Forget 'one in 32 children from IVF' – we should aim for one in ten

According to the Human Fertilisation and Embryology Authority (HFEA), around one in 32 children born in the UK today is conceived through IVF (see BioNews 1295). Yet, in countries such as Denmark and Israel, nearly one in ten births result from assisted reproduction, showing what is possible when access is treated as a national priority.

To rise to this challenge, the UK should focus on two aspects of IVF expansion: first, deliver a coordinated national IVF strategy; and second, ensure easy access to treatment for all who need it.

Limitations with local commissioning: why a national strategy offers better decision-making

Access to IVF remains a postcode lottery. Integrated Care Boards operate under strict annual budgets and focus on meeting statutory targets such as cancer waiting times and A&E delays. IVF, lacking such measures, consistently falls down their list of priorities (see BioNews 1247). Local rules vary dramatically: some boards fund three cycles, others one, and many impose restrictive criteria based on age or previous children.

A national strategy would replace fragmented decisions with cohesive, evidence-based policy. Centralised commissioning allows:

• Long-term planning: National bodies can take a generational view. Past population policies show how decisions made decades ago still shape today's challenges. For example, policies in several countries during the 1970s and 1980s aimed at limiting population growth successfully reduced birth rates at the time but have also inadvertently contributed to today's ageing populations and declining fertility. These outcomes demonstrate that demographic decisions have long-lasting effects that can take generations to manifest. IVF's benefits also unfold over decades, demanding the same foresight.
• Expert input: Panels of fertility specialists, economists, and demographers can be available at the national level, to integrate clinical outcomes with economic and population projections. Policy that evolves with advances in science and society avoids the short-termism of local budgets.
• Consistency: Uniform standards end postcode inequalities, ensuring eligibility and funding do not depend on geography. This builds public trust through predictable and fair access.
• Efficiency: Central purchasing and streamlined administration cut duplication and costs. Negotiating better prices, standardising laboratory protocols, and reducing bureaucracy free up funds to benefit patients directly.

Other services, such as organ transplantation programmes, already benefit from this model. These programmes, like IVF, involve high-cost interventions that deliver long-term benefits, require specialised expertise, and must be equitably available regardless of location. Organ transplantation is centrally coordinated to ensure organs are allocated fairly and efficiently across the country, avoiding regional inequalities. IVF shares these characteristics: it is a specialised service with profound personal and societal benefits, where inequitable regional provision undermines both fairness and overall impact.

However, while centralisation alone ensures fairness and may help with efficient delivery, it must be paired with expanded funding to increase overall access. Expanded access to IVF is not only beneficial to those who suffer from infertility; it is also a cost-effective solution on a societal level.

Why economics favours more IVF

IVF delivers strong economic returns. UK research estimates each IVF-conceived child contributes over £100,000 in net lifetime taxes versus an effective public cost of around £13,000–£16,000 per live birth. Funding three cycles (£15,000) still yields a strong return on investment. US models confirm this, with returns of $155,000 per child. Unlike treatments with ongoing costs, IVF is a one-off intervention generating decades of economic contribution.

For context, the National Institute for Health and Care Excellence generally approves treatments that cost £20,000–£30,000 per quality-adjusted life year (QALY), and for end-of-life cancer therapies, thresholds may rise to around £50,000 per QALY. These drugs often extend life by only a few months. By contrast, IVF is a single intervention that results in a new individual who contributes economically and socially for decades. This straightforward comparison underlines why IVF is exceptionally cost-effective.

It should be acknowledged that diminishing returns with advancing maternal age mean some treatments are less effective in older patients. This is an argument for better age-targeted policies, not for underfunding IVF altogether. Countries that have achieved high access levels have done so by tailoring funding criteria sensibly, ensuring both efficiency and fairness.

The UK fertility rate is just 1.44 children per woman – below the 2.1 population replacement level. IVF alone cannot reverse this, but it ensures those who want children are not denied the chance. As part of wider measures – affordable childcare, parental leave, housing support – IVF supports demographic resilience.

Addressing other concerns

• Demand fears: In Denmark, demand for IVF stabilised at eight to ten percent of births under universal access. We can, therefore, be reassured that expansion does not lead to uncontrolled demand, and central systems can negotiate prices to keep costs sustainable.
• Fairness: Infertility affects one in six adults and is recognised by the World Health Organisation as a disease. National funding would remove current barriers, ensuring equal treatment for all patients with medical need.
• Ethics: IVF is tightly regulated by the HFEA. Over 12 million babies worldwide have been born safely via IVF. Expanding access under this regulation preserves safety and ethical oversight.

Building on previous calls for change

Past proposals, including those from professional societies and government strategies, have focused on advocating fairness and ending the postcode lottery. These are important foundations, but they stop short of envisioning what expanded provision could achieve. My argument builds on these earlier calls by advocating for a strategy that not only unifies access but also scales it up, aiming for the 'dream' goal of one in ten births from IVF. This approach combines equity with a proactive vision for economic strength and demographic stability.

With national leadership and funding, the UK could move from 'one in 32 births from IVF' to an ambitious yet achievable 'one in ten'. Centralisation ends inequity and enables expert-led decisions, while investment unlocks IVF's full potential. This is not just about numbers and policies – it is about fairness, hope, and the belief that everyone who wants to build a family should have that chance.

The UK can choose to lead with vision, learning from countries that already treat fertility as a priority. The real question is not whether we can afford to do better, but whether we can afford not to.

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The early days of IVF will be explored at the upcoming free-to-attend online event Robert Edwards at 100: Remembering an IVF Visionary, taking place on Wednesday 24 September 2025.

Find out more and register here.