May 9, 2019

expert reaction to the latest HFEA figures on trends in fertility treatment

Reactions to a report released by the HFEA (Human Fertilisation and Embryology Authority) on trends in fertility treatment in the UK.

Prof Simon Fishel, Founder and President and Head of R&D CARE Fertility Group, Professor of Human Reproduction, Honorary Fellow and Professor Liverpool John Moores University, said:

“The HFEA has indeed the strongest world-wide opportunity to help steer best practice in IVF and secure highest quality of patient care. The biggest single achievement in recent years has been the commendable reduction in multiple pregnancy. This has been greatly helped by improvements in technology and practice to enable only single embryos being transferred, whilst for many clinics not diminishing success rates (delivery/cycle started).

“IVF has helped redefine family life and the HFEA statistic support this laudable social change. The introduction of genetic testing into conventional IVF practice, especially for the treatment of severe genetic disease and it’s licensing by the HFEA continues to be of great benefit not only to the patients seeking this technology but also to UK health economics; although it still remains a relative small activity.  Outside the HFEA’s power is the NHS funding provision, and the variable criteria when funding is available, which is still grossly unfair, iniquitous and puts the UK in very poor light when compared to many countries worldwide.

“Given the HFEA’s preoccupation with transparency and the provision of ‘Birth Rates’ it remains surprising that there is no clarity on the statistics for natural cycle IVF, nor clarity on defining ‘mild IVF’ and presenting its statistics where there remains considerable confusion and opacity. An example is the Kato Ladies clinic in Japan (from where I’ve just returned) undertaking ~30,000 IVF cycles annually based solely on natural cycle and ‘mild IVF’ who offer 80% natural cycle and 20% ‘mild IVF’. They define ‘mild IVF’ as the use of tablets only – any more powerful ovarian stimulant that requires injection is deemed to be ‘stimulated IVF’.”

Prof Joyce Harper, Professor in Human Genetics and Embryology, University College London (UCL), said:

“The latest HFEA data shows that there are changes to the way we are making families, with an increase in the number of women going through treatment with another woman or with no partner, standing now at 8.9% of cycles. And it is not surprising to see a 10% increase in egg freezing in just one year. But the key findings from the data are that the average age of women going through fertility treatment is increasing and the funded cycles are at an all time low. Even for women under the age of 35, the UK IVF live birth rate is only 30% and the results go down from age 35 onwards. Under 40% of IVF cycles in England and Wales are funded. Fertility treatment is turning into a middle class procedure, with the UK having some of the highest IVF costs in Europe. It is time to address the commercialisation of IVF and how the NHS fund it.”

Prof Allan Pacey, Professor of Andrology, University of Sheffield, said:

“This is a very useful update from the HFEA about the UK’s use of assisted reproduction in 2017. It’s very pleasing to see that IVF success rates have continued to increase whilst seeing improvements in safety through a reduction in multiple births, even though the age of women receiving treatment has increased.

“The report also confirms the changing nature of family creation in the UK, with more women in same sex relationships and single women seeking treatment. This echoes what we are seeing in clinics and I suspect there are also more gay males seeking to build families through surrogacy, although it doesn’t appear that the HFEA data specifically records that data.

“However, what is alarming to me is the shocking difference in NHS funded cycles across the four nations of the UK, with Scotland being the most generous and England being the least. This is really shameful and unfair. We really need to change this and make NHS provision of IVF equitable, regardless of where people live.”

Dr Jane Stewart, Chair of the British Fertility Society (BFS), said:

“The report confirms that IVF remains a safe and effective approach to address fertility issues. Success rates increase year-on-year and, as reasons for choosing when to start a family change, uptake of fertility treatment continues to rise.

“While uptake rises, the availability of NHS funding continues to fall. It is frustrating to see CCGs cutting the availability of IVF, with almost all now failing to line up with NICE recommendations. Infertility is a real disease, recognised by the World Health Organisation, and it should be treated just the same as any other. The reality is that infertility has been sidelined and that represents a false economy. The costs to the NHS of not treating infertility are significant, particularly in regard to the impact of infertility on mental health. We want to see CCGs reconsider the economics of providing up to three full cycles of IVF.

“The safety of fertility treatment in the UK is excellent – we have one of the most highly regulated industries in the world. While it is good news that the target of 10% multiple births has been reached, we feel that 10% is still too high. And 10% is an average so some clinics are still breaching this target. Of course some clinics will come in under 10% multiple births and we may be able to learn from their practices.

“It is also worth noting that the HFEA requires reporting of PGD (pre-implantation genetic diagnosis) but not PGT-A (pre-implantation genetic testing for aneuploidies). While PGD looks to rule out genetic disease in the child, PGT-A may be added to the IVF process to check the viability of an embryo. PGT-A still requires validation – described in the HFEA list of ‘add-ons’ – however there is little difference in the techniques used. In both cases, it would be useful to know if the technique itself has any impact on subsequent outcomes. No specific license is needed for PGT-A but it is a requirement for PGD. This is an anomaly we would like to see HFEA address. There seems little reason not to report PGT-A and every reason to bring regulation and reporting into line with PGD.”

Ms Sarah Norcross, Director, Progress Educational Trust (PET), said:

“The HFEA’s Trends in Fertility Treatment 2017 report illustrates starkly the results of two different approaches to NHS funding of IVF in the UK: the sustained disinvestment seen in recent years in England versus Scotland’s policy, since April 2017, of following the recommended fertility guidelines and providing three full IVF cycles for women under 40. England’s piecemeal approach means only one-third of patients (35 per cent) can now access NHS fertility treatment, while in Scotland nearly two-thirds can (62 per cent). This appalling divide between the countries is set to widen: since the start of 2017, one in five of England’s clinical commissioning groups has cut or removed NHS fertility services and a further ten CCGS are considering changes, according to Fertility Fairness data. Latest figures show just 12 per cent of CCGs follow national guidance and provide three full IVF cycles.

“PET is also concerned to see that the HFEA’s data on egg freezing – the fastest growing sector of the fertility industry – reveals that more than two-thirds (67 per cent) of women freezing their eggs are 35 and over, when it is known that the chance of IVF success is greater if egg freezing takes place before age 35. Is the current policy on egg freezing for non-medical reasons, with its ten-year limit on storage, encouraging women to have expensive, invasive, and sub-optimal treatment? Are fertility clinics doing enough when advising women of the likelihood of a future pregnancy?”

‘Fertility treatment 2017: trends and figures’ was published by the HFEA at 00:01AM UK time on Thursday 9^th May 2019.

Declared interests

None received.