As Technology Advances And IVF Is Normalised, Could Change Be On The Horizon When It Comes To Fertility?

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I've lost count of the number of times I've been asked if I have frozen my eggs. I’m a married 37-year-old woman who is unsure about when – or even if – I want children. And yet, many think it’s totally acceptable dinner-table chat to ask about my procreation plans, and if I am considering IVF. Beyond the presumption that I would want to talk about something so personal, what really boggles the mind is how casually people suggest something that is so expensive.

According to the World Health Organization, infertility impacts one in six people globally. In the UK, the average cost for one round of private IVF – with preliminary testing, consultations, egg storage and transferring – is between £7,000 and £10,000. And beyond the costs, there is a litany of other barriers like age, health, sexuality, race and even your postcode.

The issues surrounding free NHS fertility treatments are widely documented. While the waiting lists can be especially off-putting for anyone attempting pregnancy ‘later’ in life, there are many restrictions around who can even seek help. The guide-lines from Nice, the National Institute for Health and Care Excellence, include prerequisites such as having regular unprotected sex for two years, and you would still only be eligible if you’re under the age of 42.

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Where you live can also affect your chances. This is because NHS Integrated Care Boards (ICBs) in each part of the UK make the final decision about funding, and their criteria can vary depending on your area and be even stricter than Nice.

‘It’s a postcode lottery, really. And a route that couldn’t work for me,’ says Danielle Fox, founder of fertility-health agency The OVA Company. She went through a long, but eventually successful, private IVF journey, after a failed NHS experience. The Guardian recently reported that the waiting list for fertility appointments is growing faster than any other area of health care. ‘When it comes to fertility,’ Fox adds, ‘the NHS really doesn’t have the capacity to help [most people].’

‘Everyone should have access to fertility treatment, and my hope is that it becomes available for all on the NHS,’ says Marta Jansa Perez, the Director of Embryology at Bridge Clinic, a top fertility-care centre based in London. ‘But it’s not a life-threatening condition, so it doesn’t take priority.’ Perez had a vision of offering ethical, high-quality fertility care that is not free, but more accessible, affordable and smoother to navigate. Her clinic is leading the way. On their website, you can see set prices for treatment, not ‘from’ or ‘estimated’ numbers, so people can calculate what they’re going to have to pay from the outset – and all tests, consultations and extras are included.

But still, the price at Bridge is around £4,110 for a round of IVF, which is unattainable for most. New companies, such as Gaia, a ‘fertility insurance plan’, are offering to help. After paying an upfront cost, Gaia pays for all your medical bills and invoices until you’ve successfully had a child, after which you pay them back in monthly installments for up to eight years. If you’re not successful, you don’t have to pay back a thing.

Employers are also beginning to build fertility into their company benefit plans. Last year, Amazon announced that it would offer reproductive health benefits, including IVF, to its more than one million employees globally. According to job platform Adzuna, employment ads including fertility benefits have increased by 700% since March 2022. Research by clinic Apricity shows that 61% of Britons expect their employer to at least partially cover the cost of their IVF treatment.

The economics of fertility can become even more complicated, and expensive, depending on one’s sexual preference or race. The average price of IVF for same-sex couples is 17% higher than for heterosexual couples, owing to the additional cost of a sperm donor. Meanwhile, Black patients already have a lower IVF birth rate compared to mixed and white patients: 23% vs30% (the reasons for which are not certain, but factors such as a predisposition to fibroids are thought to come into play). They then often face a struggle to access donor eggs; a recent report showed that 89% of donor eggs are white, with only 3% Black and 4% Asian, and the remaining 4% mixed-race. The stats are cruelly imbalanced, and could explain why IVF treatment figures are so low amongst Black women – a 2018 report showed there were only 1,526 treatment cycles for people of Black African and Black Caribbean backgrounds, compared to over 46,000 for white patients.

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Your relationship status can come into play, too. Like same-sex couples, a single woman wanting to ‘futureproof’ her fertility will be faced with finding a sperm donor as well as all the money and emotional support. This is the situation Sophie Jewes, a London-based publicist, found herself in as she approached her 35th birthday soon after a long-term relationship broke down. ‘It felt like one of those real “life junctures”,’ she says. ‘I’d thought about freezing my eggs before but dismissed the idea as something too big to tackle alone.’ An idea started to form to approach this with a ‘communal effort, to bring the people I love along for the ride’. So she started a GoFundMe page, inviting friends and family to donate to her egg-freezing efforts.

The reception – from her ‘crew’ and others – was overwhelmingly positive. And the donations were generous, funding over half of the £7,000 bill for her successful egg freezing. Although the idea might seem too public for some, it can be a comfort to know that you don’t have to do it alone. As Perez puts it when we talk: ‘People need support in creating that family.’

It’s also worth remembering that if you’re struggling to conceive, IVF is not the only option. One technique currently resurfacing is intracervical insemination(ICI), a treatment that some might refer to as the ‘turkey baster method’. ‘ICI existed long before IVF was commercialised, then it all but disappeared,’ says Tess Cosad, co-founder of Béa Fertility, who uses the method. ‘When IVF came around in the 1970s its efficacy climbed quickly, but it plateaued around 25-30% and hasn’t shifted since.’

But there’s a lot of clinical data showing that the effectiveness of ICI could be much higher. Alongside medical advice and a personalised treatment plan, Béa gives a ‘modern take on old tech, bringing clinical-grade fertility into your home’. It involves pouring semen into a cervical cap, which is then inserted into the cervix using an applicator and left for up to an hour, increasing the exposure of semen to the canal. And with a full treatment programme, including three kits, costing £550, it’s a fraction of the price of IVF, with evidence showing ICI has a success rate of up to 50% over a six month period.

As I’m still unsure of my own desire to start a family, egg freezing isn’t something I’m willing to invest in yet. But I have, however, had some fertility tests to the cost of around £400 (an intrusive but comfortable internal ultrasound and a blood test, to indicate my ovarian reserve and hormone levels). The closer I get to 40, the less likely I am to be able to rely on the NHS, but there are sparks of hope for change as transparency improves, research increases, and socioeconomic barriers are addressed. The future of fertility looks promising: not just for me, but for all others on their journey facing hurdles much higher than mine.

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