Infertility is currently known to affect 3.5 million people, or one in every seven couples in the UK. The World Health Organisation (WHO) has now recognised that infertility is a disease and the reality of the devastation and grief it causes has been widely acknowledged. However, with the NHS cutting the number of cycles it provides, treatment is starting to become inaccessible for all who require its assistance.
With the majority of patients self-funding treatment, many are now widening their search for clinics and choosing to travel abroad. It’s a common opinion that overseas IVF costs are more favourable, but how does the treatment realistically measure in terms of price, service and results, when compared to staying in the UK?
There are various reasons why couples struggle to conceive; conditions such as endometriosis, polycystic ovaries or other ovulation disorders are thought to affect one in five women, in the UK. Male factor infertility is also rising and, in 2016, was recorded as the most common cause requiring treatment, followed by unexplained infertility. Many couples will never even be aware that assisted conception is required until they begin trying for a family.
IVF costs in the UK
The use of IVF is increasing steadily each year and, according to the HFEA’s latest figures and trends (Human Fertilisation and Embryology Authority), is most commonly accessed by patients using the female’s own eggs and partner’s sperm (OEPS). These treatments accounted for 88% of all UK 2016 cycles. The majority of clinics are found in London, where IVF rates and female patient age are at the highest. From treatments undertaken in 2016, there were just over 60,000 cycles of IVF, in the UK, which resulted in the birth of 20,028 babies.
According to the NHS, one treatment cycle of IVF costs around £5,000. However, despite being regulated, fertility clinics are completely free to set their own price lists, meaning patients can pay differing amounts for the same treatment depending which clinic is used. There can also be huge discrepancies between what clinics advertise and what patients pay; decoding the actual costs of IVF is arduous and bewildering.
On average top clinics advertise a rate of between £3,000 – £4,000 per IVF cycle. However, this price won’t always include everything necessary for treatment, such as blood and virology screening or stimulation medication. Some clinics will also charge extra for the anaesthetic used during the egg retrieval and / or surgical embryo transfers. For clients undergoing ICSI there’s usually an additional fee of circa £1,000 on top too.
Another option, which is understandably increasing in popularity, is the use of unlimited IVF packages which offer up to 100% refund if couples do not have a baby within a specified timeframe. These programs can be arranged by some individual clinics or independent providers. Prices start at around £9,000 for IVF; ICSI and various donor or advanced maternal age packages are also available with some schemes. Again, the price doesn’t always cover every aspect of treatment with medications, blood tests and extra consultant appointments often levying an additional fee.
Wherever in the world patients go for treatment, confirming what is included is imperative. There is no real transparency around fertility services costs and there are likely to be hidden extras which aren’t included in the advertised prices. One UK clinic recently charged a client £4,000, in excess of the IVF costs, just for tests.
Clinics also sell popular yet controversial IVF “add-ons”, such as immunology tests, assisted hatching and artificial egg activation. As these are relatively new advances for reproductive science, they haven’t yet been fully medically recognised or proven to improve pregnancy or live birth rates. However, with 70% of all UK clinics currently offering a form of additional treatment, the HFEA are in the process of starting to regulate these, advising that further research is required before conclusions can be drawn. The question can therefore be raised over how fair, or ethical it is for clinics to recommend, what are essentially test phase services and may not actually provide the increased odds they are selling?
Add-on costs across the UK do vary but patients would typically pay; £500 for assisted hatching, £600 for Blastocyst cultivation and £200 for an endometrial scratch. Couples requiring PGD (preimplantation genetic screening) pay circa £2-3,000 in the UK, and elective “freeze all” cycles are not yet available, although a large clinical trial is underway.
Average costs of IVF “add-ons” in the UK
- ICSI – £800 to £1,200
- IMSI (in addition to ICSI) – £450 to £600
- Blastocyst culture (5 day embryo transfer) – £500 to £700
- AH – assisted hatching – £450 to £550
- Embryscope / Time Lapse – embryo monitoring – £750 to £1,150
- PGS – aneuploidies – £2,000 to £3,000
- FER – Frozen Embryo Transfer – £1,500 to £2,000
- EmbryoGlue – £130 to £360
- ERA test – £950 to £1,250
If you’re interested in egg donation in the UK – you may read: Egg Donation in the UK – costs, law and availability.
IVF NHS funding
According to a 2016 report from Healthcare Intelligence experts, LaingBuisson, the UK fertility business is thought to be worth £320 million. With infertility on the rise and more NHS postcode lotteries coming into effect, many patients are finding themselves privately aiding its steady market growth. In 2017 only 12% of CCGs (Clinical Commissioning Groups) followed the NICE (National Institute for Health and Care Excellence) guidelines of three cycles for every couple, where the woman is under 40. Although the governance of fertility services is UK-wide, the authorisation of NHS funding is delegated to a local level, giving CCGs the power to choose the amount of cycles, if any, they fund.
Scottish regions offer what is described by the HFEA, as a “Gold Class” standard of NHS funded IVF services. All eligible patients, in Scotland, can access the recommended three full cycles, including couples where one partner already has a child. Their English counterparts do not compare as favourably with funding reductions or complete cuts becoming commonplace. Currently seven CCGs, across England, have completely ceased funding for IVF altogether.
Alongside the cuts to the number of funded cycles, CCGs are also tightening the criteria for those eligible, wrongly allowing some couples to be accepted as private patients at clinics which previously refused to treat them on the NHS. Patients can therefore be left vulnerable and confused when it comes to costs and eligibility.
In England, couples hoping to qualify for NHS funded IVF or ICSI must both be childless and have been trying to conceive for an average of two years, with a diagnosed condition, or three years if unexplained. Where the female is over 36, this time is usually decreased, however, some CCGs will only fund treatment for women under 35. 8% also restrict funding based on male age. Both patients should be a healthy weight and 25% of CCGs refuse to fund IVF if the man’s BMI is not in line with their policy, even if it is female factor infertility. 25% of areas also deny funding based on AMH (Anti-Müllerian Hormone) levels. According to NICE guidelines, whilst AMH is a predictor of ovarian response, it cannot fully determine the chance of having a baby through IVF.
Being approved for NHS treatment is a much hoped for outcome but isn’t always straightforward, even when meeting the required criteria. Patients aren’t guaranteed their clinic of choice and consultant waiting times average at around 18 weeks. What is actually provided also differs depending on region. In some areas one cycle entitles patients to a fresh transfer and the freezing of any additional, good quality embryos. The NHS will then fund a certain number of FETs (Frozen Embryo Transfers) using those which have previously been vitrified (frozen). In other parts of the country, one cycle means just that; the transferring of one fresh embryo. If patients, in these CCGs, find themselves with embryos to freeze, they are required to self-fund any vitrification processes or further FET treatments. Similarly, sperm freezing, unless for cancer patients, is a private service and IVF add-ons are not included with NHS funding.
IVF Success rates in the UK
In 2016 UK birth rates per own egg partner sperm treatment cycles (PTC), were reported by the HFEA as 25% from fresh cycles and 28% from frozen. When looking at success rates per embryo transfer (PET) this was lower with live birth rates at 20% fresh and 22% frozen. 2015 was the first year that a higher live birth outcome was achieved by frozen embryos over fresh transfers. These results do not document whether any add-ons were used during treatment.
Seeking treatment abroad
Discovering IVF is required to have a family is incredibly overwhelming. The harsh criteria for NHS funded cycles can mean patients are left feeling unsupported during what is a confusing and complicated time. With lack of funding and clinics having free rein to charge whatever they like, it’s no wonder couples are looking further afield for treatment. But are the costs and levels of service comparable to the UK, and just how much of a realistic alternative is IVF overseas?
Destination and average IVF costs in Clinics abroad
The most popular destinations across Europe are Spain, Czech Republic, Cyprus and Greece. Spain is often described as the so-called centre of fertility tourism, with many other European countries quickly following suit.
Patients would expect to pay around £3,700 per cycle of IVF in Spain. A figure which includes stimulation medications, monitoring throughout the stimulation stage, the egg retrieval with general anaesthetic, day three embryo cultivation and the embryo transfer. Treatment is cheaper in the other top destinations, with clients paying on average; £2,800 in Czech Republic and £3,200 in Cyprus and Greece, for the same treatment inclusions.
Patients also favour Ukraine where clinics charge circa £3,200 per cycle, Poland at £2,800 and Latvia where fees are around the £3,200 mark, for own egg partner sperm IVF. India is fast becoming a popular destination for those seeking a UK alternative too. Whilst flights may be longer and possibly more expensive, IVF costs are only £1,800, on average.
Due to high success rates patients are also travelling to America, although treatment in the USA is notoriously costlier with patients paying around £9,000 for each cycle.
IVF Success rates overseas
IVF success rates overseas are advertised as higher than those achieved by UK clinics. It’s speculated this is partly due to their more controversial approach to treatment, especially regarding the previously mentioned “add-on” procedures. Additional techniques including embryo glue, IMSI (Intracytoplasmic morphologic sperm injection) and embryonic time lapse imaging, are typically conducted as standard in the majority of clinics abroad, despite the current absence of evidence. As reproductive research and scientific knowledge is readily amassing, it’s only a matter of time before substantial data is acquired to show whether, or how much, the widely disputed add-ons can enhance treatment and / or improve the odds of a successful outcome.
American success rates are higher when compared to the UK. The latest CDC report records a 31% live birth rate per treatment cycle (PTC), increasing to 45.7% per embryo transfer (PET), for women under 35 using their own eggs and partner sperm. America also reports a 49.9% live birth rate PET, from frozen cycles, within the same age range. In women between 35-37 years of age there is a 24% live birth rate PTC and 37.6% PET. Again, FETs are performing better with a 46.5% live birth rate, for women in this age group. It’s would be expected that experienced European clinics can also achieve similar results with specialist clinics potentially offering greater outcomes. Unlike the UK, European clinics are not required to report treatment statistics to an independent regulatory body, therefore it can be confusing when trying to unpick what the data actually reveals. However, the latest IVF-monitoring Consortium, produced by the ESHRE, included information gathered from circa 82% of all clinics operating across Europe.
All clinics worldwide are fully aware that patients are influenced by their statistics. It’s hugely important, when choosing a clinic, to fully understand what is being advertised, most crucially whether the results are based on pregnancy or live birth outcomes.
Why do patients go abroad?
Without a doubt, the popularity of overseas IVF is increasing. Overseas clients currently constitute up to 50% of all patients in European fertility clinics. With the lack of NHS funding, more patients are starting to look past the assumed complex logistics, preferring to swap the security of home comforts for more affordable treatment advertising greater odds for a positive outcome. Many experienced fertility centres across Europe boast success rates which are double those experienced in the UK.
Patients are also able to find a country whose individual legal requirements best match their own needs. This is particularly poignant when it comes to surrogacy or women requiring IVF with donated eggs; treatment in Europe can offer donor anonymity and larger donor pools.
Whilst CCGs continue restricting the amount of funded IVF cycles, and no pricing regulations are in place for UK clinics, it’s not surprising that many hopeful parents are now booking flights to access high quality treatment with a lower price tag.