TV Review: Inside Out West - 29.10.18 (BBC)

Fertility treatment is big business within the UK. The ever-increasing demand for fertility services combined with the dwindling availability of NHS-funding for fertility treatment has created a booming 'fertility industry'. There are now over 150 licensed fertility clinics in the UK, all competing for potential patients, and the combination of medical care and financial profit is a worrying mix. 

Individuals and couples searching for a fertility clinic are in an incredibly vulnerable position and the potential for patient exploitation is extremely high. Matthew Hill, a health correspondent for the BBC, carried out an undercover investigation into the marketing practices of a new fertility clinic in Bristol. The results of the investigation can be seen during a recent episode of the documentary series Inside Out West and make for some concerning, but also confusing viewing. 

Create Fertility, one of the largest fertility providers in the UK, describe themselves as 'pioneers of natural and mild IVF' and aim to use lower doses of ovarian stimulation drugs during treatment to collect a smaller number of potentially higher quality eggs than conventional IVF treatment. Inside Out West sent an undercover reporter posing as a potential patient to Create Fertility's clinic in Bristol. 

Recorded footage of an informal patient information event shows Dr Gurpreet Kalra, a consultant clinician at Create Fertility Bristol, telling the prospective patients that Ovarian Hyperstimulation Syndrome (OHSS) – an extreme reaction to ovarian stimulation drugs – is responsible for the death of approximately three IVF patients each year. Dr Kalra repeats this statistic again during a one-to-one consultation that the undercover reporter has with the consultant.

OHSS is a known risk of ovarian stimulation and can range from mild to critical. All cases of severe or critical OHSS in the UK have to be recorded and reported to the Human Fertilisation and Embryology Authority (HFEA). 

Professor Enda McVeigh, a clinician and academic at the University of Oxford, tells Hill 'there has not been three people die from OHSS, or from IVF, last year, or the year before that, or the year before that. It is just not correct'. He says that this type of misinformation makes him 'really cross', and as someone who works in the fertility field, I too find it upsetting that potential patients are being given inaccurate information.

Dr Kalra says that he 'never intended to misrepresent facts or scaremonger but may have made a mistake'. 

Patients need to be able to trust that they are getting accurate information from clinicians. As Professor McVeigh says, because Dr Kalra is using inaccurate facts 'you have to call into question everything else that this gentleman says'. One fallacy can create doubt around everything else.

Matthew Hill seems to take this sentiment to heart and the remaining portion of the programme sees the investigative team hunting for more inaccuracies in the information that Create Fertility provide to their patients.

Hill questions whether the way the clinic presents their success rates is misleading to patients. He also questions the clinic's claims of a mild or natural approach when some patients receive a similar daily dose of stimulation drugs to patients who are undergoing conventional IVF.  However, I did not feel that adequate evidence was produced to substantiate these concerns.

Viewers are introduced to Natalie, a patient who underwent an unsuccessful mild IVF cycle at Create Fertility. Natalie states that she was give the same stimulation drug dose as a friend who was undergoing conventional IVF at a different clinic, and she now queries whether her treatment was really mild. However, it is not just the daily drug dose that defines whether a cycle is mild, you also need to take into account the number of days that the patient underwent stimulation and the characteristics of the patient, such as age and body mass index. Making comparisons between different people with incomplete information is not evidence. 

Hill meets with Professor Geeta Nargund, Medical Director of Create Fertility, and challenges her about the dose of stimulation drugs that Create Fertility patients receive. The discussion is difficult to follow, and it seems like Hill and Professor Nargund are having two separate conversations, and each seems to have a different definition of what mild IVF is. The programme makers give the impression that Professor Nargund is acting in a defensive manner, however, I think her reaction simply reflects the high degree of miscommunication between the two parties. 

Overall, the programme can be considered incredibly important in that it highlights the vulnerable position that fertility patients are in. In the first part of the programme we see how damaging inaccurate information from fertility experts can be. During the second part of the programme the investigative team seem to misinterpret some of the other information that Create Fertility provides to their patients and inadvertently demonstrate that fertility patients are also vulnerable to misinformation from the media. 

Although the programme is quite difficult and confusing to follow I would recommend it to anyone seeking fertility treatment. It will hopefully serve as a cautionary tale and prompt people to seek advice from unbiased sources such as the HFEA. 

The featured episode of Inside Out West is available on the BBC iPlayer until 27 November 2018.