Fertility Costs Questioned
One of the problems of fertility treatment is accessibility and the high costs involved.
Costs Cutting Choice
What fertility treatment you are offered on the NHS may depend on what is most cost effective overall and where you live. Using a decision tree helps doctors to decide the most appropriate fertility treatment, and you may be offered a cheaper treatment first, if it is statistically likely to be effective.
Despite the NICE guidelines that says eligible infertile couples should be able to receive 3 cycles of treatment on the NHS if the woman is between the ages of 23- 39, many Primary Care Trusts (PCT's) do not offer more than one treatment cycle. This is mainly due to the general funding cutbacks in the NHS. Another reason that costs are high is that many health authorities base their charges to PCTs on the costs of ART in the private sector rather than the actual costs involved. This means that less people can be treated.
What Are The Real Costs?
Lord Robert Winston, the noted Emeritus Professor of Fertility Studies, at Imperial College London and the Past Director of NHS Research and Development, Hammersmith Hospitals Trust, recently questioned the high costs and availability of fertility treatment in the House of Lords (ref Hansard 9th May 2011). He believes that the NHS should look at the real costs involved of the various treatments.
When he was running the Hammersmith clinic, he kept his costs as low as possible and was still able to turn over £1 million a year for research. Hammersmith Hospital also benefitted from surplus funds, which they used for treating other patients. Lord Winston pointed out that clinics are often charging as much as £3,400 per cycle, with drugs costing from around £1,000 to £3,200 whereas these fertility drugs could be obtained on contract for around £500-£700 per cycle.
Embryo Freezing Charges
Another concern of Lord Winston is the costs charged for embryo freezing. As more and more women are only having a single embryo transfer (SET), it is very important to be able to freeze other embryos for future use. However, many clinics charge a lot of money e.g. £900+ for embryo freezing which is a relatively simple procedure. Storage fees can also be high e.g. £300+ per year when the actual costs of the nitrogen needed to store the eggs or embryos is pence per litre. These costs may make being able to have more treatments or another child prohibitive for many couples.
Are Treatments Effective?
Lord Winston also questioned in the House of Lords the fact that many private clinics offer additional treatments such as 'preimplantation genetic testing' to people who do not have a genetic defect or 'assisted hatching' without any evidence that they work. These types of treatments are not cheap, but "...patients who are desperate will do anything..."
Baby Take Home Rate
According to Lord Winston, many private clinics give misleading information. They often advertise very high success rates, by quoting success rates without saying that they are actually talking about pregnancy rates not a 'baby take home rate'. They may also give cumulative cycle results where women have had many treatments in order to get pregnant, rather than the rate per cycle. This is especially true when they are quoting success rates for older women (40 - 42+), e.g. 30%, where the actual implantation rate even for women under 40 is between 18% -25%.