Louise Brown, the first so-called test-tube baby, was conceived in 1977 by what became known as in vitro fertilisation (IVF). In this process an egg is fertilised by a sperm, outside the body, and then reimplanted into a woman’s womb.
IVF treatment was pioneered by two British researchers, Professor Sir Robert Edwards, who died earlier this year, and his colleague Dr Patrick Steptoe. Although their collaboration on IVF began in 1966, they had already worked together in the field of reproductive health.
Professor Edwards had discovered a way to fertilise human eggs within the laboratory, while Dr Steptoe had perfected a method of harvesting human eggs directly from the ovary using a long thin, telescopic instrument called a laparoscope. Their combined skills enabled them to harvest eggs at the optimum moment to enhance their chances of fertilisation and development.
Today, the landscape of reproductive medicine is very different. Rapid developments have seen the introduction of a whole range of high-tech treatments. However, it was the ability to freeze, thaw and then transfer embryos that Edwards and Steptoe developed which made the most significant breakthrough in IVF treatment.
Recent research, published in the journal Fertility and Sterility, showed that frozen embryos are more likely to produce successful, complication-free IVF pregnancies than those that are fresh. The Aberdeen research revealed that using stored embryos cuts the risk of bleeding in pregnancy, premature birth and having an underweight baby by almost a third compared to freshly transferred embryos.
The ability to freeze, thaw and then transfer embryos made the most significant breakthrough in IVF treatment
The technology and its use continued to develop until in 1991 the Human Fertilisation & Embryology Authority was set up to regulate UK fertility clinics, set standards and issue licences.
In 2004 the first national guidelines were published by the then National Institute for Clinical Excellence (NICE), with the aim of providing consistent NHS fertility treatment across England and Wales. It stated that women, aged 23 to 39, with an identified cause of fertility problems or who had been having problems conceiving naturally for at least three years, should be offered up to three cycles of IVF. Earlier this year the guidelines were amended so that women up to age 42 may now be able to access at least one round of IVF treatment.
Dr Tim Child, consultant gynaecologist and director of the Oxford Fertility Unit, who sat on the guidelines committee, explains that recent progress in the field prompted the committee to reconsider their previous recommendations.
“When a woman reaches her mid-30s, her fertility begins to decline. However, many women do conceive naturally in the 40 to 42-year age group. For those who have been diagnosed with infertility, the improvement in IVF success rates over the last decade means we are now able to offer them treatment.”
The British Fertility Society says that, nearly ten years since NICE first published its guidelines, couples face an “untenable position” as not all hospitals comply with the guidance and offer the same treatments to all. Sue Avery, a spokeswoman for the society, says: “The guidelines have not been fully implemented across the country and, in many areas, patients are unable to access treatment.”
Many couples find a postcode lottery awaits them if they are seeking infertility treatment. Only around 25 per cent of patients receive IVF on the NHS and for many couples, desperate to have a baby, digging deep into their own pockets is the only way to fund the high cost of private treatment with fees up to £6,000.
“Britain is very bad at access. We know that 75 per cent of IVF cycles in the UK are carried out in the private sector,” says Dr Francoise Shenfield, a clinician at the Reproductive Medicine Unit at University College London Hospital and an executive committee member at the European Society of Human Reproduction and Embryology (ESHRE).
Little wonder that many couples faced with huge costs in the UK decide to seek help abroad, fuelling the growth of “fertility tourism”. There has recently been a rapid expansion in fertility treatment abroad, with over 500 clinics in India and more than 600 in Japan.
A recent global survey of fertility treatment covering more than 100 countries has revealed wide variations in international laws governing IVF. Although in principle foreign and local patients should be treated the same and with the best possible treatment, there is evidence that this is not always the case.
According to ESHRE, the ideal is fair access to fertility treatment at home for all patients. “However, often faced with no realistic alternatives due to legal restrictions, long waiting lists, lack of donors, or unavailable or expensive treatments, patients travel across borders and may not receive adequate treatment in the country of their choice,” says Dr Shenfield.
Now ESHRE is setting the first-ever standards in treatment, so that in future, Dr Shenfield says, patients can be assured of high-quality assisted conception treatment, and international standards can be maintained with a proper code of practice for all couples who make use of fertility treatments, in the UK and elsewhere.