If the same standards were applied to IVF centres as cardiac surgery, then one in five IVF centres in UK would be closed immediately'. True or False?
Formerly, one was focused on providing the highest standards of care circumstances permitted, striving for excellence but frequently compromising for the benefit of the patient population at large, rather than the individual woman or couple. Latterly, the focus has been to guide and advise a woman/couple to undertake treatment at the best IVF facility, influenced to a small degree by ease of access geographically and financial considerations.
It becomes quickly clear that there are centres which are performing at an international level when judged by outcome data (and here only term live birth-rates should be considered) as well as other centres whose outcome data is at least half, if not a third of that reported by the IVF centres in the top tenth centile of the 70+ IVF centres in UK. When seeking to standardise for the woman's age, to consider only data from women <35years old, it is possible to remove the commonly used throwaway excuse of 'selection bias'/'we have a higher than average proportion of women over forty years of age', to reveal that this differential is real and independent of whether the centre is in the public or private sector. It is disappointing to note that wide variations in outcome between the top and bottom performing units continue to be tolerated and perhaps ignored by the regulators and commissioners. Little attempt is made, for a variety of reasons, to share good practice and guide the underperforming units out of their unsatisfactory situation.
Academics preparing to address this phenomenon are puzzled, since the technology, in terms of consumables, equipment and protocols is accessible to all and is more or less routine. First, they wish to determine why such differences occur. Secondly, why do some centres continue to underperform, whilst those at the top end maintain their position? Thirdly, and more importantly, academics wish to establish what it is that the high performing centres do that the underperforming centres do not. It is too simple to interpret this type of investigation as a witch-hunt.
Anecdotally, centres that obtain advice from an external agent/resource (be it scientific, clinical or in combination) invariably see an improvement in outcome data - curiously even before all the recommendations made by the outside agent/resource are implemented. So why don't the underperforming centres seek this type of advice?
If they do not, one may present a case for regulatory sanctions until such time as they do. Underperforming centres continue to receive public funding and/are patronised by fee-paying patients. A few clinical leaders are proactive enough to seek independent advice as to how to fill any gaps in the safety and effectiveness of their IVF procedures. The time has perhaps come when we insist that more of their colleagues should follow suit. This change in attitude is necessary to improve IVF care in this country and reduce the wide variations in quality of care across the sector. As I once said 'I am not sure that standards will improve if we change but I am certain that we need to change if standard are to improve!'