Fertility trends: Outcomes improve but NHS cycles down

The Human Fertilisation and Embryology Authority (HFEA) annual trends and figures reports are eagerly awaited by clinicians, funders and patients. They provide a window into developments in the fertility sector, featuring prominently in counselling patients and providing information about success rates. They also assist funding authorities in reviewing their policies.

The preliminary trends and figures for fertility treatment carried out in 2022 were published in July (see BioNews 1248), although the fully validated results will not be available until the end of 2024. However, the report sheds light on the volume of treatments offered, improvements in clinical and laboratory practice and success rates, the prevalence of conception delay, as well as attitudes to egg freezing and use of donor gametes.

Crucially, the report also highlights the degree of access to NHS-funded treatments among couples and individuals.

Several trends suggest that clinical and laboratory practices have improved:

• The average overall pregnancy rate from IVF using fresh embryo transfers and patient's own eggs increased from 21 percent per embryo transferred in 2012 to 31 percent in 2022. This increase was observed despite the age of first-time IVF patients increasing to just over 35 years.
• The pregnancy rate among women aged 43-44 who used their own eggs increased from five percent in 2012 to nine percent in 2022.
• The multiple pregnancy rate has been the lowest observed so far. This highlights the widespread adoption of elective single-embryo transfers.

The causes for the observed increase of female age at first IVF is not known but the post-pandemic effect and difficulty of affordability and access may have a role. However, the increased age also suggests that IVF is not being carried out or offered prematurely.

The use of donor eggs, sperm and embryos in fertility treatments has increased over the last decade, accounting for around one in 200 of all live births in the UK in recent years. The increased use of donor sperm, particularly, is understandable given the rise in single persons and same-sex female couples accessing fertility treatments. These figures reveal wider acceptance of donor gametes and embryos as well.

The number of UK-based sperm donors has fallen, with over half of new sperm donations being imports, whereas 96 percent of new egg donors were UK-based.

Egg and embryo storage cycles have increased substantially, possibly reflecting growth in both medical and elective fertility preservation. The landscape is changing with increased awareness and conversations about fertility preservation options. Despite this, egg freezing still only accounts for five percent of treatments.

Despite ever-increasing fertility treatments, the proportion of treatments funded by the NHS was at an all-time low, accounting for 27 percent of treatments across the UK. This is a substantial drop from 40 percent in 2012.

Although integrated care boards and funding authorities seem to be addressing funding disparities, several challenges remain:

• NHS funding is still inconsistent across the UK
• Strict criteria in terms of age, BMI and ovarian reserve restrict access to NHS funding
• Donor insemination for same-sex female couples and single women is not routinely funded and both groups have to have self-funded treatments unless they have proven infertility or demonstrate multiple unsuccessful cycles
• NHS funding is not available for individuals and couples who have existing children. The preliminary data does not reveal how many cycles of IVF were carried out for secondary infertility
• Surrogacy is excluded from NHS funding

The preliminary figures reveal good practice but also highlight the fact that the vast majority of fertility treatments are carried out in the private sector. Collectively, more work is needed to understand why the number of NHS-funded cycles has declined compared to previous years. There could be merit in comparing fertility care with other elements of healthcare and with the socio-economic health of the population. For example, how does the cost of living impact access to privately funded healthcare?

More information is required to understand some of these trends such as the average duration of conception delay, the proportion of cycles incorporating pre-implantation genetic testing, and possible reasons for delays in accessing care.

The HFEA trends are a crucial resource for patients, healthcare professionals and funding bodies and we eagerly await the fully validated results.