IVF – what to expect when you’re expecting returns

A recent World Health Organisation report finds that about one in six people worldwide experiences infertility. Unsurprising, then, that this year would-be parents around the world will spend an estimated £12.8bn on fertility treatments, a figure growing at an annual rate of 10.3%. The UK IVF market – valued at around £420 million in 2018 – is expected to reach £760 million by 2026.

WHO officials highlight that IVF remains “underfunded and inaccessible to many due to high costs, social stigma and limited availability”. In the UK, IVF is provided through a mix of NHS and private services, and regulated through the Human Fertilisation and Embryology Act, passed in 1990. The Act has been updated only once, in 2008, despite the sector having witnessed scientific breakthroughs and an accompanying shift in public perception in the time since. Both factors have contributed to a significant growth in demand. As attitudes and access to IVF have evolved, sector stakeholders have started to highlight issues: regional variations in NHS funding, poor regulation of treatment ‘add-ons’ and perceived profiteering.

Although the National Institute for Health and Care Excellence (NICE) recommends three cycles of IVF for women under 40, some Integrated Care Boards offer only one cycle, or only offer NHS-funded IVF in exceptional circumstances. In the absence of national standardisation, and at a time of squeezed public sector budgets, the recent years have seen a steady decline in the number of IVF cycles funded by the NHS. Data shows that NHS-funded cycles in England fell from 40% in 2014 to 32% in 2019. In Wales, they fell from 42% to 39% over the same period, and in Northern Ireland they fell from 50% to 34%. Scotland is the only devolved nation to have seen an increase in the proportion of IVF cycles funded by the NHS, up from 58% to 62%.

Reflecting these developments, IVF has attracted media and political interest, with MPs from across the political spectrum becoming more vocal about the issues in the sector.

Launched in Summer 2022, the Government’s Women’s Health Strategy acknowledged the need for action and announced NICE would be updating its guidelines on fertility, with changes expected to be published in November 2024. The strategy removed the requirements for same-sex female couples to self-fund fertility treatment before becoming eligible for NHS-funded care and committed to exploring the possibility of publishing data nationally on IVF provision and availability. Several Labour MPs, including senior Shadow Cabinet members, have criticised the strategy for failing to get to the heart of the problem, claiming that increased transparency around available funding doesn’t do anything in improving provision or tackling the postcode lottery for fertility services.

According to HFEA, in 2019 the average birth rate per embryo transferred (IVF attempt success rate) was 24%. It comes as no shock that would-be parents have increasingly been opting for add-on treatments in hopes of improving their chances of conception. Add-on procedures are optional extras that are offered by clinics on top of normal fertility treatments. There is currently little direct evidence that add-ons, which can add up to £2,500 to the cost of each attempt, improve the chances of success. In the absence of available evidence, and the growth in demand for add-ons, in June 2021 the Competition and Markets Authority issued guidance for fertility clinics to ensure they don’t mis-sell add on treatments. Still, HFEA’s 2022 National Patient Survey found only 46% of people who used add-on treatments felt their clinic has clearly explained how likely the add-on was to increase their chance of conceiving. This debate is part of the reason why HFEA has been calling for reforms to the Human Fertilisation and Embryology Act for years.

It was only earlier this year that the Government asked the independent fertility regulator to submit reform recommendations for consideration. Now HFEA is seeking additional powers to enforce standards, including the ability to introduce economic sanctions on non-compliant providers. The lack of control over fertility treatment add-ons by HFEA have enhanced the criticism of the poor regulation and fuelled the ‘profiteering’ debate.

Given the mounting scrutiny, increasing size of the sector and the fact that the Women’s Health Strategy had already set out that government would consider changes to regulatory powers to cover fertility treatment ‘add-ons’, it is likely HFEA’s recommendations will be accepted. Even if parliamentary time is squeezed, and the Government doesn’t make progress ahead of a General Election expected in late 2024, women’s health will be high on Labour’s agenda should it form the next government.

Labour MPs have been vocal on a number of women’s health issues, with menopause awareness in the workplace being the most recent example. And with the Shadow Secretary of State for Women and Equalities, Anneliese Dodds, calling for a “national conversation” on women’s health and wellbeing, it is safe to assume Labour would take a more interventionist approach in government.

With 3.5 million people struggling to conceive in the UK, and the proportion of IVF cycles provided by the NHS steadily declining, private provision of IVF remains a growth industry. Considering the WHO’s recent findings and calls for better policies and public financing, the regulatory landscape is likely to tighten, so those looking to invest in the sector will need to keep an eye on both regulatory reform and updates to NICE fertility guidelines. The policy agenda of a potential Labour government, which is more likely to scrutinise profit-making delivery models in the health space, should also be a key consideration.

However, tighter regulation needn’t be discouraging, especially if it is followed up with better public financing. As we have seen in other sectors, if done well it is likely to build confidence and present growth opportunities for high quality providers committed to doing their best for patients. And that should motivate investors to drive the innovation that will deliver better outcomes for patients – and reward all expecting stakeholders in the long run.