December 14, 2017

expert reaction to HFEA’s ‘state of the IVF sector’ report

The Human Fertilisation and Embryology Authority (HFEA) has released it’s ‘State of the IVF sector 2016-17’ report.

Prof. Darren Griffin, Professor of Genetics, University of Kent, said:

“The new HFEA report provides room for cautious congratulation and optimism.  Over 75,000 births per year is now a significant proportion of the population and while inspection, in general terms, can often be seen to be intrusive, the overall picture is a positive one.

“The overall feel of the report is one of mature support and guidance and, while targets are often challenging (such as the reduction in multiple births) it is pleasing to see the challenge being taken up and fulfilled.

“One grade A incident is one too many of course but the positive thing is that there weren’t more.  By identifying problems and areas for improvement however (e.g. in the Grade B and C incidents) the path to maximizing the patient experience is a clear one.”

Dr Ali Abbara, Senior Clinical Lecturer in Endocrinology at Imperial College London and member of the Society for Endocrinology, said:

“The report highlights the power of promotion of good practice messages from regulators, with an important decrease in multiple pregnancy rate, and consequently a beneficial health impact for both mother and baby.  Patients undergoing fertility treatment are an extremely well informed population and it is crucial that they continue to have access to reliable information from an independent body like the HFEA.  A significant proportion of IVF cycles are carried out through the private sector, and patients have a wide range of choice with regards to treatment choices and treatment centres.

“It is very helpful for patients to be supported in making informed choices when it comes to what remains a costly treatment for patients’ self-funding.  The report also highlights the ongoing need to monitor the occurrence of adverse events and develop processes to prevent these from recurring.”

Dr Roy Farquharson, ESHRE (European Society of Human Reproduction and Embryology) Chair 2017-19, said:

“Within Europe, the HFEA report mirrors the decreasing multiple birth rate (MBR) trend that has been welcomed by many experts and patients alike.  The dangers of MBR are well known to all health care professionals but are often underestimated by the wider public and the media.

“The European Society of Human Reproduction and Embryology (ESHRE) has undertaken rigorous and extensive surveillance of IVF within Europe on a voluntary basis for many years.  The most readily available publication shows the downward trend of MBR with some national rates as low as 5 to 8% where single embryo transfer has been universally embraced.

“ESHRE welcomes this news and hopes that HFEA continue the good work that has been achieved in the UK.”

Dr Richard Kennedy, President of the International Federation of Fertility Societies (IFFS), said:

“IFFS welcomes the reduction in multiple pregnancy rates to 11% in the recent HFEA report but calls for continuing efforts to further reduce twin rates comparable to Japan, Australia and Scandinavia.”

Prof. Adam Balen, Chairperson, British Fertility Society, said:

“We welcome the report, which shows the extraordinary commitment our specialty has to transparency.

“Every year we get better at reporting to the regulator so we would actually expect to see a rise in the number of reported incidents.  The rise is also generally in parallel with a rise in the number of treatment cycles.

“We are confident that, in reality, there is no evidence that practices have changed or that there ought to be concerns about the sector.  The fact is we are the most highly regulated medical specialty in the UK and we consistently uphold very high standards of clinical practice and care.

“The British Fertility Society is working very closely with the HFEA to help drive down the rate of adverse incidents.  In particular, we are working together to ensure good practice in the reporting of ovarian hyper stimulation syndrome.  We have developed evidence-based guidelines to help limit the incidence of this complication and to provide a resource for clinicians looking after women who develop the condition.

“It is hugely satisfying to see the significant fall in the number of multiple births.  This is a goal we have worked on closely with the HFEA.

“With over 75,000 treatment cycles per year we have seen a significant increase in the chances of having a baby, which on average is about 32% of all cycles and at the same time a huge reduction in multiple pregnancy.  So the planned transfer of a single embryo has not reduced the chance of success.

“By reducing the number of embryos implanted and at the same time improving our success rates, we protect parents and babies from the potential complications that come with twin or triplet pregnancies and births.

“In the 40 years since Louise Brown, the world’s first IVF baby, was born in the UK, IVF has revolutionised the treatment of infertility and the UK has led the way with both innovative research and also careful regulation by the HFEA.

“It is very disappointing that the NHS only funds 40% of cycles.  If three full cycles were funded, as recommended by NICE, we know that at least 80% of couples would end up carrying a baby.  IVF is cost-effective and the economic benefit to society of those born from IVF far outweighs the cost.”

Prof. Nick Macklon, Medical Director, London Womens Clinic, and Professor of Obstetrics and Gynaecology, University of Copenhagen, Zealand University Hospital, said:

“The HFEA fulfills an important role in providing a clear framework in which assisted conception services can flourish the UK, and this report confirms the benefits they bring to the quality of care our patients receive.  My colleagues in clinics across the UK should be congratulated on achieving the remarkable decline in multiple births that this report highlights, and which the HFEA has been rightly advocating.  Challenges remain, but the constructive relationship between the HFEA and the UK Fertility sector means that we  remain at the forefront of innovation in treatment and research, and in improving our patients’ experience during a challenging time in their lives.”

Prof. Simon Fishel, Founder and President and Head of R&D, and Professor of Human Reproduction, CARE Fertility Group, said:

“Multiple pregnancy reduction is an important and acclaimed achievement, and the HFEA deserve enormous credit for driving this policy.  That the best clinics have done this without compromising live birth results, and the fact that we have trebled IVF live birth rates since I started in IVF nearly 4 decades ago is a magnificent testament to scientific endeavour, especially in the development of longer term culture (to the blastocyst), chromosome screening, cryopreservation and other technologies.  However, it is still unacceptable that ‘average’ success rates hide the enormous gap between the top performing clinics and those whose live birth rates are well below the national average.

“That the HFEA, along with most responsible clinics, have for over 15 years striven hard to provide the highest standard of care in a complex area of medical science is recognised internationally, and welcome.  However, the HFEA’s lack of data in areas such as the escalating numbers of natural cycles, and so called ‘mild IVF’, and their lack of coherence on what should be defined as ‘mild IVF’ is causing consternation amongst patients and practitioners alike, and somewhat diminishes their stated “commitment to open, frank and constructive regulation”, and this urgently needs to be addressed.  Hopefully future publications will include such detail.”

Prof. Alastair Sutcliffe, Professor of General Paediatrics, UCL, said:

“This is a fabulous report.  The main problem of the outcome of assisted reproductive technologies (ART) is the birth of twins, triplets or more (higher order births).  Having spent 25 years studying the child outcomes of ART, for which I am internationally known, I welcome this report.

“Natural twin birth rates in the UK are 1 in 80 births (1 in 60 pregnancies).  Natural triplets should be 1 in 3000 births – human being are made to have singletons or at a push twins.  Twins attract many higher risks.  Triplets a much higher risk, for example a 30 x the risk of cerebral palsy in those who survive.  Twinning rates have risen as a direct effect of ART and the historical rates reflected lack of certainty about what mattered, for example refinement of hormonal regimes.

“Then there was the classic work by Alan Templeton analysing HFEA data which showed that the effect of replacing three embryos only achieved a higher rate of triplet birth but not an overall increased take home baby rate.  This has been followed by work to show that the take home baby rate if you do SET (single embryo transfer) and cryopreserve other embryos, to put back one at a time, is no different than putting back two even in older mothers.  Mothers and couples coming for ART are desperate for a baby and clinics are desperate to help (and also improve their performance in league tables) yet there is no medical justification for inducing a twin pregnancy, when all the medical literature shows twins do less well.  Some countries have approached this problem by legislation for example in the NHS of Sweden only SET is allowed.  As we are British our approach was less formal but has evidently achieved the thrilling result shown here.

“I welcome these findings as a paediatrician who has witnessed first hand that epidemic wave of higher order births often with sad consequences.  IVF, invented here in the UK, was quoted and referred to as one of the six greatest medical inventions of mankind in the last century.  It is a boon, but is now also a lot safer for treated women and their babies.”

* https://www.hfea.gov.uk/media/2437/hfea_state_of_the_sector_report_tagged.pdf

Declared interests

Prof. Darren Griffin: “No COI.”

Dr Ali Abbara: “No conflicts of interest.”

Dr Roy Farquharson: “No conflict of interest to declare.”

Prof. Simon Fishel: “Minor shareholder in CARE Fertility.”

Prof. Alastair Sutcliffe: “Professor Sutcliffe has MRC funded research using HFEA data.”

None others received.