Couples seeking in vitro fertilisation can dramatically increase their chances of having a baby by choosing the right clinic in which to have treatment.
Official figures published yesterday show that the best clinics are continuing to improve their success rates while the poorest are getting worse. They provide the clearest evidence of the enormous variation in the quality of treatment that applies across the medical spectrum.
Last year, only one clinic had a live birth rate below 5 per cent and none scored more than 25 per cent. This year three scored more than 25 per cent, better than the monthly success rate for couples conceiving naturally, and three dropped below 5 per cent. The average live birth rate for all clinics was 15.1 per cent.
The figures, published today by the Human Fertilisation and Embryology Authority in its Patients' Guide, show a zero live birth rate for the first time - at the Reproductive Medicine Unit in Withington Hospital, part of South Manchester NHS Trust.
The clinic, which also came bottom of last year's table, treated 54 patients and had only one live birth. This was not counted because it was from a frozen embryo which is excluded under the system for compiling the figures in order to ensure the results for all clinics are comparable.
The top performing clinics are achieving their success at a price. The Guide, which covers the period April 1995 to March 1996, shows that many clinics are now routinely using three embryos in each treatment, the maximum permitted under the regulations, increasing the risk of a multiple birth. The proportion of twin and triplet births is about twice as high in the best performers compared with the rest.
One exception to this rule is the Assisted Conception Clinic at the Royal United Hospital, Bath, described as "seriously good" by one insider, where more than half the treatments involved the transfer of only two embryos. The remaining four clinics among the top five used only two embryos in less than 20 per cent of treatments.
Nationally almost a third of births by in vitro fertilisation are of twins, triplets or quadruplets which carry an increased risk of complications and can impose emotional and financial pressure on parents. Ruth Deech, chairwoman of the authority, said last month that the multiple birth rate would be kept under "active consideration."
Yesterday, Mrs Deech said: "The main factors that determine the chances of a successful outcome are the age of the woman, the length of time the couple has been trying to have a family, previous ability to conceive, and the quality of the sperm. If couples are in a position to choose, they should obtain information from a number of clinics and then decide which one best meets their needs."
The Patients' Guide is available free from the HFEA, Paxton House, 30 Artillery Lane, London E1 7LS.
FIVE BEST PERFORMERS
Live birth rate Treatment
per egg collection cycles
(per cent) (number)
Welbeck Clinic, London W1 29.7 74
Lister Hospital, London SW1 25.8 981
Royal United Hospital, Bath 25.7 143
Nurture, Queen's Medical Centre, Nottingham 24.3 853
Holly House Hospital, Essex 23.7 278
FIVE WORST PERFORMERS
South Manchester NHS Trust 0 54
Newham General Hospital, London 1.8 51
Hope Hospital, Salford 2.6 99
Cromwell Hospital, London SW5 7.5 388
Singleton Hospital, Swansea 8.3 68