Wide gap in success of fertility treatments

Birth rate variations revealed by patient guide raise questions about the quality of service

LIZ HUNT

Health Editor

The first patient guide to fertility treatments in British hospitals and clinics reveals a wide variation in success rates, as measured by the number of live births.

The data raises the possibility that scores of people have been paying thousands of pounds for poor-quality treatments. In-vitro fertilisation (IVF) costs pounds 700-pounds 2,500 per cycle and donor insemination (DI) costs pounds 100- pounds 500.

The report shows the live birth rates for IVF treatments vary from 0 per cent to almost 20 per cent, giving a national average of 14 per cent. DI success rates range from 0 to around 43 per cent, giving a national average of almost 7 per cent.

The Patients' Guide to DI and IVF Clinics, published yesterday by the Human Fertilisation and Embryology Authority (HFEA), lists more than 90 fertility units and, for the first time, provides couples with information that, in theory, should maximise their chances of conceiving.

However, Professor Robert Winston, the leading British fertility expert who works at the Hammersmith Hospital, west London, dismissed the data in the Guide as "flawed and meaningless" and said its publication would force some units to abandon research in favour of improving their success rates for commercial reasons.

"I just don't believe that the patients are getting the information the HFEA says they are getting. I don't believe that clinics will be honest in providing the [raw] data," he said yesterday.

A spokesman for Issue, the National Fertility Association, welcomed the HFEA initiative but said some of the data was two years old.

Ruth Deech, chairwoman of the HFEA, dismissed claims that the Guide was a "league table" of fertility clinics.

She said the Guide had been published only after wide consultation with clinics, patients and health authorities about the best way to present the information, a fact disputed by Professor Winston.

The data had been adjusted to account for factors such as the age of the women treated, couples' fertility history, including previous treatments, and whether fresh or frozen embryos had been used. This meant it was "clear and meaningful and fair to clinics" and comparable, Mrs Deech said. The British Fertility Society welcomed its publication, she added.

"Success is not necessarily to be measured by the 'take home' baby rate. What matters is [a couple] being properly investigated and being enabled to make a decision about what is right for them."

Mrs Deech said patients would want to consider other issues, such as waiting lists, location of the clinic, restrictions on treatment such as age, tests and investigations offered, and range of treatments.

The Guide urges patients to use the live birth rate figure only as a general guide and to discuss with the clinic the likelihood of success in their own particular circumstances.

But critics of the Guide say that the only figure that will matter to couples desperate for a baby is the live birth rate. They will not consider factors such as number of patients and number of cycles of treatment (each attempt at achieving pregnancy is called a treatment cycle) which largely determine success rates.

The multiple birth rate at a particular clinic is also an important factor because twin or triplet pregnancies can endanger the life of the mother and foetus.

The Guide shows that the live birth rate following IVF (in which egg and sperm are mixed outside the womb) was 0 per cent at the Bupa Hospital Norwich, where only 28 cycles of treatment had been administered, compared with 19.8 per cent at the Lister Hospital and the Royal Masonic Hospital, both private hospitals in London, where between 650 and 957 cycles were given to women.

Success rates for donor insemination varied from 0 per cent at Queen Mary's Hospital Sidcup (41 cycles) and the Balfour Hospital in Orkney (2 cycles) to 42.6 per cent at the University of Bristol IVF Service (23 cycles).

Professor Allan Templeton, a member of the HFEA, said that the Guide provided a "broadly reassuring picture" and a continuing gradual increase in the national success rate for IVF and DI.

n The Guide is available from HFEA, Paxton House, 30 Artillery Lane, London E17LS. Send a SAE with 52p postage.

Leading article, page 20

Patients' guide to fertility treatments

D.I I.V.F.

Number Number Live Number Number Live

of of birth of of birth

Hospital patients cycles rates patients cycles rates

St Michael's, Bristol 168 238 5.8 380 314 1614

BUPA Bristol 15 23 42.6 360 446 42.6

Southmead General, Bristol 56 263 3.2 49 74 16.8

Chiltern Fertility Unit, 14 19 24.5 46 70 12.2

Buckinghamshire

Bourn Hall, Cambridge 91 185 17.4 1065 1501 13.8

Hartlepool General, Cleveland 16 26 6.0 62 76 8.1

Esperance, East Sussex 135 386 10.0 137 176 12.7

Bupa Roding, Ilford 49 110 6.8 120 170 12.9

Holly House, Essex 60 90 19.9 210 314 11.7

Manchester Fertility Services 243 720 10.3 349 560 13.7

Withington Hospital 51 122 14.7 92 134 4.8

St Mary's, Manchester 191 573 13.8 561 821 13.9

Bupa Southampton 176 616 6.5 300 366 19.7

Hull IVF 63 185 3.2 223 332 9.4

Chelsfield Park, Kent 24 44 17.7 79 90 17,7

Leicester Royal Infirmary 58 182 6.4 99 107 8.0

Middle England Fertility Clinic, 29 76 9.0 53 76 10.8

Leicester

Lister, Chelsea 36 68 14.9 647 905 19.8

Churchill Clinic, London 34 52 15.3 411 594 14.4

UC London 43 95 14.5 234 278 10.4

Bridge Fertility Centre 239 563 12.2 369 458 13.5

Portland, London 7 10 34.3 114 148 13.5

Cromwell, London 35 68 9,3 252 343 9.3

Wolfson Family Clinic 11 17 9.6 876 1098 17.

Royal Masonic Hospital 2 3 33.5 500 653 19.8

London Gynacology Centre 43 74 8.2 584 728 10.1

London Women's Clinic 278 597 14.9 419 577 15.3

Cromwell St George's, London 68 133 111 130 143 10,3

Birmingham Maternity Hospital 42 85 8,3 946 1161 11.4

Fazakerly Liverpool Hospital 82 243 1.8 188 203 9.0

Wirral Fertility Centre 34 115 2,3 116 132 11.3

Royal Maternity Hospital 169 448 4.7 408 459 16.2

Bupa Norwich Hospital 125 417 5.2 22 28 0.0

Nurture, Nottingham 234 1060 3.6 534 720 10.1

BMI Park, Nottingham 64 110 6.2 501 647 17.6

Aberdeen University 111 449 6.9 173 231 12.6

Edinburgh ACU 139 528 4.1 257 344 12.7

Glasgow Royal Infirmary 95 222 9.5 471 643 9.2

Ninewells, Scotland 75 236 2.1 276 312 11.

Washington Tyne and Wear 52 94 11.0 216 293 8.7

UH Wales 54 123 10.8 85 101 13.3

Walsgrave Midlands 65 136 14.6 343 466 16.0

Midlands Fertility, Aldridge 134 461 5.8 404 606 16.2

BMI Priory, Birmingham 73 193 9.5 264 335 13.9

Sheffield Fertility Centre 4 5 34.4 384 507 16,3

Leeds General 148 500 4.6 527 734 19.4