Infertility is not a lifestyle choice

National Fertility Awareness Week

I wanted to share some thoughts following on from this year’s National Fertility Awareness Week, which was full of extremes. Most of us focussed on the appalling lack of fair and equitable funding for IVF and other assisted conception treatments, whilst at the end of the week we spent two days at the “Fertility Show” which displays the best and the worst of the “Fertility Industry”. Those of us from the Professional Societies (BFS, BAS, ACE, SRF, BICA, ABA) manned our usual stand and did our best to help the bewildered “customers” attending the show – we also tried to populate the talks with evidence-based medicine and science. Many exhibitors were once again peddling unproven “therapies” or trying to entice people to go overseas for treatments that can be delivered better here in the UK.

The HFEA also published data revealing that more than 300,000 children in total have now been born in the UK from licensed fertility treatment since 1991 – and we have to remember that these data were collected some 13 years after Louise Brown was born on the 25th of July 1978. Indeed she was probably being conceived in a dish about 40 years’ ago now! 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 (the most recent data available), breaking through the million barrier. The overall number of treatments carried out since 1991 being 1,034,601. The HFEA report that the average age of women having fertility treatment is 35 years and this has remained largely static over recent years. Interestingly also almost a third of all IVF and DI babies since 1991 were born in the last six recorded years (2010 to 2015).

This week we also saw an article on the number of celebrities who are conceiving in their forties, usually without saying that this is as a result of egg donation treatment. Commenting on this in the press I stated that: On its own, this finding is not particularly concerning, but in the context of poor or absent fertility education, it is a worry that women are acquiring knowledge about fertility from celebrity focused magazines. We think fertility should be included in health and social education for teenagers and young people. Clearly there are a number of celebrities who have conceived in their late thirties and early forties and that’s completely believable. The fact is that if a woman is ovulating and there are no other fertility issues, she retains a chance of pregnancy and therefore many women will conceive at older ages. That said, the likelihood of conception per cycle of trying drops as a woman crosses 35, and the drop becomes steeper in her late thirties.

Also, the risk of losing the pregnancy to miscarriage rises, as does the risk of certain genetic conditions for the child (e.g. Chromosome 21 trisomy Down Syndrome). This is basically down to the fact that eggs also age and some women may indeed run out of time to start or complete their families if they start trying in their late 30s or into their 40s because of egg ageing. The net effect is that women who start trying in their late thirties are less likely to have a baby, or will have fewer babies than they wished to.
It’s really important to remember that IVF is not an easy fix – it’s hard, both physically and emotionally, and it won’t always be successful. But treating infertility, which is a real disease, recognised by the WHO, 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.

This brings us back to the hard facts of the funding problems: Whilst the NICE Guidance states that all eligible couples should be entitled to 3 full cycles (including the use of frozen embryos) and we know that this will give them an 80-85% chance of having a baby, using latest statistics – and indeed many will not require the full three cycles, with on average 30% conceiving with one cycle (and in the best cases maybe 40-45%).

The actual costs of funding 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 (approx. (£2,000 per person). In the UK we spend 9.1% of our GDP on healthcare and this is falling – and is much lower than most of the “developed world”.

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.

There was an interesting debate on You and Yours (BBC Radio 4) that I participated in. This was a phone in which presented a variety of views from listeners about the funding of IVF. Amanda Doyle the CCG commissioner from Blackpool said that they are the most deprived part of the UK which was her excuse for only funding 2 cycles – I turned this around and said if they can actually afford two cycles in the most deprived part of the country, why cannot the whole country fund at least two – and preferably the full three?

Interestingly the best areas for funding are in Greater Manchester (Bury, Heywood, Middleton, Rochdale, Oldham, Thameside & Glossop) and the worst Herts Valleys, Cambridge and Peterborough, Croydon, South Norfolk, Basildon & Brentwood, Mid-Essex and North East Essex.

On You and Yours someone phoned in and suggested that people with infertility should adopt rather than have treatment funded – another listener responded by saying, quite rightly that “adoption shouldn’t be the burden of people with infertility.”

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!

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