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IVF Success: What Makes Scotland Special?

22 November 2020
Appeared in BioNews 1073

'IVF Success: What Makes Scotland Special?' – the most recent event organised by the Progress Educational Trust (PET), the charity which publishes BioNews – highlighted the fantastic work that has taken place in Scotland for those in need of fertility treatment.

PET's director, Sarah Norcross, welcomed the many Zoom viewers and started the event by showing a short film featuring Joe FitzPatrick, the Scottish Government minister for public health. He spoke of his pride that Scotland has the fairest and most equitable fertility treatment in the UK, and introduced the Scottish National Infertility Group that was set up in 2010 by Scottish Government ministers with the goal of developing and improving fertility services.

Since the group was founded, the criteria for accessing assisted reproduction have been expanded in a number of ways, to help ensure equitable access for eligible patients. The expansion has included ensuring that patients are able to access three full cycles of IVF with unlimited embryo transfer (where available) no matter where they live in Scotland, increasing the age for women who can access treatment, and allowing couples to access treatment even if one member of the couple has a child from a previous relationship.

After the video, Norcross introduced Sally Cheshire, chair of the Human Fertilisation and Embryology Authority (HFEA), which regulates fertility clinics across the UK. Scotland delivers around 5000 IVF cycles per year and all Scottish clinics have five-star reviews from HFEA inspections, as well as four- or five-star patient ratings. Cheshire discussed how the Scottish success rate for births from cycles is 28 percent compared to the UK average birth-rate of 23 percent. In addition, Scotland has managed to maintain a low six percent multiple birth rate (multiple births are among the biggest health issues in IVF), well below the goal of ten percent and the UK average of eight percent.

Cheshire then turned to a pressing issue that is affecting all healthcare, not just fertility services: COVID-19. As in the rest of the UK, all NHS non-emergency treatments – including fertility treatments – were paused from April in Scotland.

Finally, Cheshire left a goal for Scottish fertility centres: to improve the amount of patient feedback on the HFEA website. The reviews of Scottish clinics by patients are good, but there are only a couple of dozen per centre, compared to hundreds for some clinics in England.

The next speaker was Colin Sinclair, the chief executive of NHS National Services Scotland. He outlined three reasons for Scotland's success in its fertility treatment provision: standardisation of access criteria, equity of access regardless of where patients live in Scotland, and the funding provided by the Scottish Government to the four health boards who deliver NHS IVF across Scotland.

The National Infertility Group has met its initial goal of increasing treatment provision to three cycles, and for almost three years, 100 percent of patients have begun treatment within 12 months of their referral. The current focus is on increasing fertility preservation, for example in transgender patients, and on creating a national storage centre for gametes. Sinclair concluded that the most important things for Scotland's successful system are patient representation, strong support from the Scottish Government, and the dedication and determination of all the teams involved.

A clinician's perspective was presented by Professor Abha Maheshwari, lead clinician for the strategic fertility network in Scotland and an honorary clinical senior lecturer in reproductive medicine at the University of Aberdeen. Like the previous speakers, she discussed how existing expertise between networks and a willingness to collaborate has led to fantastic support for fertility services in Scotland.

To illustrate the benefits of collaboration, Professor Maheshwari used the example of recruiting donors for fertility clinics. Previously, all four centres had different questionnaires when recruiting new donors. By comparing the questionnaires, running feedback groups, and speaking with clinicians, they were able to work collaboratively to create a single document that could be used in every clinic, cohering the process. This collaboration has also helped during the COVID-19 lockdowns, as the four centres had regular meetings to discuss the restarting of treatment and licensing.

Professor Maheshwari observed that collaboration is key not just for IVF and fertility preservation, but for everything related to fertility – from preconception and primary care to maternity, tertiary care with oncology and genetics, and long-term neonatology healthcare. The time and work spent improving clinical governance, education, research, and innovation are all helping to pave the way in Scotland.

The final speaker was Gwenda Burns, chief executive of Fertility Network UK, who spoke about the experience of fertility treatment in Scotland prior to the National Infertility Group being set up. Issues included unequal access to treatment similar to the current 'postcode lottery' in England, different numbers of cycles, different definitions of what constitutes a cycle, and inconsistency in access criteria and waiting times. Burns concluded by saying Scotland has turned these shortcomings around, and is now the 'gold standard' of treatment in the UK.

Norcross then invited questions from attendees. The first question concerned online consent process that had been introduced during the COVID-19 pandemic, with concerns about the possibility of coercion. Professor Maheshwari explained that these online processes are not currently in use for all treatments, and that where they are used, there are a number of security steps to help ensure that the right person is answering. Cheshire added that electronic consent forms are already used by a number of clinics and are becoming more popular, but confirmed that the HFEA plans to incorporate guidance related to online consent forms in the next edition of its Code of Practice.

On the positive side, the speakers observed that – even outside a pandemic – online consent processes can be helpful for patients who may live far from their clinic, avoiding the need for multiple visits. Burns agreed that moving consent online would be welcomed by many patients, as it will give them more time to assess all of the relevant information. Norcross said that it would be important to ensure that patients still had adequate opportunity to talk to doctors and nurses during their treatment journey.

The audience question that prompted the liveliest discussion concerned how to improve the public's understanding of (in)fertility. Some asked whether a lack of knowledge about the physical and mental effects of infertility was limiting the amount of funding for infertility services across the UK.

Norcross mentioned how in her campaigning for better funding for fertility treatment, it was clear that some members of general public do not appreciate what a serious problem infertility is for many people. Sinclair agreed that this is a serious concern, as some people take being able to have children for granted.

Other questions touched on the success rates displayed on the HFEA website and the availability of surrogacy in Scotland. The conclusion was that patients and their interests must be at the centre of decisions about access to treatment, and Scotland has been exemplary in this regard.

PET is grateful to the Scottish Government for supporting this event.

Register now for PET's next free-to-attend online event 'An All-Consuming Problem? How to Protect Patients in the Fertility Market', taking place on Thursday 14 January 2021.

Find out more here, and register for your free place here.

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