Having IVF treatment can feel like dancing, often in secret, through a minefield of the unknown and the uncertain. Sometimes you are referred without even finding out what was causing your infertility in the first place. Beforehand, you don’t know how it’s going to make you feel and, once you’re in the midst of it, you don’t know if how you feel is real or another side effect of synthetic hormones. You don’t know how many eggs might be collected, you don’t know how many embryos might be created and you certainly don’t know how many will stay to become viable pregnancies. The only welcome unknown is that, for many of us… we never find out how much it all costs. Because thousands of us have our IVF paid for by the NHS. Yes, our beloved beleaguered NHS. Not only has it aided the safe birth of millions of babies over the last 70 years, but since the early 1980s it has also funded the conception of hundreds and hundreds of thousands of them. Yet this is looking more at risk than ever.
Last week, Fertility Network UK released data showing that a growing number of areas in England have axed the treatment on the NHS and the proportion offering the recommended three cycles of treatment has fallen to just over one in 10. Patients now effectively face a postcode lottery of services, with some families even resorting to moving home to areas where they can be treated or travelling abroad for treatment.
There are also those, most recently health adviser (and IVF entrepreneur) Geeta Nargund, who criticise the current system for paying what Nargund this week called “mismanagement”: currently, clinical commissioning groups, which spend NHS cash locally, pay wildly different amounts, depending on where they are in the country. Critics point out that private clinics – where the NHS sends patients for their IVF – charge wildly differing fees, often pushing unproven “extras” when they could be spending less but treating more patients.
Clearly, the system would be more fair if the treatment a patient was entitled to had one set nationwide amount. But the inconsistencies of the NHS system are symptomatic of the wider burgeoning industry of fertility treatment and the increasing emotional and financial pressure it is putting on patients and would-be patients. As the treatment we will get on the NHS looks only likely to decrease, we are ever more exposed to what is without doubt an increasingly competitive industry, ambitious for UK cash.
It can be torturous, trying to work out how much treatment you can stand, let alone what you can afford. Do you half-live years of your life, in a perpetual state hope for next time? Do you keep going, trying to ensure you don’t reach your late forties filled with regret that you couldn’t stand “just one more try”? Or do you call it a day and spend the rest of your life wondering, on low days, if you could have tried a little harder, spent a little more?
Do you call it a day and spend the rest of your life wondering, on low days, if you could have tried a little harder, spent a little more?
These are valid questions, but they’re not merely existential ones – they are questions that businesses know we are asking. They are basing their business models on these anxieties. An example is the Spanish clinics now operating in the UK as well as in Europe, offering “your newborn baby or your money back”. The enormity of that promise is only matched by the immense sum, should you conceive with relative ease. They ask for around £26,000 up front. Increasingly, foreign clinics are coming up with “deals” like this, hoping to attract those the NHS will no longer treat.
One suggested solution now marketed at us is egg-freezing, particularly since headlines created by big Silicon Valley firms offering the service as part of an employee package. But The Human Fertilisation and Embryology Authority, the UK’s regulatory body, reports that success rates are still low – an average of eight babies born per year between 2008 and 2013. Yikes. And that is before you’ve even hit your late thirties. No point delaying babies when the odds are so stacked against you, is it now, ladies?
Except – as so many of us have suspected for so long – the primary cause of women delaying motherhood and ending up having to seek fertility treatment isn’t the age-old “indulgence” of focusing on our career. Instead, research conducted by Dr Marcia Inhorn at Yale University, recently presented at the European Society of Human Reproduction and Embryology in Barcelona, found that the primary reason for egg freezing “mostly revolves around women's lack of stable partnerships with men committed to marriage and parenting”. Indeed, prioritising work in your twenties and thirties is the least likely reason women have the procedure. It’s actually the lack of men.
This pincer movement of NHS treatment cuts and women apparently finding themselves less able to find men who want to settle down while their partners are still at their most fertile leaves women bearing the brunt of the consequences. It is already we who endure the physical intrusions of IVF treatment and, increasingly, it is looking as if we’ll be the ones making the financial decisions about whether or not to freeze our eggs long before we’ve even met our future partner.
This isn’t fair, but then neither is much of biology. Perhaps the only way to keep ourselves psychologically and emotionally in check if we find ourselves dancing through this minefield is to remember that it is a business. Distressing though it is when you are confronted with the reality of requiring help to conceive – and infuriating though it is that those early decisions are falling to us – we must remember that the prices, the procedures and the pitches are not value judgements on us. They might be a bump in our life plan, but they are merely part of someone else’s business plan. Let’s just hope the rest of the NHS doesn’t head that way, too.