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Lack of evidence for interventions offered in UK fertility centres

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6295 (Published 28 November 2016) Cite this as: BMJ 2016;355:i6295
  1. Carl Heneghan, professor,
  2. E A Spencer, researcher,
  3. N Bobrovitz, researcher,
  4. D R J Collins, researcher,
  5. D Nunan, researcher,
  6. A Plüddemann, researcher,
  7. OA Gbinigie, researcher,
  8. I Onakpoya, researcher,
  9. J O’Sullivan, researcher,
  10. A Rollinson, research assistant,
  11. A Tompson, researcher,
  12. B Goldacre, consultant,
  13. K R Mahtani, general practitioner
  1. Centre for Evidence-Based Medicine, Nuffield Department Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to: C Heneghan carl.heneghan{at}phc.ox.ac.uk

Carl Heneghan and colleagues call for better quality evidence to help people seeking assisted reproduction make informed choices

Infertility affects about one in seven couples, many of whom seek medical help to have a child.1 Although numerous new fertility interventions and products have been developed over the past decade, there are concerns that some might not be evidence based and that some clinics may be offering additional services that are not based on the most up-to-date research.2

In vitro fertilisation (IVF) is expensive—a single cycle can cost £5000 (€5800; $6200)—and places considerable financial burden on patients, especially as 59% of procedures are not NHS funded.3 On top of this UK fertility treatment centres offer a range of additional investigations and treatments,4 costing from £50 for a single screening blood test to as much as £8000 for egg freezing packages (box 1).

Box 1: Example of costs for interventions additional to standard IVF

  • Individual screening blood tests—start at £50

  • Embryoglue—up to £160

  • Intralipid infusions—up to £250

  • Endometrial scratch—up to £325

  • Assisted hatching—up to £450

  • Blastocyst culture—up to £800

  • Time lapse imaging—up to £850 for the Eeva time lapse incubator, up to £800 for the Embryoscope

  • Intracytoplasmic morphological sperm injection (IMSI)—up to £1855

  • Percutaneous epididymal sperm aspiration/testicular sperm extraction (PESE/ TESE)—up to £1600

  • Preimplantation genetic screening—£3500

  • Egg freezing packages—up to £8000

Guidance from the UK regulator, the Human Fertilisation and Embryology Authority (HFEA), suggests questions that couples might want to ask before deciding on treatment.2 These include: Is this treatment recommended by the National Institute for Health and Care Excellence (NICE) and, if not, why not? Has this treatment been subjected to randomised controlled clinical trials that show it is effective and is there a Cochrane review available? Are there any adverse effects or risks (known or potential) of the treatment? 2 Given concerns over the evidence base …

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