Getting fertility treatment on the National Health Service can be a postcode lottery and going private is equally challenging, writes Kate Brian, who offers a guide for couples in need of help
If you know you’re going to need help to have a baby, choosing the right fertility clinic can be a challenging task when there are so many options. In the UK, clinics offering IVF are regulated by the Human Fertilisation & Embryology Authority (HFEA), whose website provides details of all licensed units and the types of treatment they offer.
Success rates are the first thing to investigate when selecting a clinic. Individual clinics quote their own success rates, but HFEA publishes rates for all UK clinics, allowing you to compare performance. Some clinics quote the number of embryos fertilised, while others supply the number of pregnancies achieved after treatment or the number of babies born. Not all clinics provide all these figures, so it is important to make sure you consider the same set of figures for each clinic in order to make comparisons.
The rates can vary from year to year, and making judgements based on small percentage differences is not meaningful; the key statistic to look at is how a clinic’s rates compare with the national averages. HFEA can tell you whether a clinic is below or above the national average which will help with decision-making. The number of multiple births is also important. Although the idea of twins may sound attractive when you are trying to conceive, a multiple birth is the single biggest health risk from IVF treatment. The better fertility clinics will have high success rates and low multiple-birth rates.
Most fertility clinics in the UK, whether they are based in NHS hospitals or private units, will treat both private and NHS patients. New guidance on fertility treatment, produced by the National Institute for Health and Clinical Excellence (NICE) earlier this year, recommends who should be eligible for treatment. The guidance says women under 39, who have been trying to conceive for two years, should be eligible for three full cycles of IVF and women aged 40 to 42, who haven’t had previous treatment, should qualify for one cycle, if tests show she has a current supply of eggs, as this suggests the couple has a better chance to conceive.
We are dealing with a disgraceful ‘treatment by postcode’ situation whereby it depends totally on where you live whether you can access NHS-funded treatment
Professor Mark Baker, director of the centre for clinical practice at NICE, says: “We would urge healthcare professionals and commissioners to take these guidelines into consideration when developing fertility services.”
A spokesman for the Department of Health says that it expects NHS organisations to consider the NICE guidance when they are making provision for fertility treatment.
But Clare Lewis-Jones, chief executive of Infertility Network UK, says NICE recommendations aren’t always followed as decisions about fertility funding are made locally.
“We are dealing with a disgraceful ‘treatment by postcode’ situation whereby it depends totally on where you live whether you can access NHS-funded treatment,” she says. “This is further compounded in England by the equally disgraceful variation in the eligibility criteria.”
These eligibility criteria are also set locally, so different age restrictions apply in different areas, and you may be denied treatment if you smoke, already have children, or are obese or underweight.
If you are going to pay for your fertility treatment, you will want to know exactly how much it is going to cost. Yacoub Khalaf, medical director of the Assisted Conception Unit at Guy’s Hospital, says the figures many clinics quote on their websites are far lower than the sums patients end up paying.
“Unfortunately the headline figure you are given doesn’t always mean the same thing at different clinics,” he says. “Check if they charge extra for blood tests and extended embryo culture, and ask about prices for medication. The important question to ask is what the average patient actually pays.”
Some clinics quote one price, but may be unclear whether this is the price of one cycle, with additional cycles of treatment costing extra. The drugs used in IVF are expensive and are not usually included in the headline price. To help patients, HFEA requires clinics to provide a personalised payment plan before treatment begins.
There are other practical issues to consider when choosing a clinic. For example, not all clinics offer all types of treatment. If you know that you are going to need egg or sperm donation, check that this is on offer and ask how long a clinic’s waiting list is. Location is vital as travelling can become stressful when done two or three times a week. You may want to find out more about the counselling and support the clinic offers. All licensed clinics must offer counselling to patients and some will include sessions with a fertility counsellor in their treatment prices, and some clinics also run support groups for their patients.
You should never underestimate the importance of following your gut instincts when choosing a clinic, as Spencer Humphrys, general manager at London’s Centre for Reproductive and Genetic Health, explains: “The most important thing is finding the right clinic for you. Go to all the open evenings and look at all the clinics, even if you think you know where you want to go. It’s all about feeling comfortable with the team treating you.”
Fertility treatment is often described as an emotional rollercoaster, and if you like and trust the staff at the clinic you choose, it will certainly make that journey easier to cope with.