June 20, 2023

expert reaction to HFEA report, ‘Fertility Treatment 2021: Preliminary Trends and Figures’

A report by the Human Fertilisation and Embryology Authority (HFEA) looks at preliminary UK statistics for IVF and DI (Donor Insemination) treatment, storage, and donation in 2021.

Prof Daniel Brison, Honorary Professor of Clinical Embryology, Department of Maternal and Fetal Health, University of Manchester, said:

“I welcome the most recent data from the HFEA, although would have liked to see more detail.  The major piece of good news is the continuing decrease in the multiple birth rate, now down to 5%.  This is an excellent example of the way risks from IVF treatment can be managed and mitigated, and demonstrates the value of strong regulation in an area of medicine with strong commercial pressures.  In light of that it is disappointing to see the number of cycles funded by the NHS continue to fall, with an increasing number of couples having to go self fund.  It is very difficult to comment sensibly on recent success rates as the 2020/21 data are preliminary, however in line with recent years the live birth rate per cycle for most age groups appears to have levelled off since about 2017.  The HFEA should also publish the pregnancy and live birth rates per cycle, as well as the headline figure per embryo transferred.”

Prof Ying Cheong, Professor of Reproductive Medicine and Honorary Consultant in Reproductive Medicine and Surgery, University of Southampton, said:

“HFEA data is retrospective and so is subjected to comparative bias, but in general such data is useful for observing trends.

“It is excellent news that fertility treatment cycles continue to increase when birth rate in UK, like many parts of the world, has reached its lowest.

“The dramatic rise in egg and embryo freezing signals a medical and social acceptance and demand to preserve fertility.

“The success rate for younger, good prognosis patients have improved slightly from last year, but with technological advancement, we should see this improvement continue in the future.

“The average age for women seeking fertility treatment continues to rise which question the effectiveness of current fertility education and strategies for supportive working environment for women in their reproductive age.”

Prof Alison Campbell, Chief Scientific Officer, Care Fertility Group; and Honorary Professor at the University of Kent, said:

“There are some promising trends in the new HFEA report which analysed licensed fertility clinic data from treatments started in 2021.  Of note is the 64% increase in egg freezing and fertility preservation, since 2019. Improvements in education, awareness, availability and scientific methodology are all likely to have contributed to this.

“The fact that IVF fresh and frozen embryo pregnancy rates continue to increase, year on year, must provide reassurance to people seeking support with their fertility.  This is likely to be due to continuous improvement in both laboratory and medical practice.

“Families come in many forms, and it is good to see such a continued increase in numbers of single patients and those in same-sex partnerships undergoing fertility treatment and building their families.  However, access to treatment can be challenging for these patients who often do not qualify for NHS funding, and so require them to self-fund.  NHS-funded IVF treatment cycles remain below pre-pandemic levels for most age groups, with great variability by nation and region.

“Whilst increases have been reported across almost all fertility clinic activities, including fresh and frozen embryo transfers, and embryo freezing and storage treatments, it is disappointing that the number of new egg and sperm donors has declined nationally since 2019, especially as there is great demand for both and very few clinics, like Care Fertility, have their own donor sperm and egg banks.

“The UK is believed to have the longest running database of national fertility treatments in the world.  Data is submitted to the UK regulator (HFEA) by fertility clinics and is typically validated before the HFEA reports on trends and figures.  Conclusions drawn from the current reporting period may not be as accurate or robust as previous years, however, as they are based on unvalidated preliminary treatment and pregnancy data for 2020-2021, and preliminary birth data for 2019-2021.  This is due to their being a new data submission system, whereby these data have not been subject to quality checks or validation, so they cannot be considered official, verified statistics.”

Mr Stuart Lavery, Consultant in Reproductive Medicine and Honorary Associate Professor, University College Hospitals NHS Foundation Trust, said:

“The new report from the HFEA provides reassuring data showing that success rates of IVF procedures continue to improve.  This sort of information is welcomed as it is derived from externally audited and validated sources.  The data underline a major achievement of clinics in improving birth rates whilst at the same time reducing the incidence of multiple pregnancy to a record low.  Perhaps the most startling and yet probably unsurprising statistic is the 64% growth of elective egg freezing.  It is disappointing to learn of the 16% fall in NHS funded treatment- it is important to understand whether this reflects post-pandemic recovery, or is truly representative of less NHS financial support.”

Mr Bassel Wattar, Consultant Obstetrician and Gynaecologist, Epsom and St Helier University Hospitals; and Senior Research Fellow, Comprehensive Clinical Trials Unit, UCL, said:

“It is reassuring to read the HFEA report on fertility treatment trends in 2021, which offers a robust and reliable overview of the fertility sector in the UK.  The report summarises routinely collected data from all licensed fertility clinics and it depicts an almost complete recovery from the COVID-19 pandemic.  However, some worrying signs should not be missed.

“There is a consistent increase in self-funded fertility treatments which reflects the government systemic under funding of NHS fertility treatments and the persistent effect of the post-code lottery to access IVF treatment funding.  If neglected, this trend will continue to increase health inequality when it comes to accessing life changing fertility treatments especially for same-sex couples and single patients.

“There is a significant increase in the uptake of social egg freezing (from 2,500 in 2019 to 4,000 in 2021).  Egg freezing is becoming very popular among single women, hoping to preserve their fertility for the future.  Unfortunately, there is limited public awareness on the pros and cons of this treatment and how it could be best planned to optimise chances of starting a family in the future.  Perhaps the HFEA as the sector regulator, should do more to engage with patients and promote a healthy debate on safe fertility preservation treatments.

“While the report paints a positive picture of the safety and efficiency of fertility treatments in the UK, more work is needed to support patients and guide them through their fertility journey.”

Sarah Norcross, Director of PET, said:

“The 16% drop in the number of IVF cycles funded by the NHS between 2019 and 2021 is an extremely worrying trend.  While some of this could be attributed to the pandemic, it is unlikely that all of it can.

“The fact that most people under 35 (63%) are having to fund their own fertility treatment, during a cost-of-living crisis and when mortgage rates are expected to soar, means that many will not be able to afford to have the chance of having a family.

“The dramatic rise in the number of egg freezing cycles could be linked to the pandemic.  Restrictions on socialising may have prompted some women to think more about their fertile window, and decide to try to increase their reproductive choices.”

‘Fertility treatment 2021: preliminary trends and figures: Preliminary UK statistics for IVF and DI treatment, storage, and donation’ by the HFEA was published at 00:01 UK time on Tuesday 20 June 2023.

Declared interests

Prof Daniel Brison: “I am the Scientific Director of an NHS IVF clinic.”

Prof Ying Cheong: “Director of Complete Fertility.”

Prof Alison Campbell is a minor shareholder of Care Fertility and a member of the HFEA Scientific and Clinical Advances Advisory Committee (SCAAC).

Mr Stuart Lavery: “I’m a consultant working in an NHS clinic and I work in the private sector.”

Mr Bassel Wattar: “No conflict of interest to declare.”

Sarah Norcross: “PET – https://www.progress.org.uk/ – is a charity which improves choices for people affected by infertility and genetic conditions.”

For all other experts, no reply to our request for DOIs was received.