Professor Robert Winston: Couple being misled over chances of IVF success
It’s been four decades since Louise Brown became the first human to be been born after conception by IVF, and since then, there have been well over a million ‘test-tube babies’ born worldwide. But Professor Robert Winston, whose multi-award winning work on fertility treatments helped thousands of women give birth to happy and healthy babies, says the 40-year anniversary should be a time to re-evaluate its successes.
“The 40th anniversary is a time to celebrate the great happiness of millions of couples. But this achievement of Patrick Steptoe and Robert Edwards [who developed the IVF technique], and many other pioneers, is also a moment for most serious reflection,” the leading fertility expert says.
Louise Brown was born on July 25, 1978 and as the anniversary approaches, Professor Winston, who is chancellor of Sheffield Hallam University, is at odds with the fact couples who are struggling to conceive are shelling out thousands of pounds on private treatment, and are being exploited by misleading statistics.
“Most people who go in for IVF are over the age of 35 and have a lower success rate than the national statistics show,” says Winston.
Yet despite this, he describes a “major problem” with private clinics “selling the dream” to desperate couples, leading people to believe they are much more likely to get pregnant than they really are.
With some clinics keen to profit from expensive treatments, he believes people don’t always understand that the chance of getting pregnant from an individual IVF cycle in Britain still only stands at about 21 per cent if you’re under the age 35 – and that your chances are even lower if you’re older.
“The NHS and the HFEA (Human Fertilisation and Embryology Authority) websites are quite self-congratulatory if you look at them,” he notes, “but the reality is, people are being sucked into IVF without a full recognition of exactly how low the success rate is.
“The HFEA records success rate per embryo transfer, but that in itself is misleading, because a large number of women start a cycle but never get to the embryo transfer stage, either because their ovaries don’t respond or because the eggs don’t fertilise.”
Currently, around one in seven couples may have difficulty conceiving across the country - approximately 3.5 million people.
The broadcaster and author, who has written more than 300 scientific publications, sees first-hand the negative psychological effects, along with the crippling financial issues, that conflicting or unreliable advice on IVF can have on couples.
Speaking at his office at Imperial College London, he explains he’s spent the majority of his morning answering emails from patients who are desperate to understand why the IVF treatment hasn’t worked for them.
Through his work with The Genesis Trust, a charity seeking better health for women and babies, Winston aims give women factual and unbiased guidance when it comes to IVF. He has also long been vocal about his criticism of the commercialisation of the treatment.
He says the private sector is on a “gravy train” with IVF, with some clinics charging up to £8,000 for a single cycle of treatment, describing the combination of “desperation” from couples and “avarice” from private practices as a “dangerous combination”.
Although national guidelines suggest would-be mothers under 40 should be given three free IVF cycles paid for by the NHS, patients are increasingly only offered one, or sometimes none at all in what’s been dubbed a ‘postcode lottery’. How many IVF cycles you’re entitled to is up to local clinical commissioning groups (CCGs) to decide.
Last March, research revealed NHS Bassetlaw CCG was the only organisation in the region offering three IVF treatment rounds on the NHS to those who are eligible.
While NHS Hull CCG offered up to three cycles, if a third cycle was required then each case had to go through an Individual Funding Request Panel, which will check eligibility criteria are still met and that the probability of conception remains above 10 per cent.
Another CCG, Hambleton. Richmondshire and Whitby in North Yorkshire, had offered three NHS cycles until but has reduced this to one in October 2016 in response to financial challenges.
Research done by Fertility Network UK showed the regional picture was echoed nationally, with only 31 of England’s 209 CCGs offering the recommended three fully-funded cycles. At that time, almost 60 per cent offered only one cycle, with a handful of CCGs not offering any IVF treatment at all for women under the age of 40.
Disappointed couples were found to be spending an average of more than £11,000 on private treatment, with many getting into debt or remortaging their properties to help pay the extensive bills they face.
“The first thing we need to change, which is something we’re not doing in reproductive medicine, is to regard infertility as a symptom,” Winston says. “Right now, we regard it as a diagnosis and it’s fundamentally wrong to offer a treatment on the basis of symptoms – because the underlying cause of the symptom will vary.”
He says infertility might have “50, 60 or 70 different causes”, and that it’s therefore important to investigate the cause of the infertility to offer the best treatment, claiming there are often issues that could be resolved via cheaper and less stressful methods.
“In many cases, in vitro fertilisation is not the best [treatment] – but it’s the most profit,” he says.
“Unexplained infertility is a nonsense, it’s a failure to make a diagnosis. People are reluctant to go through with investigations, which in my view are justified, because at the moment, so many patients are failing to get pregnant with an IVF cycle and then get pregnant after the IVF has finished.
“One of the important issues is making a diagnosis and finding other more effective simpler remedies, but most clinics are now geared up to do IVF, so they don’t actually treat the underlying issue.”
Winston says one of the most common causes of infertility in women is a hormone deficiency, which is usually better treated by drugs - yet very few clinics offer this. And with the spotlight thrown on the landmark date, he believes it’s time to make a change.
“The 40th anniversary will be a cause for regret if we don’t focus on better treatment, which is geared to the diagnosis. It’s clear the success of IVF could be improved substantially, but without research – such as before Louise Brown’s birth – IVF will continue to cause great distress.
“More basic research and randomised controlled trials of experimental treatments are urgently needed.”
Louise Brown turns campaigner
Louise Brown, known as the world’s first ‘test tube baby’, has campaigned for people with fertility problems to be offered an equal chance to be a parent.
Brown spoke in the European Parliament last year about the importance of providing parity of IVF treatment across the continent.
“Everyone should be entitled to have the chance to be a mum,” she said last year.
“Everyone should be offered the same amount of tries at IVF, it shouldn’t be determined by where you live.”
Brown has said it is only in recent years she has felt comfortable in her role of being famous by birth. “When I was younger it could play on my mind that everyone knows my name. But now I like raising awareness.”