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A Realistic Look at Assisted Reproduction

Progress Educational Trust’s one-day conference entitled “Reality Check: A Realistic Look At Assisted Reproduction” took place in London on 4 December 2019.

Louisa Ghevaert was delighted to attend the event and join the debate addressing key issues affecting fertility treatment in the UK and globally. Key themes included: the use of “add-ons” threatens the reputation of fertility treatment in the UK, ICSI should only be used for male-factor infertility but is still used in a large number of IVF treatments in the UK costing an additional £1,300 – £1,400. Forty years after the advent of IVF there are still no green HFEA traffic light ratings for “add-ons” and more evidence based research is required to fill the gaps in understanding and better inform the future delivery of fertility treatment for patients.

Professor Søren Ziebe, Professor of Clinical Embryology at the University of Copenhagen, issued a timely reminder of the basic principle in medicine to ‘do no harm’. He highlighted the risk of financial harm in the provision of fertility treatment, as patients often have limited financial resources and struggle to afford even basic treatment services. He highlighted the risk of administrative and regulatory harm, where excessive demands of administration and bureaucracy can increase costs, which are then passed on to patients. He raised questions about whether a person is a patient or customer and whether clinicians are doctors or salespersons and the impact of this, explaining that patients put their trust in fertility experts and expect them to use their knowledge, expertise and judgment in delivering treatment. He also raised concerns about the use of “add-ons” in treating patients with reproductive difficulties in the absence of clear medical evidence proving their efficacy, pointing out that this is not acceptable in many other areas, including surgery, aviation and the food industry. He questioned why “add-ons” are offered in the fertility sector and highlighted concerns about financial incentives and profit, as well as the challenges of managing patient demands for “add-ons” in the desperate hope this will increase their chances of having a baby.

Professor Nick Macklon, Director at the London Women’s Clinic, highlighted the urgent need for more research into IVF. He explained that there is still poor understanding about the reasons for IVF failure and a limited evidence base. He went on to question why forty years after the advent of IVF there are still no HFEA green traffic light ratings for “add-ons”, concluding this is down to lack of good quality medical evidence, funding difficulties and research gaps. He added that the HFEA should collect data on “add-ons” to produce more evidence and understanding about their efficacy and use in treatment.

Professor Christopher Barratt, Professor of Reproductive Medicine at the University of Dundee, explained that ICSI is currently overused in fertility treatment in the UK, increasing the cost of fertility by around a third. He explained that it should only be used in the treatment of male infertility (e.g. severe deficits in sperm quality and obstructive azoospermia). However, it is presently being used in a large number of UK fertility treatments, meaning fertility clinics could generate hundreds of thousands of pounds extra each year.

Dr Cristina Hickman, Chief Scientific Officer at Apricity, highlighted the importance and value of artificial intelligence and digital solutions to enhance fertility patient care and reduce costs. She explained that as we move into an era of precision medicine and personalised care AI will help reduce risks, make treatment safer and produce more live births. She went on to highlight the need for global standards to manage and process data to bring improvements and innovations to the fertility sector.

Dr Jan Grace, Consultant Gynaecologist at Guy’s and St Thomas’ NHS Foundation Trust, discussed genetic testing. She explained that there are two types, PGD (also known as PGT) for recurrent and inherited genetic disorders and PGS (also known as PGT-A) for random genetic disorders. She explained that most fertility treatment in the US now routinely includes PGS. She explained that PGS is not covered on the NHS and that it has to be funded privately in the UK, where it currently carries an HFEA “amber” traffic light rating.

This was followed by Professor Robin Lovel-Badge, Group Leader in Stem Cell Biology and Developmental Genetics at the Francis Crick Institute, who discussed the implications of genome editing for Down’s Syndrome. In answer to Louisa’s question about recent news of a Spanish/Greek collaboration and first clinical trial for the use of 3-person-IVF in the treatment of infertility, he explained that there are good indications for its use in avoiding mitochondrial disease but currently no clear evidence of benefit in the treatment of infertility.

Overall, the conference generated thought-provoking debate and highlighted the need for more high quality medical research into the causes of infertility to better inform treatment delivery and the use of “add-ons”. It also highlighted rapidly evolving innovations in digital, AI and genetic technology in the fertility sector and you can read more about these issues and the need for fertility reform here.

If you would like to discuss your situation or you require specialist fertility and family law advice and assistance please contact Louisa by email Louisa@louisaghevaertassociates.co.uk or by telephone +44 (0)20 7965 8399.

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