picture of exploitative fertility clinics, of a treatment that rarely succeeds and of ill-informed women, when in fact the picture is far more complex. Professor Jardine says she is “enough of a feminist” to believe that women who want fertility treatment at an age when it is less likely to work should be able to make that choice for themselves, but suggests that we need a more open debate about the fact that not everyone is going to come out at the end of treatment with the baby that they long for.
It is true that there is still so much stigma and anxiety around fertility that it makes having an open and honest discussion difficult at times. I’m not sure how we change that – but there is a growing ground swell that is pointing in the right direction.
There has been a lot of discussion in the last week or so about how successful IVF really is after the Chair of the HFEA Professor Lisa Jardine talked about the “discouragingly low” success rates in an industry which “trades in hope”, pointing out that for each cycle of IVF, fewer than a third of women over the age of 35 would emerge with a baby. In the wider discussion of the issue, it has since been repeated that IVF is only successful for this relatively small percentage of women with none of the necessary caveats.
In reality, most women who have a baby after IVF don’t get pregnant after their first cycle. The reason the NICE fertility guideline recommends three cycles of treatment is because that has been shown to be clinically effective. Cumulative success rates for IVF are often hard to come by, but a recent study at Bourn Hall Clinic in Cambridge has shown a success rate of more than 70% over three cycles of treatment – and cumulative success rates are key if you are considering IVF success.
The chances of getting pregnant with IVF depend very much on who is having the treatment. The likelihood of a positive outcome may be high for a woman of 28, but a 43 year old having fertility treatment is far less likely to succeed – and this is the balance that needs to be taken into account when considering IVF success rates as they are so dependent on the patient.
Of course, Professor Jardine is right that we need to think more about what happens when IVF doesn’t work and whether we are preparing people for this possibility – but we also need to acknowledge that one of the main problems we see today is women who are still assuming that IVF will be able to help if they leave it until their late thirties or early forties to start trying to have a child.