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Professor’s Corner with Daniel Brison

The cost of IVF treatments – to add on, or not?
The cost of IVF treatments has been under quite a bit of scrutiny recently, because of concerns over the cost to the NHS, to couples who are paying for their own treatment, and because of lack of availability of IVF in developing countries.  In some respects IVF treatment is not at all expensive of course; if we consider that a successful treatment leading to a live baby is effectively a permanent, lifelong “cure” to the “disease” of subfertility.  Compare the costs involved in an IVF cycle to the costs every year to manage life-long disease such as diabetes.  Nevertheless, IVF clinics have recently come under particular criticism for offering technologies which are not necessarily proven to work (evidence-based), some of them at a high cost to patients.  These have become known as “add-ons”.

In a recent Radio 5 programme presented by Anna Foster (July 2016), the Chair of the British Fertility Society, Professor Adam Balen, criticised the practice of charging patients for treatment add-ons which do not necessarily work.  The Economist also ran articles including a leader in a recent edition (The Economist, August 27th– September 3rd, 2016) calling for IVF costs to be reduced, particularly unnecessary add ons.  The Human Fertilisation and Embryology Authority (HFEA) together with patient support groups such as Infertility Network UK  are concerned about this and are currently producing guidance for patients on how to critically examine the add ons on offer, which staff at St Mary’s are advising on.

St Mary’s has always followed a tradition of keeping costs to the NHS as low as possible while still remaining financially viable, and we have recently extended this to our new fee-paying service.   We also take particular pride in not offering any services that are not based on evidence, so on our website you will see no mention of add ons such as immune testing or embryo genetic screening.  This is not because the NHS cannot afford them, quite the contrary; if they worked we would be the first to invest in them.  But they simply do not have the evidence to support their routine use.   However if you look elsewhere on our website you will notice that several of the famous add-ons are mentioned.  The only one which incurs a charge is Sperm DNA damage testing.   We offer this because the test is based on many years of research by a very well respected academic scientist, but because the company who do the work are based outside of our hospital there is a fee.   However you will also see that other add ons such as EmbryoScope and EmbryoGlue are offered completely free of charge at St Mary’s to both NHS and fee-paying patients.  We are delighted to be doing our bit to support evidence-based medicine while keeping our success rates high and keeping costs down for the NHS and for couples.

Controlling your natural cycle