Fertility clinics are not all the same, which is why IVF success rates vary so greatly. In the UK, the latest live birth rate for the under 35‘s (per cycle started), ranges from 14% to 63%. Therefore, to give yourself the best chance of a successful outcome, it is imperative to understand how to choose a fertility clinic.
In the UK, the HFEA advises patients to choose an IVF clinic based upon 3 ‘top-line’ measures. Firstly inspection ratings, secondly patients ratings and finally, whether the IVF birth rate is consistent with the national average.
However, I would argue that these are not the most accurate way to distinguish one centre from another, for the reasons detailed below. The data for which was taken from the Human Fertilisation & Embryology Authority’s (HFEA) UK website, in May/June 2019.
Understanding the 3 ‘top-line measures
1. Inspection Star Rating
The HFEA issues different licenses for treatment, storage and research of eggs, sperm and embryos. In addition, a clinic may hold a basic treatment license, such as for Intrauterine Insemination (IUI), with partner or donor, or it could have full license for all types of fertility treatment, including IVF, ICSI and genetic diagnosis.
No permanent licences are granted by the HFEA, who charge an average of £500 renewal fee for each one they issue. The Inspection Star Rating only indicates the length of the centre’s current licence, which can vary from 4 years to 3 months (Table 1.). Also, the licence is for the particular premises, not the whole organisation. For example, if a fertility clinic has multiple locations, every individual address will need an independent license, each of which could be for a different duration. This applies even if the sites are in the same street, for the same company, using the same treatment protocols.
In June 2019, 80% of HFEA licensed IVF clinics had a 5*rating, 11% had a 4* rating and 9% were new clinics with no ratings (Table 2).
In June 2019 all the current UK fertility clinics had similar inspection star ratings
2. Patient ratings
The world is currently undergoing a paradigm shift, as society is reshaped by the 4th Industrial revolution. Millennial’s are used to rating and reviewing products, creating a data rich 24 hour market, that is rapidly driving all areas of the economy, including healthcare.
Patient ratings comprises of 5 questions that are answered anonymously via the HFEA’s ‘Rate your clinic’ page. They are supposed to be by patients who have had treatment in the last 12 months only. These ratings are not currently verified by the HFEA and the system is, therefore, potentially open to abuse. There were 84,055 IVF cycles in 2017-18 and between July 2017 and March 2018, 1,500 respondents used the rating system (which equates to 1.78% of cycles). Approximately 90% of clinics had less than 30 ratings and only 2 clinics had more than 400.
Only a fraction (<2%) of patients undergoing IVF cycles have rated their clinic
3. Comparison to the national average IVF success rate
Finally, the third measure, is to compare all centres against the national average IVF live birth success rate per embryo transferred (PET). This is currently 27% for under 38 years, 11% for 38 and above, and 21% for all ages. Clinics may be deemed consistent with the national average, even if their IVF success rates are considerably below it.
A review of the HFEA website in June 2019 showed that the majority of clinics were within the national average (Table 4.), the remaining did not have any verified statistics for the time period.
Almost all UK clinics are deemed to be comparable with the national live birth average, despite wide variations in IVF success rates
How to choose a fertility clinic?
I would advise using the ‘detailed statistics tool‘ on the HFEA website. This enables a comprehensive search of the latest statistics for both pregnancy and live birth rates of the 7 age groups, for multiple years and for all treatment options. The data demonstrates the number of treatment cycles started by each individual clinic, with the resulting number of egg collections and embryo transfers. These can be compared to produce additional statistics. For example, if a clinic starts 100 IVF cycles and 80 of them have an egg collection, the clinic has a 20% cycle cancellation rate. This may be for a number of reasons, but one of the most common is the incorrect initial choice of drug protocol (which may lead to over or under stimulation with fertility medications) and inadequate monitoring . Also, the final percentage of embryo transfers (in relation to the total number of cycles started) should be considered. As similarly, this indicates the level of effective egg collections, laboratory techniques, freeze-all due to OHSS and overall clinic performance.
In addition, I would advocate looking at multiple time periods. In the 24 years since the HFEA began publishing IVF success rates, there have been occasions where a clinic has produced exceptionally high statistics, but for one year only. The next year the rates fall again.
The best clinics have consistently high IVF success rates, per treatment cycle started, year on year.
The clip below demonstrates how to use the HFEA’s detailed statistics tool
Comparison of UK IVF success rates
The following tables were compiled using the latest statistics available on the HFEA website, accessed May 2019. They are shown as per cycle started.
In 2014 the HFEA asked patients how they would like IVF success rates to be presented. Their survey confirmed that 82 % of patients, donors, donor conceived people or their parents wanted the results to be shown as per cycle started, rather than per embryo transferred. This is because they prefer to view clear unambiguous data, that demonstrates their individual chance of success, from starting a treatment cycle at each clinic.
Table 5. represents pregnancy success rates for the under 35 years age group. For the time period July 2015 – June 2016 and is collated from fresh stimulated IVF + ICSI cycles, in which patients used their own eggs. IVF success rates for other age groups may be viewed using the links under the table.
Why are the results outdated?
IVF success rates are always slightly outdated. It takes more than a year to collect and collate the information about each treatment cycle. The final outcome cannot be entered until the baby is born and sometimes this takes even longer to be reported back to the clinic. Parents do not always realise the importance of informing the clinic about their new baby, or they may have changed contact details and are difficult to trace. This results in a delay, or even a missing outcome, as the data must be certified by each clinic before being published.
Originally, the results were published annually. This created a great fanfare and was covered by the multimedia of the time. The frequency of the statistics release date was then changed to 3 monthly. This proved too cumbersome for everyone involved and so was amended again, with IVF success rates being updated every 6 months. However, this has not happened now for the last 3 years. This is because since 2015/16 the HFEA have been developing a new data submission system called PRISM and have not updated the IVF success rates on their ‘Choose a Fertility Clinic’ web page during this time. More recent results may be viewed on individual clinics websites, but unless stated as ‘HFEA validated’, this data cannot be confirmed as correct.
Why are some clinics not listed in the tables?
Success rates are published for each licensed clinic. However, some clinics will not perform enough treatment cycles to qualify for statistical significance, particularly in the older age groups. Or may not treat patients within that age group. Other clinics are new and will not have validated results for the given time period, despite being operational during this time. This is compounded by the current delay, due to PRISM. A number of clinics hold a license for Intrauterine Insemination (IUI) but not IVF/ICSI and, therefore, will not have any success rates for these treatments.
Finally, some clinics do not hold their own HFEA licence and use the facilities of another licensed centre. The primary unlicensed clinic manages the ovarian stimulation of the patient, but perform the egg collection and embryo transfer at a secondary licenced centre. Thereby, incorporating the statistics for this patient into the second clinic’s results. The first clinic will assemble their own IVF success rates and show them on their website. However, the results will not be independently validated or published on the HFEA’s website.
UK IVF success rates per age group
Conclusion
The HFEA advises patients to choose a fertility clinic based upon 3 ‘top-line’ measures. These are inspection ratings, patients’ ratings and whether the IVF birth rate is consistent with the national average. However, by using these measures all clinics appear to be the same. Which cannot be the case, because IVF success rates vary greatly.
It is possible to make a more in-depth assessment of each clinic by using the ‘detailed statistics tool‘ on the HFEA website. It allows a full search of both pregnancy and live birth success rates for all of the 7 age groups. This, together with a statistical analysis of cycle cancellation rates and failed embryo transfers, is a reliable indication of overall clinic performance. Especially if it can be consistently demonstrated over a number of years. Links to league tables presenting statistics for different age groups are provided in the UK IVF success rates per age group paragraph above.
It is not possible to choose a fertility clinic by simply applying the HFEA’s 3 top-line measures. The best way is to make an in depth assessment of success and cancellation rates.