# UK falls behind most of Europe on provision of infertility treatment



## Anthony Reid (Jan 1, 2002)

INUK Press Release 4th July 2007

Patients angry that UK falls behind most of Europe on provision of infertility treatment and success rates

Figures announced today on the success of ART treatments in Denmark, leaves patients and patient representatives in the UK sickened at how far behind we are from much of Europe on both success rates and NHS provision of treatment.

The UK continues to have a postcode lottery on infertility treatments.

Looking at the report coming from Danish doctors today Clare Brown, Chief Executive of Infertility Network UK said  The UK pioneered infertility treatment and had the first baby being born from IVF. Sadly, since then we have become among the lowest providers in Europe of NHS treatment for infertility sufferers. The recommendations in the NICE Guideline seem very similar to the provision in Denmark, but have yet to be fully implemented. The question has to be asked that if they were fully implemented and people had access to 3 full cycles of treatment, would we also see success rates improve.

Ms Brown went on to say  We need to look closely at what they are doing in Denmark and how they are doing it. We need to look at how they choose the best embryos, how the treatments are costed in the public health system there, and is it a case of practice makes perfect.

Given that there is a move toward elective single embryo transfer in the UK, Infertility Network UK calls upon the government to ensure that the NICE guideline is fully implemented immediately. In order to ensure that pregnancy rates are not significantly affected, a full cycle of IVF needs to include both a fresh embryo transfer and the subsequent replacement of frozen embryos derived from that cycle.

Finally Ms Brown stated  If three full cycles of treatment can be given to patients in counties like Denmark and if they can achieve success rates in the region of 60%, then the UK must act immediately to ensure that patients here can also access the very best services possible. To be so far behind other countries in Europe in the provision and success of fertility treatment is totally intolerable


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## Greeneyed (Apr 12, 2006)

Should those who are paying for treatment all be going to Denmark then instead if the success rate is 60% 

This is an interesting statistic, I wonder what % the lifestyle factor accounted for (making an assumption that Danes are healthier than us brits!)


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## Lorna (Apr 8, 2004)

I just love the way this article, manages to muddle up, two completely separate issues, and makes it sound like the lack of NHS provision is responsible for the low success rates in the UK. It is brilliantly done.
I read the sentences The UK pioneered infertility treatment and had the first baby being born from IVF. Sadly, since then we have become among the lowest providers in Europe of NHS treatment for infertility sufferers. and my brain goes: Subject disconnect!
My reaction is surely The UK pioneered infertility treatment and had the first baby being born from IVF, is about quality of care, what our success rates are like, and so on, rather than, whether you get free goes on the NHS.

And when I read about eSET, and then about Denmark: In order to ensure that pregnancy rates are not significantly affected, a full cycle of IVF needs to include both a fresh embryo transfer and the subsequent replacement of frozen embryos derived from that cycle.
Finally Ms Brown stated  If three full cycles of treatment can be given to patients in counties like Denmark,....
I am left with the feeling that Denmark is giving 3 full cycles of eSET. In fact, the government of Denmark has categorically rejected eSET.
http://www.sst.dk/publ/Publ2005/CEMTV/IVF_1_2/IVF_1_or_2summary.pdf
The Danish government discovered that, if it insisted, on fresh SET/Frozen SET, then the rise in treatment costs, completely swamps, any saving, you might make in maternity services, or SCBUs. As the Danes say from an economical point of view, DET was more cost effective per delivery, and per child than a SET policy.
And in Denmark only one full cycle of treatment is offered to *all* patients. When a patient wants to go for another full cycle of treatment, the Danish Health service, look at what happened in cycle1, before allowing you to proceed. And so on for cycle 3. Yes the vast majority of patients get 3 full cycles, but not *everyone*. And I feel to imply that is misleading.

Whoever wrote this article has done a fantastic job of completely muddling up multiple issues, NHS provision of IVF, quality of care, eSET, and so on. I take my hat off to them. Superbly done.
I guess I had better turn sarcasm mode off, although I am finding it hard.

First issue: number of cycles funded by a government
The provision of more low cost, I doubt it is entirely free, cycles of IVF in Denmark, couldnt possibly have anything to do with the fact that the Danes pay more taxes and have done for years. If Denmark is anything like Belgium, then high taxes will also have paid for, better public transport, better pensions, better child care provisions, and so on.
So the Danish Health service provides 3 heavily subsidized IVF cycles, and the UK NHS provides very few. Well that couldnt be due to the fact, that the Danish government has a 5000 million dollar budget surplus to play with, while the UK government is struggling to reduce our 60,000 million dollar budget deficit! https://www.cia.gov/library/publications/the-world-factbook/rankorder/2187rank.html
Yes? No? Maybe?

Success rates is a completely different subject.
If a tabloid journalist wants to trash someones reputation, they dont come and out, and write something malicious; theyd get sued. What that journalist does instead, is, ask a question. Is XXX sleeping with someone other than their spouse? XXX maybe having an affair, or they may be totally innocent, but the question, makes you wonder about XXXs morals.
So when the above article says The question has to be asked that if they(the NICE guidelines) were fully implemented and people had access to 3 full cycles of treatment, would we also see success rates improve. You, well maybe I should say, I am left with the distinct impression, the answer is yes.

True there does seem to be some correlation, between countries, that provide, 3 or more heavily subsidised cycles, and excellent success rates. So if you want to get pregnant, go to Belgium, which provides its tax payers with 6 cycles of IVF on the Belgium Health service, or Denmark which under some circumstances, but not for everybody, provides 3 cycles of IVF.
But maybe their success in getting women pregnant, is due to the fact that in Belgium, Denmark, Finland, etc., it is doctors who make the treatment decisions, not a committee made up of dentists, media experts, lawyers, etc.? Or maybe it is something else?

So why is country A more successful in getting women pregnant, than country B. Well IMO, the reasons are many, and complex, and I dont even begin to understand all the issues. To suggest *success*, is due to one criteria, availability of IVF on the NHS, or freedom of doctors/patients to make treatment decisions is, quite frankly, ludicrous.
If the reason why Belgium, Denmark and Finland have such good pregnancy success rates, is because doctors/patients make treatment decisions, why is the deregulated USA languishing around 12th in the leagues tables? I think there is something else going on.

With IVF the reasons are many, and complex, as to why one country is more successful in getting women pregnant, than another country. You cant just tweak one bit, and expect, most transfers to go to pregnancies, and then tweak something else, and have most pregnancies to go to live births. The person, who manages that, will be rich beyond their wildest dreams. Wouldnt you go to the clinic, that could guarantee you a 90%, 95%,98%..... chance of a live birth, after one cycle of treatment?

So, The question has to be asked that if they(the NICE guidelines) were fully implemented and people had access to 3 full cycles of treatment, would we also see success rates improve, is, of course we wouldnt see success rates rise. They would be as dismal as ever, and we would still be languishing around the bottom of the European league tables http://www.timesonline.co.uk/tol/news/uk/article696419.ece British Fertility Clinics At Foot Of IVF League.
But by asking the question, people have been diverted from looking at the real reasons!

Now I am going to state two facts, one after the other, just like this article did. It might look like the two sentences are linked. And because these two sentences come after the previous paragraph, it might look like everything is connected. But that is of course just coincidence. I am much too angry, with this article, to write down coherent thoughts.
Seventeen years ago, the then, Conservative government passed the HFEA Act, which resulted in the creation of the HFEA Committee.
Since 1990 the UK has been slipping down the league tables of pregnancy success rates, till now we are around, 17th in Europe. By the time we add in results, from North America, the Far East, and Australasia, my best guess is that the UK is about 25th in the world.

What other point would I like to make about this article? Well theres .....OOPs, I think that is a bit derogatory, maybe Id better shut up

Sorry this article really did make my blood boil.

Lorna ( who has steam coming out of her ears)

/links


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## Morvern (May 16, 2005)

Lorna - thank you for such an informative post.  You have picked the issues apart with surgical precision. Are you an academic or a journalist by any chance? If not you should be.


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