IVF: Care and Vulnerability

By Professor Peter Hollands

It is now over 40 years since IVF was introduced to the World by Bob Edwards, Patrick Steptoe, and Jean Purdy at the birth of Louise Brown in Oldham General Hospital.

There were many doubters when IVF was first announced, some even claimed that the mother became pregnant naturally. This was despite the fact that she had blockage of both Fallopian tubes and a long history of infertility. IVF then subsequently developed in the sleepy Cambridgeshire countryside at the first, and at that time the only, IVF clinic in the World known as Bourn Hall Clinic.

In those early days, patients travelled to Bourn Hall Clinic from all over the World and the treatment itself was on a strict inpatient basis. The overall success rate at that time was approximately 30 percent live birth rate but female patients aged 40 and above had a success rate very close to zero. Since these pioneering days, IVF has grown into a global medical industry worth an estimated $14.2 billion in 2020 with an annual growth rate of 6.5 percent.

Today, there are approximately 2,200 IVF clinics around the World and there have now been over 8 million babies born following IVF treatment. It is estimated that one in six couples suffer from infertility and this does not include LGBT patients who represent an ever-growing group of patients.

This all sounds like a fantastic success story for both those providing IVF and fertility patients. Despite this, on closer examination cracks are starting to show in the global fertility industry which impacts directly on fertility patients. The major problem in IVF is the overall success rate, currently standing at a 30 percent live birth rate, is exactly the same as the live birth rate in 1978. It is important to note that the live birth rate should be the only statistic of interest to fertility patients. ‘Beautiful’ embryos or a positive day 14 pregnancy test or a day 35 scan showing a fetal heart are not measures of success.

A healthy live birth is what all fertility patients seek, and it is the only statistic that matters

It is interesting to compare IVF with other medical technologies introduced in the 20^th Century. Heart transplantation, for example, had a success rate of approximately one percent in the early days and today the success rate is estimated at 85 percent. Kidney transplantation had an early success rate of around two percent and today success rates stand around 93%. There are many other examples in the field of medicine where technology has improved in both safety and efficacy over the years, and this is of course due to thorough research and development providing new technology which in turn improves success.

There are many problems that result in the lack of progress in IVF today, which in some ways may stem from the pioneering attitude of Edwards, Steptoe, and Purdy without which IVF may never have happened. I was present at the start of IVF, and it was a time of great innovation, attention to detail, and amazing ingenuity, dexterity, and skill. It was also a time when IVF was a true team effort. There were no over-bearing physicians or crackpot scientists or massive egos, everyone involved had a say in what was proposed, and where possible all decisions were evidence-based. There was also no massive fertility industry supplying Bourn Hall Clinic. Equipment and consumables were purchased from existing medical and scientific suppliers. Everyone at Bourn Hall Clinic constantly thought about possible ways of improving the technology and this sometimes led to minor improvements in overall success rates when these ideas were very cautiously tested in the clinic with very clear informed consent from the fertility patients involved.

The problem in IVF today is that this pioneering spirit has been taken to the extreme. New ideas or technology (often known by clinics as ‘add-ons’) are introduced into routine clinical practice with little or no thought for safety and efficacy but with a steel-eyed focus on profit. These ‘add-ons’ are sold to very vulnerable fertility patients who are told that the ‘add-on’ might improve their chances of success. The fertility patients of course immediately accept these ideas, and their overall cost of a treatment cycle can increase exponentially. The sad thing is that fertility patients are being deliberately misled by fertility clinics and everyone, including the regulatory authorities, simply stands by and watches. The only benefit which results from ‘add-ons’ is to the bank balance of the fertility clinic.

IVF today is far from perfect for many reasons and sadly the ultimate price is paid (both financially and emotionally) by fertility patients. The answer to this problem is to inform and empower fertility patients to be critical and to ask the right questions. This will decrease the vulnerability of fertility patients at the hands of some IVF clinics and might even force properly controlled research and development into fertility treatments with the ultimate goal of increasing what is currently a stagnated live birth rate.

Professor Peter Hollands is a consultant clinical scientist and author of The Fertility Promise, you can purchase a copy by clicking here.