How do couples choose between the different types of assisted conception? “It comes down to what their sub-fertility is,” says Stuart Lavery, a consultant gynaecologist and director of IVF Hammersmith. “Usually the treatment is more successful if it is directed at addressing the particular cause for the couple’s sub-fertility.
“For example, if a woman has blocked fallopian tubes, IVF is going to be the best treatment because it bypasses the blocked tubes. If there’s a problem with low or poor quality sperm, then ICSI will be best because it relies on choosing only the healthiest-looking sperm. ”
For about a third of couples, though, all the diagnostic tests will come back normal and the reason for their inability to conceive will remain a mystery. It is mostly in these unexplained cases where personal choice for the type of treatment comes into the picture.
Naturally, couples will want treatment that offers the highest rate of success. But generally the success rates of assisted conception techniques vary a lot depending on the woman’s age. The success rate for women under 35 is 32 per cent. For women aged 40 to 42 the success rate drops to 14 per cent and for women older than 45 it is about 2 per cent.
Success rates are not the only factor that couples will take into account when choosing a treatment. For many people, whether they are eligible for treatment on the NHS and, if not, the cost of private treatment will also be an important consideration. Particular when the success rates suggest that most couples will need more than one treatment before conceiving.
The NHS funded 40 per cent of IVF and ICSI treatment cycles in 2011; the rest had to be funded out of couple’s own pockets.
IUI is the least expensive treatment, ranging from around £400 to £800 for a single cycle of unstimulated treatment. Stimulated IUI is more expensive, because of the hormone treatments needed to increase the chances of success, and costs around £1,000.
A single cycle of IVF costs about £3,000. To keep an embryo for frozen embryo transfer at a later date costs about an extra £3,000 to £4,000 for the first year, then several hundred pounds for every year after. FET costs between £1,000 and £2,000, and a cycle of ICSI costs around £4,000.
If cost is important, couples may wish to consider treatment abroad. The UK is one of the most expensive countries in the world for assisted conception treatment at a private clinic. Before they go, however, couples need to consider carefully the issues and risks of having treatment abroad. The Human Fertilisation & Embryology Authority’s website is useful.
For all types of treatment, couples also need to factor in costs, such as consultation fees, diagnostic tests, drugs, scans and other extras, including travel and time off work attending appointments.
These are only the pragmatic considerations, but fertility treatment can also place a huge emotional strain on relationships that can’t be quantified or known going into treatment.
CLINICS IN THE UK
Almost 40,000 patients had upwards of 50,000 cycles of treatment in NHS and private clinics in the UK during 2008, according to latest figures from the Human Fertilisation & Embryology Authority.
But having IVF or other assisted conception services on the NHS, particularly after women reach a certain age, is difficult.
Clare Lewis-Jones, chief executive of Infertility Network UK, says that although the National Institute for Health and Clinical Excellence recommends IVF treatment is offered to women up to the age of 39, in certain areas, such as Oxfordshire, Bedfordshire and Hampshire, women are only offered NHS fertility treatment up to the age of 35. Older women have to pay. “You can understand that they look at all the options including going abroad”, she says.
British women who travel abroad for treatment tend to be older than those travelling from other countries. Some estimates say nearly two-thirds of British women are over the age of 40.
Another factor that may have prompted more couples to seek treatment abroad is that in the UK egg and sperm donors no longer have the right to anonymity. This has led to a shortage of donated eggs and sperm, and UK waiting lists can be months or even years.
The last reliable figures for how many UK women go abroad seeking fertility treatment were from the European Society of Human Reproduction and Embryology (ESHRE) in 2009. ESHRE gathered data from 1,230 people who attended fertility clinics in Belgium, the Czech Republic, Denmark, Slovenia, Spain and Switzerland over a one-month period. But only 53 of the survey respondents were British.
Most of the British women in the ESHRE survey chose Spain or the Czech Republic, where the cost of IVF treatment can be as low as £2,000 for one cycle.
IVF Spain, a private clinic in Alicante, treats about 40 British women a year. Dr Jon Aizpurua, its general director, says: “The main reason British patients come to Spain is because we have anonymous egg and sperm donation. Also, people come to our clinic because there is no waiting list.”
Infertility Network UK’s Clare Lewis-Jones agrees. “I think the main reason people go abroad is because of the waiting lists.” But she adds: “The waiting lists are for donors, not for treatment. There are no waiting lists for straightforward IVF in the UK. Women can just go ahead and have it.”
BENEFITS OF TREATMENT IN THE UK
- Assisted conception for women aged between 23 and 39 should be free on the NHS
- All clinics offering IVF in the UK are regulated by the Human Fertilisation & Embryology Authority
- No language barriers
- No need to travel abroad if follow-up treatment is needed
- If things go wrong, it is easier to get legal redress in the UK
- Counselling is offered at all clinics before treatment with donor eggs or sperm
BENEFITS OF TREATMENT ABROAD
- Short waiting times for donor eggs or sperm
- Donors have the right to remain anonymous in some countries
- Treatment is often cheaper than at private clinics in the UK