March 14, 2018

expert reaction to HFEA Fertility Trends Report

The Human Fertilisation and Embryology Authority (HFEA) has published a new report: Trends and Figures on Fertility Treatment 2014-16.

Prof Ying Cheong, Professor of Reproductive Medicine Human Development and Health, University of Southampton, said:

“Despite the advent of assisted reproduction over the last 40 years, it is hugely disappointing that more than two thirds of patients who undergo an IVF cycle will not have a baby at the end of their treatment cycle. The demand for assisted reproduction is increasing dramatically, and people are investing huge amount of resources in order to get the family they want. But doctors do not yet have the magic wand; with no scientific answers to explain the majority of the failures, many clinics resort to offering pointless, expensive add-ons to try to improve their success rate to no avail.  We need more government and commercial investment in research to facilitate the development of truly novel technologies, to evaluate the state of the womb and the developing gametes and embryo using minimally- or non-invasive technologies. Without which, in my opinion, this sad state of affairs will continue into the foreseeable future.”

Sarah Norcross, Director of the Progress Educational Trust said:
“We welcome the fact that the HFEA has, for the first time, included data on surrogacy in its report. At a time when Parliament is working to permit surrogacy for single people and when the Law Commission is reviewing surrogacy law more broadly, it is increasingly important to have access to reliable data about this field.”

Dr Channa Jayasena, Society for Endocrinology member and Senior Clinical Lecturer at Imperial College London, said:

“This report demonstrates that the use of IVF is gathering pace each year. I think the biggest challenge is that most IVF cycles are now performed in the private sector, because NHS funding of IVF is very limited in many regions of the UK. We need to consider safeguards to prevent a situation where only the affluent are helped in having a family.”

A spokesperson from the European Society of Human Reproduction and Embryology (ESHRE), said:

“The European Society for Human Reproduction and Embryology welcomes this comprehensive report from the HFEA, and congratulates our UK colleagues on their continuing and significant achievements in helping couples who face difficulties in achieving a healthy pregnancy.

“The continuing reduction in Multiple Birth Rates is a welcome trend allied to the clear need to improve this figure of 11% over the next period to single figures.

“We look forward to continuing our close working relationship with the HFEA, the British Fertility Society and our UK members to further increase the efficacy, safety and access to scientifically based fertility treatments.”

Prof Alan Thornhill, Country Manager UK and Senior Scientific Advisor, IGENOMIX, said:

“The rise in number, proportion and success rates of frozen embryo cycles is very encouraging. If this continues and is further supported by robust evidence, we will see a paradigm shift in the way IVF is performed with the egg collection and embryo transfer procedures separated allowing safer treatments. We should take pride in the increasing preimplantation genetic diagnosis (PGD) cycles which will reduce the burden of genetic disease in the UK via NHS funding and better access especially for younger women. The advent of comprehensive carrier screening for couples will further increase the demand for PGD in this demographic.”

Dr Jane Stewart, Chair, British Fertility Society said:

“The British fertility Society welcomes the new HFEA report of Fertility Treatment – trends and figures, released today.  IVF and related treatments are safe and effective.  The HFEA data confirms year on year advances in success rates and efficiency (low multiple birth rates and increased use of frozen embryos).  These services are highly regulated for safety and quality.

“The resolution of a fertility problem either through achievement of a live birth or support in coming to terms with childlessness is life changing.  Fertility issues are a blight on the lives of so many young adults but in addition have long term effects on not only their own quality of life but also their extended families and across generations.  It is enormously frustrating to see that despite all of this, the broader picture and clear benefits are not taken into account by some commissioners – particularly in England and Northern Ireland – when short term gains of cost cutting priorities are considered and the needs of this group are largely disregarded.”

Prof Adam Balen, Professor of Reproductive Medicine and Surgery, Leeds Centre for Reproductive Medicine, said:

“With the birth of Louise Brown, the world’s first IVF baby, 40 years ago it is timely to reflect on how far we have come and far we can potentially go with assisted reproduction technology (ART). The UK has led the way both with scientific innovation and tight, yet permissive, regulation.

“It took Professor Bob Edwards and Patrick Steptoe over ten years and 467 attempts at IVF in 250 patients before baby Louise was born on July 25th 1978. A live birth rate of 0.21% per cycle started. Now approximately 3% of babies born in the UK are as a result of IVF and the average success rate is 29% per cycle in women under 35 years using the new way of calculating outcomes. The fall in multiple pregnancy rates to 11% is also a great success, confirming that single embryo transfer does not compromise the overall chance of a livebirth.

“More than 300,000 children in total have now been born in the UK from licensed fertility treatment since 1991, when the Human Fertilisation and Embryology Authority (HFEA) started to keep records – and we have to remember that these data were only begun to be collected some 13 years after Louise Brown was born and worldwide at least 7 million babies have been born as a result of IVF. Furthermore the HFEA also reported that the total number of treatment cycles carried out in UK clinics also passed a significant milestone in 2015, breaking through the million barrier.

“Infertility is common. Infertility affects 15% of couples and may be the result of a large number of medical conditions. Fertility also declines as both women and men get older – although for a woman the decline is more rapid once she gets to her mid- to late thirties. Furthermore the chance of conceiving with treatments such as IVF also declines in parallel with the fall in natural fertility. In addition to age there are many other factors that influence fertility in both women and men, such as sexually transmitted infections, smoking, being overweight (or underweight) and the exposure to toxins in the environment to name a few. Through our Fertility Education Initiative, the British Fertility Society is promoting the need for better education of young people about the factors that affect reproductive health so that they are armed with the knowledge to make the right choices at the right time.

“Many causes of infertility can be treated without IVF, for example by surgery for endometriosis or drugs to stimulate ovulation in polycystic ovary syndrome. The high-tech treatments such as IVF can also be used to help couples conceive with donated eggs or sperm, when required or surrogacy for women who do not have a uterus (womb). Eggs and sperm can be frozen to preserve fertility prior to sterilising treatments for certain cancers and other conditions. And embryos created through IVF can be tested prior to being replaced into the uterus to screen for life-threatening genetic diseases that run through some families. Recent technology even allows the manipulation of embryos to remove the risk of some diseases and even permanently alter the genetic make up of an embryo – although such genetic manipulation is not permitted at the current time anywhere in the world where IVF is properly regulated. So there are many potential non-fertility uses for IVF techniques.

“Whilst the UK has led the way with the research into the causes and management of infertility, unfortunately many couples are denied treatment because of the lack of funding, restrictive eligibility criteria and the huge variations in provision around the country. Yet treating infertility has been shown to be cost effective and can significantly improve the overall wellbeing of families. Relative to many other medical interventions, it is quite inexpensive, and it’s a travesty that NHS funding has been cut by so many clinical commissioning groups over the past few years.

“The NICE Guidance in the UK states that all eligible couples should be entitled to 3 full cycles (including the use of frozen embryos), which will give them an overall 80-85% chance of having a baby – and indeed many will not require the full three cycles. The actual costs of funding IVF properly would be about £77 million pounds – which equates to £1.29 per head of the UK population. This is a tiny fraction of the NHS budget of £116 billion (approximately £2,000 per person). Currently only 12% of the 208 CCGs in the UK fund a full three cycles – a drop of 50% in the last 4 years. 23% fund 2 cycles, 61% one cycle (of which half don’t fund the use of frozen embryos) and 4% fund no treatment at all. In Scotland 3 full cycles are funded, whilst this is 2 in wales and 1 for Northern Ireland. So we must remove the postcode lottery and provide equity around the UK.

“The funding of IVF is seen to be an easy target – but infertility is a serious medical condition, resulting in huge stress and distress and caused itself by a large number of different medical problems. Indeed it is the second commonest reason for women of reproductive years to visit their GP. IVF is cost effective and has shown to be an economic benefit to society. The bottom line is that you cannot put a price on a baby!”

* The report is available here: https://www.hfea.gov.uk/media/2544/hfea-fertility-treatment-2014-2016-trends-and-figures.pdf

All our previous output on this subject can be seen at this weblink: http://www.sciencemediacentre.org/tag/fertility/

Declared interests

Prof Ying Cheong:

Director and Shareholder in Complete Fertility Ltd

Director and Shareholder in Vivoplex Medical

Grant holder for research funded by NIHR

Dr Channa Jayasena: No conflicts of interest

Prof Alan Thornhill: Country Manager, Igenomix UK Ltd (Provider of Reproductive Genetic Testing Services)

Department of Biosciences, University of Kent, UK

Stockholder of Illumina, Inc

Dr Jane Stewart: No COI

Prof Adam Balen: No COI

None others received.