Older women being exploited by IVF clinics - when just two a year will achieve success after the age of 44

Laura Donnelly
Sally Cheshire, chairman of the Human Fertilisation and Embryology Authority  - Paul Cooper

Older women are being exploited by IVF clinics “trading on hope” - despite the fact just two a year will achieve success after the age of 44, the fertility watchdog has warned.

Sally Cheshire, chairman of the Human Fertilisation and Embryology Authority (HFEA) said those seeking motherhood later in life were being targeted by increasingly aggressive sales tactics from the sector.

In an interview with The Daily Telegraph, she urged clinics to be honest with those desperate for a family, accusing some of using “very selective” information to persuade middle-aged women to undergo treatment.

And she said some centres are charging four times as much as they should, at up to £20,000 per cycle, as she called for the regulator to be given powers to clamp down on profiteering.

New figures show that since 2004, the number of women in their 40s undergoing fertility treatment has doubled, with 10,835 cases in 2017.

But the statistics reveal that among those using their own eggs, just 75 women aged 42 to 43 will end up with a baby, unless using eggs frozen when they were younger.

Among those over the age of 44, fewer than two a year are successful, the figures show.

In total there have been 25 such cases between 2004 and 2017, from 2,406 embryos transferred - a success rate of just one per cent.

The watchdog chief said she was worried that parts of the sector have become “incredibly commercial,” with “blatant” sales tactics used to exploit a vulnerable market - and disguise the true odds.

Mrs Cheshire, 50, said she had herself had been offered IVF treatments by staff from a number of clinics - unaware that she is chairman of Britain’s fertility regulator - as she undertook an unannounced visit to a fertility show in Manchester.

Even firms taking part in the events were shocked by the sales tactics being employed by their rivals, she said.

“We now see things like ‘guaranteed baby or your money back,’’’ she said.

“Some of the private sector clinics use very selective success rates in their sales tactics which we are also trying to stop. Because they need to be honest about their results by age group, by category of patient - all of which is available on our website.”

“I would like our clinics to be honest about the success rates,” she added. “They are catering to a bunch of vulnerable women.”

“What the clinics shouldn’t be doing is trading on that hope. That hope and vulnerability. They should be honest and transparent about a woman or a couple’s chances,” she said.

She said the watchdog, which regulates all fertility services in the UK, is increasingly concerned about the excessive prices being charged by private clinics - which make up 60 percent of the IVF market.

“We have no legal powers to regulate prices. But a cycle shouldn’t cost more than £5,000 £3,000 to £4,000 plus an extra £1,000 maybe for an extra frozen embryo transfer.”

“Yet we hear anecdotal evidence of cycles which are £10,000, £15,000 or even £20,000,” she said.

Mrs Cheshire said there is “a very clear reason” that costs are being inflated - the growing use of “add-on” treatments, being promoted by clinics as boosting fertility chances, despite no clear evidence that they work.

Selling the “extras” - like embryo glue and endometrial scratches which are supposed to help the embryo stick to wall of the womb - has enabled centres to charge vast sums without improving fertility outcomes, she said.

Recent research found three in four patients had taken up an add-on treatment in the last two years.

“That is a lot - that is 50,000 couples,” she said. The regulator has introduced a new traffic light system to rate such treatments on its website. None have been given the green light.

Earlier this year, the watchdog signed a consensus statement, along with leading fertility doctors and patients’ groups, which says that all clients must be informed that such treatments are “experimental”.

Mrs Cheshire would like to go further.

“I would love the [1991 Human Fertilisation and Embryology Act] to change .. to give us economic powers of regulation,” she said.  

In the absence of that, the watchdog intends to publish guidance, to encourage clinics to be more transparent about their pricing, and benchmark themselves against their peers.

“We need to be doing the right thing by our patients - making sure that the price is not exploitative; that the information is accurate and that patients are not being offered add-on treatments that are unproven without the facts,” she said.

An 'intensively competitive market' in fertility treatment can take advantage of the vulnerable 

Sally Cheshire describes herself - laughing slightly - as “a woman of a certain age”.

At 50, she was surprised to be targeted by IVF clinics, assuring her that they had the very treatment for her.

The staff from the clinics, which were exhibiting at the Manchester Fertility Show last year, were perhaps more surprised to discover that they were trying their sales pitch on the chairman of the UK’s fertility regulator.

“I was wandering around with a colleague,” she says. “We are both women of a certain age. “They offered us both treatments - whether it looked like we were a couple, I don’t know.”

“I said, ‘Do you realise I am the chair of the HFEA (Human Fertilisation and Embryology Authority)? You really shouldn’t be offering this’”.

Some persisted, insisting she was not too old to embark on treatment.

For Mrs Cheshire, it was yet another reminder of an “intensely competitive market” in fertility, where the desire to conceive - whatever the odds - can mean easy profits for an ever-expanding industry.

She became chairman of the watchdog in 2014, having joined the authority some years earlier after a corporate career with Deloittes.

Her interest was personal, after a long battle to have her own family.

“I was a fertility patient myself a long time ago, 15, 20 years ago,” she says. “We have three adopted teenagers we adopted a long time ago, after treatment was unsuccessful so I am passionate about patients. I am the only chairman of the HFEA who has ever been a patient.”

She is painfully aware of just how vulnerable women in that situation can be.

The watchdog is becoming increasingly vocal about the exploitation within the IVF market.

Earlier this year it warned that there is no good evidence to support the use of “add-on” treatments such as “embryo glue” and “endometrial scratches” which can triple the cost of IVF treatment.

Its website now offers a “traffic light” rating of all such options - and none get the green light.

“I was offered add-on treatments 15 years ago and was vulnerable and accepted,” she says.

Such memories drive her in a mission to “do the right thing by our patients”.

Much of that is about arming women and couples suffering infertility problems with the facts.

“One of our key aims is to be the go to place for information where people will get independent advice and statistics,” she says.

“Everything from your chances of success - in a number - to advice and guidance on add-on treatments and whether they are worth it, if you are considering [egg or sperm] donation, if you are considering going abroad for treatment. Out there is a lot of conflicting advice.”

Meanwhile, the world is changing.

“We have seen a massive increase in single women coming forward,” she says.

Last year HFEA figures showed the number of IVF treatments for single women and those with a female partner had risen by about one third in two years.

But the authority’s chairman suggests that while much of the public debate centres on the increasing number of older women, single women and lesbians seeking IVF, it ignores the fact that the vast majority of patients are heterosexual and in their 20s and 30s.

“Around 90 percent of our patients are women who come forward with a male partner,” she says.

“Two thirds of people who have fertility treatment are under the age of 37, half are under the age of 35,” she says.

“There is an increase [in older mothers] because society is changing but it’s not quite as extreme as some of the stories would suggest.”

Although the NHS normally refuses to fund cases above the age of 42, there is no age limit for fertility treatment in UK law.

Mrs Cheshire says she would not want to see this changed - but she urges clinics to be open with older women about their realistic chances of success.

“I would like to think that all our clinics are really honest with those patients when they are over 40 about what their chances are but sometimes it’s difficult to hear that message,” she says.

If women use donor eggs, they will have the same rate of success as anyone else, regardless of age, as the key factor is the age of the donor. That means success rates of around 30 per cent.

In February, Britain’s most senior family court judge asked the Health Secretary to review laws which allow transgender men to access fertility treatment to have children.

Sir Andrew McFarlane, the president of the Family Division of the High Court, invited Matt Hancock to review fertility laws after hearing the case of a transgender man who was able to access a sperm donor 10 days after legally completing his gender transition.

The man, who was born a woman and is identified only as TT, became pregnant and has taken his case to the High Court to be registered as the “father” on the child’s birth certificate.

Mrs Cheshire believes any such review of the act is unlikely.

“That’s a matter for government not for us,” she says. “I'm not sure that’s going to happen - there are no plans for it to happen any time soon.”

However, last month the Equality and Human Rights Commission abandoned a legal case against the NHS for failing to provide trans patients with fertility treatment. Instead, NHS England will re-issue guidance reminding commissioners of their responsibilities.

Mrs Cheshire insists that under the Equality Act, those who intend to transition have the same rights as those who suffer from a disease such as cancer, which can compromise fertility.

“If you have cancer treatment … it is now a requirement that if you are a young person and haven’t completed your family you should be offered fertility preservation for eggs or sperm.

“In line with that what we see is an increasing number of transgender people coming forward for fertility preservation before they undergo surgery,” she says.

“There is no reason why trans people shouldn’t be treated in a fertility clinic,” she says.

While no statistics are held centrally, Mrs Cheshire believes the number is “small but increasing”.

The HFEA’s chief executive Peter Thompson is a former civil servant, who was responsible for the Government's policy which enabled transsexual people to change their gender by law.

In March the Health Secretary ordered a review of NHS rules, which mean that transgender patients are allowed to share women’s wards even if they have not undergone medical transition.

To many, the rights of transgender individuals to have a family using eggs or sperm stored prior to transitioning, are at least as controversial.

The watchdog chief sees it differently.

“Our sector is already dealing sensitively with trans people who come forward for fertility preservation and/or fertility treatment and have done for a number of years.”

“In several respects,” she says, briskly, “we are ahead of the game”.

NHS rationing fuelling risky fertility treatment

The fertility watchdog is concerned that growing NHS rationing, and rising costs at private clinics, means increasing numbers of British couples are seeking treatment abroad, at significant risk.

In England, the National Institute for Health and Care Excellence recommends that the NHS funds three cycles of IVF for women under the age of 40.  But just 12 per cent of Clinical Commissioning Groups comply with this, a fall from 24 per cent in 2013.

“A lot of it is about cost,” says Mrs Cheshire, warning of “incredibly commercial” events hosted in this country convincing UK patients of the benefits of fertility tourism.

“People say come to our clinic in Turkey, Bangladesh, India, Russia, the Ukraine,” she says.  Recently it’s more countries outside Europe. We try to make it clear - if you are going to developing countries they may not have those standards of care or any sort of regulatory framework.”