IVF doesn't always deliver

The promise of babies for all has failed to materialise, says Victoria Lambert.

By Victoria Lambert Published: 7:00AM BST 27 May 2009

When Louise Brown, the first test-tube baby, was created 31 years ago this week, it took scientists more than 100 embryo transplants to get it right. Now, more than four million babies have been created by in-vitro fertilisation, including more than one per cent of all babies born in Britain.

In the largest study to date, following more than 6,000 women through six IVF cycles, which was published in the New England Journal of Medicine in January, it was reported that the cumulative chance of a successful live birth following IVF ranges between 65 and 86 per cent in younger women and between 23 and 42 per cent in women aged 40 and older. Almost anyone, it would seem, can have a baby.

Doctors and the media may give warning that many women are simply "leaving it too late" to have a child, but the anecdotal stories disagree; Britain's oldest mother, Elizabeth Adeney, gave birth to a son in May at the age of 66, following IVF treatment in the Ukraine. Earlier this month, ovarian cancer claimed the life of the world's oldest mother, Maria del Carmen Bousada, 69, who left two-year-old twin boys. The morality is debatable; the power of science is not.

Yet, if IVF were that easy and reliable, surely involuntary childlessness would be a condition of the past? Instead, one in six couples will seek help with conception, resulting in 35,000 women having IVF each year with just under a third of those giving birth. However, experts believe that the true number of those needing assistance is higher. Dr Gillian Lockwood, medical director of Midland Fertility Services and author of Fertility and Infertility for Dummies, explains: "A higher number are technically infertile but don't seek help. Either they can't afford it or they don't want to be labelled infertile – there is still a stigma."

She adds: "IVF can offer to the majority who seek its help the realistic possibility of a child – as long as they have the emotional and financial resources necessary. And they are not too old: to be specific, aged under 38."

For despite the stories of gamete-grabbing grannies, age remains the most important factor in IVF success. Figures from the Human Fertilisation and Embryo Authority (HFEA), which cover individual cycles, show that for women under 35 the success rate is 31 per cent. For those aged 38-39, the percentage drops to 18.2. Women aged 43-44 have no more than a 3.2 per cent chance. (The results for individual clinics differ widely; the HFEA website carries up-to-date lists.)

Dr Lockwood explains: "Little girls are born with every egg they will ever have – and as they age, the quantity and quality of those eggs will decline. Once they reach their thirties, the decline accelerates. The woman aged over 35 will take twice as long to get pregnant as her younger friends."

Dr Lockwood thinks part of the problem is that we all look and feel much younger these days but "you can't Botox your ovaries", she says. And she fears we are buying into the stories of Hollywood stars who claim to fall pregnant naturally in their forties, when the reality is they have relied on donor eggs from younger women. "Cherie Blair had a natural pregnancy at 45 – she was very lucky and very exceptional."

The second greatest restriction on the success of IVF treatment is cost; the average cycle of IVF costs £5,000 privately, according to NHS figures, and most clinics will recommend that three cycles will be needed for success.

Although the National Institute for Health and Clinical Excellence (Nice) does permit three cycles of IVF on the NHS, its criteria are strict. Mothers should be between 23 and 39, have been diagnosed with a specific fertility problem (such as blocked fallopian tubes), or have a partner with faulty or inadequate sperm, plus they must have been infertile for at least three years. Many Primary Care Trusts interpret this harshly, refusing treatment also to anyone with an existing child, aged over 35, or over a certain weight. In 2006, only nine of the 161 trusts in England and Wales offered three free cycles.

No wonder, then, that infertile British couples are among the least likely in Europe to receive the treatment they need to start a family. According to figures from the European Society of Human Reproduction and Embryology (ESHRE), Britain ranked 11th out of 13 countries, with only Germany and Montenegro providing fewer cycles of IVF in proportion to their population. Dr Lockwood believes this is unfair. "We are the fourth richest economy in the world and IVF was invented here, yet we have one of the lowest funding records in Europe, let alone the world." Dr Geeta Nargund, Head of Reproductive Medicine at St George's Hospital, London, and Medical Director of the Centre for Reproduction and Advanced Technology (Create Health), agrees.

"NHS funding has increased and that's good, but I think it is outrageous that women are usually denied it when they are over 40 simply due to poor success rates. These are the women who have been working away contributing to the public purse, and they may not have found a partner or been in a position to try for a child before. They know the risks and the possibility of failure, but they are entitled to a chance to be a mother."

No wonder many couples find themselves considering sperm, or more commonly egg, donation abroad, where treatment is cheaper. In 2004, rules governing the HFEA came in that ended the right of sperm or egg donors to anonymity, on the grounds that children should be able to know their parents. This has led to a collapse in the number of donors here, as few are willing to risk the arrival one day of a potential dependent on their doorstep.

According to Zita West, a former midwife and now fertility counsellor in central London, the problem is acute. "I wish we could change the rules; we're driving women abroad for egg donations."

A report from University College Hospital, London, on why and who travels to Europe for fertility treatment supports her concerns. It revealed that difficulties of access to treatment were cited more by patients from the UK (34 per cent) than from other countries; while 63.5 per cent of British couples were over 40.

"I hear awful stories from couples who have gone abroad for treatment," says West. "There are administrative problems, language issues, it can be very difficult at what is already a stressful time." Nor do these couples get the emotional support or "implication counselling" that is on offer at home. "I ask couples to consider how and when they will tell their child that they come from a donor egg, to think beyond the baby and consider the implications generally."

For women who, for personal or professional reasons, still want to put off conception, Dr Lockwood advocates egg freezing in your thirties. "It is not a guarantee of success, but you are more likely to get a baby using eggs frozen in your thirties than using your fresh forty-something eggs."

However, Dr Nargund disagrees. "Egg freezing should certainly be offered to women with cancer prior to chemotherapy or radiotherapy in order to preserve their fertility," she says. "But we should not promote it to all women with a view to delaying their motherhood. We need larger data to evaluate its results and safety and so far the results do not support it as an option for all women."

There is no doubt that IVF is a Pandora's Box – opening up the promise of babies on demand, but, on closer scrutiny, perhaps not the reality.

Curiously, the one area upon which all IVF experts seem to agree is that we should be doing less of it. "At 45, your chances of IVF success are so low you might as well dig a pit and throw money into it," says Zita West.

Instead what she, Dr Lockwood and Dr Nargund are agreed on is that a change of attitude is needed. "We need to remember that not all women will be in a position to have their babies younger, but that is the ideal situation," says West.

Dr Nargund would like to see preconception clinics in the NHS to teach women and men how to optimise their fertility and increase the rates of natural conception. This would lower the need for IVF, and mean women suffered fewer complications. "We would save money and have a healthier population."

Dr Lockwood adds: "We need to make it easier for couples to have babies younger. At the moment, a young woman has just a decade to go to university, get her career started, pay back her student loans, find Mr Right, get a roof over her head and then have children. No wonder the babies get put off till later."

Originally appeared in the Telegraph 27/05/09