Most people may have an understanding of the ultimate goal of IVF and similar treatments, but few know the specifics. That is unless they find themselves in need of fertility treatment, in which case it becomes arguably the single most important decision of their lives.
Fertility treatment is the use of medical procedures to aid the natural process of conception. Most of those seeking treatment are not entirely “infertile”, rather one or more parts of their reproductive system do not work properly and they therefore require medical help to conceive. This is referred to as “sub-fertility”.
For men, the most common cause of sub-fertility is poor sperm quality, which affects about 30 in 100 couples. Around five in 100 couples are infertile. For women, fertility problems can be caused by one or a combination of different factors affecting the female reproductive system, such as illnesses like endometriosis, or problems affecting the womb or the fallopian tubes.
While the general public has become broadly comfortable with the science and the life-changing benefits it has brought to couples, IVF and similar treatments still attract furious debate. As the technology progresses, it routinely challenges what society is willing to permit scientifically, morally and ethically.
Indeed, earlier this month researchers at CARE Fertility in Manchester published a small study of 69 couples that showed using a new technology – time-lapse embryo imaging, taking thousands of pictures of developing embryos from which clinicians can choose the healthiest – can boost the success rate of IVF by as much as 56 per cent.But these early findings need further testing in clinical trials to confirm the results and safety of the technique.
The most important thing in life is having a child. Nothing is more special than a child
Controversies sparked by the continuing development of fertility treatments keep the subject near the top of the media agenda. Advancing technology means older parents are able to conceive, the sperm of dead fathers and prisoners can be used, and faulty genes, as well as possibly the precise characteristics of babies, can be altered and manipulated.
IVF and other treatments are not without risk and many of the advances that are currently being developed are designed to mitigate some of these risks. But with more advances and research come difficult and controversial questions that often the law and medical ethics have difficulty keeping pace with.
In these times of austerity, there is pressure on policymakers and health service funders to restrict treatments, and IVF in recent years has been perceived by a minority as expensive, contentious and emotionally demanding for couples going through the treatment journey. But the European Convention on Human Rights is clear: it protects an individual’s rights to a private and family life, to marry and have children.
This contrasts sharply with countries, including Costa Rica, which until late last year prohibited IVF treatment, and Austria, where assisted conception techniques – like IVF, and other treatments such as intra-cytoplasmic sperm injection, egg donation and donor insemination – are prohibited if they involve the use of a donor egg or donor sperm.
Professor Sir Robert Edwards, the British biologist and Nobel Prize-winning pioneer of in vitro fertilisation, who died in April, perhaps foresaw these arguments and challenged the view that infertility doesn’t necessarily require treatment, famously saying: “The most important thing in life is having a child. Nothing is more special than a child.”
The pioneering work of Professor Edwards and his colleagues genuinely revolutionised medicine and conception, and has resulted in the births of five million babies, according to the International Committee Monitoring Assisted Reproductive Technologies.
But research presented by health economists at the European Society of Human Reproduction and Embryology showed the UK was ranked 18th out of 20 European countries in terms of state-funded IVF treatment.
Some fear that couples may choose to pursue treatment options outside the UK, raising questions about the commercialisation of assisted conception and “rogue” doctors practising in unregulated clinics.
There’s no evidence that more couples have experienced unresolved fertility problems over recent years, but there has been a substantial increase in the number of couples seeking IVF. At the same time, success rates have also improved.
The hope for the future is that, as more IVF procedures are performed, success rates will continue to improve and the treatment will become available to more couples. So information on how to navigate what can be a complex system, and make a choice that couples are happy with and is best for them, will be more important than ever.
