For the 1 in 6 couples facing fertility problems in the UK, finance plays a very important role in choosing fertility treatments. There has been much debate recently surrounding fertility add-ons, essentially new technologies and procedures which may be offered by clinics to help boost the chances of successful IVF.
Add-ons can include pre-implantation genetic screening (PGS), time-lapse photography, immunology and endometrial scratch. Although some fertility providers point to scientific research on all these "add-ons", the evidence is by no means robust enough to be taken on by patients without careful consideration of their value.
Immunology is a hotly debated topic in the field of fertility. The treatment, which is based on the idea that immune cells in your body can 'reject' a foetus has, in my opinion, been over-hyped, exploited and exaggerated by some fertility specialists. It has been widely discredited and there is no convincing evidence that immune rejection of the foetus occurs in women with fertility problems. Instead, scientists now know that during pregnancy, the mother's immune system works with the immune system of the foetus to help the placenta develop.
Pre-implantation genetic screening (PGS) allows for embryologists to examine cells from an embryo to look at the chromosomes to determine how many there are and whether they are abnormal, before two or three are planted in the womb to develop. There is a lack of evidence that having a treatment cycle with PGS will increase your chances of having a baby compared to having a treatment cycle without PGS. More robust randomised controlled trials are needed before a decision can be made either way.
Endometrial scratch, which can cost around £300, involves using an instrument to make four scratches on the lining of the womb. Doctors believe a fledgling embryo may find it easier to nestle in the grooves. It is also possible that the scratches release hormones that make the womb stickier and so the embryo finds it easier to implant. Again, studies in this area, lacks quality and larger studies are still required to validate whether endometrial scratching does in fact increase pregnancy rates from fertility treatment or spontaneous conception.
The best advice available for anyone seeking the best value from fertility treatment is:
1. Don't be afraid to ask questions of your doctor and make sure you really understand the answers. Even if you don't think of a question during the consultation give your doctor or someone at the clinic a call to make sure you get your questions answered.
2. Be wary of any costs of add-ons until you are given reassurance that there is sufficient evidence that they will increase your chances of success. Ask the question, will this procedure add value for my treatment if it is not proven?
3. Make your own decisions and consider them carefully before going ahead with anything. Don't be forced to have treatments that you don't think are right for you as this can make your treatment that much more expensive.
Mr Yacoub Khalaf will host the seminar "How to Keep Costs Down - Do You Really Need Those Add Ons" at The Fertility Show on 6th November at 15.45.