Infertile couples can rack up thousands in debt to pay for IVF. But new money-saving deals may not be the solution they seem to be
When Helen Brackley and her husband, Paul, decided to start a family, they didn’t expect that their efforts to get pregnant would turn their lives – and their finances – upside down.
The couple were among the one in seven who have difficulty conceiving. Brackley, an advertising executive from Manchester, began her IVF (in vitro fertilisation) journey in 2016 and has now spent nearly £20,000 on fertility treatment, and even quit her well-paid job to allow her to focus on getting pregnant.
“My partner and I have unexplained infertility,” she says. “We had two rounds [of fertility treatment] on the NHS, but they were both unsuccessful. We then looked at moving to Crete for a month to have cheaper IVF there, but instead we went private in Manchester, spending £9,000 on one round.”
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Desperate for a baby, Brackley, now 39, says she became “quite obsessive”, spending hundreds of pounds on acupuncture and reiki, which she hoped would increase her chances of conceiving. The process also affected her working life.
“My advertising job was quite stressful, with 14-hour days. I didn’t think my boss would be sympathetic to me consistently having IVF, so I quit and worked in a café. Sometimes I used to be clearing tables or washing up, wondering what on earth I was doing.”
Thankfully, the couple’s third round of IVF was successful and their son Eli was born in April 2019.
Their story highlights the precipitous path many couples have to go down to pay for IVF. Infertility is common: 3.5 million people in the UK have difficulty conceiving, and in 2019 almost 53,000 patients had IVF. Availability of NHS treatment is patchy due to a postcode lottery and many couples are forced to go private.
Some spend thousands, racking up debt or selling their homes, only to end up without a baby.
It is no wonder then that for many, the offer of a new way of paying for IVF seems too good to be true. Earlier this year, Care Fertility, one of the UK’s leading private IVF providers, announced a “no baby, no fee” deal. This package would mean that certain women who didn’t become pregnant after three cycles of IVF would get a full refund on their costs.
Care said the package promised “peace of mind” to couples so often financially crippled by the price of private IVF. But a group of fertility doctors, finance brokers and former patients has voiced concerns that the funding is being brought in-house and not offered by traditional third-party financiers. They have launched the Safe campaign to challenge the changes.
Its members believe that if clinics offer packages directly to women, it will lead to conflicts of interest during what is a very vulnerable time.
In a statement, the group says: “In the UK these programmes have always been provided independently from the medical clinics carrying out treatment. This means women’s health is the only priority. We must keep financial and clinical decisions separate.”
Campaigners say the deals could encourage aggressive treatments which may lead to health complications. Clinics in the US who use in-house financing often stimulate their patients with greater doses of medication in search of higher egg yields. This can lead to higher rates of complications such as ovarian hyperstimulation syndrome (OHSS).
Natalie Silverman, of The Fertility Podcast, an ambassador for the campaign, says: “We are concerned about these changes muddying the waters when it comes to clinical and commercial decision-making. We need the intentions of the clinics to be genuine and, for women’s safety, we think the financing should be kept separately from the medical side, so there isn’t a conflict of interests.”
The concerns, however, are refuted by Care. A spokesman says: “At Care, recommendations of fertility treatment are always based on the advice of doctors who know their patients. No other factors are considered, and how a patient chooses to pay for their fertility could not have any bearing on the type of treatment a doctor may recommend. To do so would breach the General Medical Council’s good medical practice guidelines.
“Our extensive measures to separate clinical from commercial decision-making are routinely subject to intense scrutiny by our regulator, the HFEA [Human Fertilisation and Embryology Authority], as are the measures we put in place to ensure patient safety.”
They also point out that their rates of moderate and severe OHSS are below the national average and say that opting for the plan offers a “high chance” of success, as its financing deal means women would receive up to three cycles at a discounted fee – significantly cheaper than paying for each round separately.
But a second leading UK provider, Create Fertility, is refusing to follow suit with in-house financing, and a third, The Fertility Partnership, offers no baby, no fee deals only via third parties.
Professor Geeta Nargund, medical director of Create Fertility, said: “We don’t offer no baby, no fee schemes and currently have no plans to do so. Instead, we are focused on using innovation to improve the overall affordability, accessibility and safety of IVF.”
Less than a year after Eli was born, Brackley and her partner decided in March 2020 that they would try for a second child. “We spent £3,000 on a frozen embryo cycle, which didn’t work and was very hard to deal with. We are now about to spend £7,000, maybe more, on another round. We’re obviously hoping it works, but I’m aware we are lucky with one child given the money we have spent.
“So many couples remortgage their homes or get loans or into debt. I think the NHS needs to help more.”
According to recommendations by the National Institute for Health and Care Excellence (Nice), the NHS should fund three full IVF cycles to women under 40 who have been trying for at least two years, and one cycle for some women aged 40 to 42.
Yet more than 80 per cent of NHS clinical commissioning groups, which make health-care decisions at local levels in England, fail to meet this guidance.
These restrictions force many couples to go private, where the average cost of a cycle is roughly £5,000, though add-ons such as genetic screening, extra drugs and freezing and storing embryos can push the price up by thousands.
Jen Bickel and her husband Andrew, both 43, of Cardiff, spent roughly £20,000 on two IVF rounds, having suffered 10 miscarriages during their attempts to get pregnant.
They found the costs were daunting. “Everything adds up,” Bickel says, “from the storage of frozen embryos, to their transfer, to endometrial scratches, which are meant to help the embryo implant better.”
After the anguish of the miscarriages, the couple were painfully aware that their vulnerability left them open to exploitation. They consulted one specialist in London but “essentially paid out £2,500 for inconclusive tests”, Bickel says.
“He wouldn’t give us a report of his findings and we felt he was money-making, pushing us towards unproven treatment and saying we either wanted a baby or we didn’t. Our families helped us out with the money, but it’s awful when it doesn’t work.”
The couple eventually became parents in 2019 from one of the frozen embryos, and Bickel is now pregnant again from another. “We knew we would never sell our home to pay for IVF,” she says, “and we had run out of money, so it’s a miracle it worked after so many miscarriages and so many attempts.”
In discussions on Mumsnet, the pain of finding money to pay for repeated IVF cycles is all too evident. On a thread about IVF costs, one woman wrote: “Never added it [the cost] up, too scared. Six rounds of IVF and any extra you can imagine. Got to be plus £50k.”
Another wrote that she sold her home to pay for treatment, while another said: “£30k on one private round. Now trying to see if we can afford another round to have a second child. I’m not sure we will be able to, which will break my heart.”
Another commented: “£30k also. One child to show for it. The costs you’re shown as a prospective patient are misleading in the extreme.”
Yet, there is hope that cheaper IVF may soon be accessible. This autumn, the British Pregnancy Advisory Service (BPAS), is opening the UK’s first not-for-profit IVF clinic. Although the charity is best known for providing abortions, BPAS has decided to set up its own fertility network to address the inequalities in IVF provision across England.
It aims to undercut private clinics by only charging the true cost of treatment, which it estimates will be between £3,000 and £3,500 each IVF cycle, not including drugs, and expensive, unproven add-ons will not be an option.
The future of fertility treatment
Artificial intelligence (AI)
AI technology could soon be in use to help improve the success rates of IVF. Research has shown that AI algorithms can outperform human analysis in predicting which embryos are likely to be viable.
Fertile for longer
Scientists are working on better understanding the ageing process of the ovaries. The research could lead to treatments that help women produce eggs for longer, and provide hope for women whose ovaries stop producing eggs prematurely.
Scientists are experimenting with growing human eggs in vitro using stem cells or ovarian cells. The work, which is in the earliest stages, could potentially help women whose ovaries do not produce eggs.
Explaining the reasons behind the launch, Katherine O’Brien, BPAS associate director of communications, says there are parallels between IVF provision in 2021 and the provision of abortion in 1968, when the charity was founded.
“In 1968, women were unable to access NHS-funded abortion care and were forced to turn to private providers, who often exploited their desperation by charging extortionate prices,” she says.
“While not as extreme as the backstreet abortions in the 1960s, it is clear that some private IVF providers are encouraging patients to undergo clinically unproven treatments at a huge personal and financial cost.”
The BPAS clinic is set to open in central London for egg collection and embryo transfers, with satellite clinics operating outside the capital.
Marta Jansa Perez, the charity’s director of embryology, says: “I feel very passionately that it’s important that people have access to fertility treatment.” But she added she would be “very honest” with couples who had next to no chance of conceiving. Too many private clinics, she says, push couples into trying for a baby when the treatment is statistically likely to fail.
Meanwhile, large companies are increasingly offering funding for fertility treatments to their employees. In the US, 5 per cent of businesses – including tech firms such as Facebook, Google and Netflix – already offer funded IVF and egg freezing.
In January 2019, in line with its American policy, the UK’s LinkedIn began offering up to £21,000 of fertility-assisting treatment to its employees. Guidance is also given to LinkedIn managers on being flexible on working hours to allow for IVF appointments or recovery.
LinkedIn’s vice president of HR, Lisa Finnegan, says the policy was about “creating a space whereby [staff] will not feel penalised if something goes wrong in their lives”.
Still, the charity Fertility Network UK, which supports patients who are struggling to conceive, believes the main funding should be provided by the NHS. It points not only to funding discrepancies within England but also within the UK as a whole. Scotland, for instance, provides the gold standard of up to three cycles, while Wales offers two cycles, and Northern Ireland only a partial cycle of one fresh and one frozen embryo.
The charity’s chief executive, Gwenda Burns, says: “There will always be the need for private provision but people urgently need access to NHS fertility treatment first and we are calling on the Westminster Government to implement an NHS fertility service in accordance with Nice guidelines.
“Infertility is a cruel and devastating disease and people should be entitled to be given the opportunity to create a family. Without a fair and equitable provision of fertility services, for some, sadly, this will never be achieved.”
Credit: Inews UK