Helping UK patients make informed fertility treatment choices via more transparency
The Independent published a story last week about fertility treatment they called “Fertility watchdog ‘increasingly concerned’ about dubious treatments sold by private clinics as experts warn childless couples are being exploited.” The article highlighted the importance of transparency in care and whether it is being offered in clinics across the UK. Here are my thoughts below on how to approach new technologies and what patients need to request of their fertility Consultant to get the best outcomes.
Consultants should work in partnerships with their patients
As in any industry, there are significant developments taking place and new fertility treatment interventions are being reported that may help couples improve their IVF treatment success rates. It is also very uncommon, as with any medical speciality, to have big trials or studies for every clinical scenario wherein thousands of patients have been enrolled. So most fertility specialists, like other specialists, have to use the available evidence in context for each patient.
I firmly believe fertility clinics and fertility treatment consultants should work in partnership with their patients. This is especially important when there is a lack of consensus with regards to the value of potentially new or controversional “add-on” services which may increase one couple’s chances of conception immensely while not really being of help to another couple. Communication is critical. Fertility specialists need to help their patients understand all the complex concepts involved.
That said, controversy is often less derived from actual practice and more derived from public perception or misunderstanding. It’s important to remember that the Human Fertilisation and Embryology Authority (HFEA) regulates fertility treatments in the UK. All HFEA licensed clinics are thoroughly inspected. Just like any area of medicine, there is not a single treatment that comes into clinical practice without any human studies or trials.
Unique cases require different fertility treatments
Each infertility patient presents a unique clinical situation or challenge for their Consultant. It is difficult to fit every patient into a single study hypothesis. With advancements in science and technology, newer infertility interventions are coming into clinical practice.
Example: Time-lapse imaging of embryos
Let’s take a look at time-lapse imaging of embryos, for a good example of how improved technology positively impacts patient outcomes. There are different systems for real-time assessment of embryos available such as:
- Embryoscope ®
- Primovision ®
- Eeva ®
Information about the real-time development of embryos during incubation can only aid with embryo selection. These systems including Embryoscope®, have a very small imaging tool that takes the image of a developing embryo every 10 minutes to gather real time information about the embryo development. This enables the embryologist to assess embryos without having to take them out of the culture. The embryos are kept there for 2-6 days until the transfer has taken place. By maintaining this closed incubation system, it maintains stable culture conditions until the embryos can be replaced back into the womb.
The new technology introduces more objectivity and transparency and provides more information that was not available before Embryoscope®. It also maintains a more stable culture, and quality embryo growth depends on the conditions present in the entire culture system.
Fertility treatment specialists agree that Embryoscope® patients have comparable success rates to patients using conventional incubating systems. There is evidence that it may improve success rates and reduce early pregnancy loss.
The implications on positive benefits will vary from one embryology laboratory to another, however, time-lapse imaging like Embryoscope® or Eeva provides the following advantages:
- A new understanding of the very early development of embryos
- Helps us improvise clinical application to the best-suited patients
- Gives a unique opportunity to understand and develop science for the benefit of mankind
This was not possible before the availability of such technology. Providing people with access to new technologies is not a situation solely facing fertility medicine. Most medical specialists provide their patients with access as new technologies emerge.
I understand it makes a fascinating human interest story for the media to speculate that some new technologies are unnecessary because the old technology isn’t broken. It is however not realistic to expect that experts in fertility medicine should not provide progressive services to the patients that require it. Doing this would be holding back the advancement of science.
Researchers have published many studies aiming to understand the role of immunomodulation or reproductive immunology in the management of patients with failed IVF fertility treatments. The reported studies vary in the enrollment criteria, treatments provided, and reported outcomes. Some reported benefits to patients like improved live birth rates, whilst others do not. In my experience, specialists consider such treatments for selected patients with
- multiple failed IVF treatments,
- multiple miscarriages, or
- a combination of miscarriage and implantation failure.
Transparency in practice
Patients should be investigated and monitored when offered such fertility treatments. In my practice, it is important that we counsel patients in simple language. We share the indications of the treatments, the scope of benefit, and any potential harm.
These treatments are common, but practice varies considerably. I discourage the empirical use of such interventions, but will not deny patients a treatment where there is a potential benefit. The Cochrane database is in the process of publishing full systematic reviews on immunomodulation in recurrent implantation failure.
We are living in an information age and most of us prefer more information and data. This helps us make informed choices in all aspects of our lives.
Patients muster up a considerable amount of courage before seeking fertility treatment. The NHS may be an option for some, but most of us are well aware of declining NHS funding for fertility treatments. When patients choose to go with private treatments, they wish to give themselves access to the best IVF success rates which are currently almost double those from the public sector.
As fertility treatment specialists, we have a responsibility to counsel patients about the latest interventions. This is how they can make informed decisions. I believe it would be irresponsible to deprive patients of the opportunity to be informed about all their technological options and choices. This is especially true when there is potential to improve their IVF treatment success.