Why I’m ashamed of the exploitation in the IVF industry

THIS week I feel ashamed. This newspaper has published evidence of widespread bad practice in my own medical speciality, infertility treatment. And I feel angry because the Government’s regulatory body, the Human Fertilisation and Embryology Authority (HFEA), has been inadequate. It has not prevented the disgraceful exploitation of patients, mostly women.

I am also depressed because, 27 years ago, we doctors promised Parliament that we would ensure the highest standards where procedures involved human life and the treatment of embryos.

One of the latest scandals concerns socalled egg sharing.

Egg sharing is offered by some clinics with apparently laudable intentions. The clinics argue that it makes treatment available to women unable to afford IVF and who are ineligible for NHS treatment.

The women agree to have their ovaries stimulated by drugs to produce eggs. Some of these eggs will be fertilised for their own treatment; others will be donated to other patients who cannot produce eggs. These recipients pay for their own treatment and for that of the donor.

It sounds reasonable but, in fact, it is fraught. First, by regulation; the maximum number of embryos a donor can have placed in her womb is one or two. But there may be many other eggs ‘left over’.

This means that from a single donor’s eggs, a clinic could, in theory, simultaneously supply donor eggs for several patients — all paying extra-high fees for IVF treatment with egg donation.

This means that, for the clinics, persuading women to donate their eggs can be extremely lucrative. It also means that clinics have an incentive to maximise the chance of getting as many eggs as possible. Therefore, they may be tempted to give the woman donating her eggs more stimulation than is strictly needed, or than is advisable from the point of view of the woman’s health.

In addition, although heavier stimulation may increase the number of eggs obtained, it may also result in poorer eggs, with more chromosomal abnormalities and increased risk of miscarriage.

The problem does not end here. While the donor’s own treatment may be unsuccessful, leaving her childless, it may well produce children for another woman who has benefited from her eggs.

Confidentiality means the donor will not know any details about the treatment of another patient or if a pregnancy resulted. But by law any child can, on reaching adulthood, find out who their genetic mother is.

So it is possible that years later a childless, grieving woman, whose own treatment has failed, could be traced and visited by a child she didn’t know existed.

Given all this, it is simply astonishing that — caught by the Daily Mail’s camera — a professional in a clinic should suggest there is nothing for egg donors to worry about.

Eggs? ‘They’re just cells,’ she says, as she shrugs her shoulders.

Another cause for concern is the increasingly fashionable idea of egg freezing. This is being sold by

The avarice of a few should be condemned

clinics as a way for career women effectively to put their fertility on hold.

But official figures on success rates from the HFeA are disconcerting. Between 2008 and 2014 — the dates for which full records are available — 3,489 frozen eggs were thawed in attempts to produce a pregnancy for the patient who stored them.

The records are difficult to interpret but, from those, about 77 pregnancies have occurred, with approximately 55 live births resulting from those pregnancies. That means the live birth rate was 1.5 per cent.

even if you look only at the 589 eggs which were successfully fertilised and transported into the womb as embryos, those 589 resulted in just 55 live births — a success rate of 9.3 per cent.

So how does this reality compare with what patients are being told? one consultant in the Mail’s investigation is caught on camera asserting that if a woman freezes her eggs, her chance of pregnancy is 65 per cent.

The website of one London clinic states: ‘our egg survival rate following vitrification [fast freezing] is very high, around 90 per cent, which helps to increase the success of having a baby in the future.’

Most lay people would assume that, if they attend this clinic, they are close to being guaranteed a pregnancy. This seems very misleading, and the HFeA should step in.

But the HFeA does not always give full information about infertility — and there is also a lack of completely reliable information about IVF. This is precisely why we established an entirely charitable website at the Genesis Research Trust to give unbiased information.

For example, I believe many women are undergoing IVF treatments unnecessarily. This explains why so many get pregnant naturally after IVF has failed.

There are dozens of causes of infertility, each possibly requiring different treatment. Like chest pain, infertility is just a symptom. But with chest pain you expect your doctor to do adequate tests. Complain about infertility and there is every chance you will simply be shunted off to an expensive IVF clinic with little or no investigation by the GP or the clinic.

In 2014, around 45,000 patients were treated with IVF — but significantly, no cause for the infertility was found in more than 18,000 of them, the HFeA reports. Some 40 per cent had ‘ unexplained infertility’ or were uncategorised.

Clearly, many of these couples did not have sufficient testing before IVF to ascertain the cause of their infertility.

Treatment without first making every attempt at a diagnosis is thoroughly bad medicine. We are all outraged at a surgeon removing breast tissue without making a proper diagnosis, but we ignore what is happening in many infertility clinics.

When I mentioned this in a Radio 4 broadcast, I was joined by fertility expert Professor Adam Balen, then chairman of the British Fertility Society, representing ‘good’ practice across the UK.

I respect Adam, who is a good doctor. But I was surprised how he downplayed my concerns. After the broadcast, a welleducated professional woman who had listened in called me. She had been trying for a baby for about a year, and had been referred to an IVF clinic with no testing.

There, she was scheduled for IVF. She was also told to take Humira, a drug which riskily suppresses the immune system. She was given a private prescription but, worried, did not take it. Fortunately, she got pregnant without further treatment.

To confirm what I had stated on the radio, I emailed Adam Balen twice, explaining how commonly I encountered this kind of malpractice. Perhaps he did not get my emails, as he didn’t respond.

The HFeA must be firmer. There are many good, truthful doctors out there, but women seeking fertility treatment are deeply vulnerable. They are anxious, often depressed and in psychological pain, and will grasp at any straw in forlorn hope.

We, as doctors, must treat them properly and with respect.

The avarice of just a few in the burgeoning fertility industry is something that we should all be more ready to condemn.