The Perverse Outcomes of IVF rationing by Post Code

Kat Lay reports in The Times 31st May 2017: Foreign fertility treatment raises pressure of multiple births on NHS

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Doctors have begun an investigation into the pressures being put on the NHS by couples going abroad for IVF treatment and coming back pregnant with twins or triplets. Hundreds of women are returning to the UK with multiple pregnancies after fertility treatment overseas, experts fear.

The trend comes as the NHS increasingly rations IVF in an effort to curb spending. These restrictions on fertility treatment have been condemned as a false economy, as short-term savings risk being cancelled out by the higher cost of multiple births, which can lead to lifelong health problems.

Multiple birth rates fell in Britain after an industry agreement in 2008 to implant only a single embryo at a time to reduce risky twin and triplet pregnancies. However, many foreign clinics do not follow the same guidelines and doctors are investigating whether a rise in British multiple births in recent years is linked to more couples going overseas for IVF. Jane Denton, director of the Multiple Births Foundation said: “We are seeing more women who are coming in with multiple pregnancies — and telling us they have had treatment abroad.”

Twin pregnancies cost more because of the need for more scans and appointments, higher caesarean rates, longer hospital stays and increased risk of a baby needing a neonatal unit. At least half of twins and more than 90 per cent of triplets have low birth weights, putting them at risk of health problems.

A 2006 study from the University of Sheffield found that a singleton pregnancy cost the NHS £3,313 compared with £9,122 for twins and £32,354 for triplets.

“This problem of going abroad and coming back is one we have increasing concerns about,” Ms Denton added.

A study from University College London Hospital, published in 2008, found of 94 women expecting three babies or more as a result of IVF treatment, 24 had treatment abroad.

Only 35 of the 207 clinical commissioning groups in England follow national guidance and offer three funded cycles of IVF for eligible women under 40. Even many of those restrict access if one partner already has children from a previous relationship.

Susan Seenan, chief executive of the Fertility Network UK charity said: “Restricting or denying access to NHS IVF is a false economy.”

Data from, a website used by couples considering going abroad for fertility treatment, show inquiries to overseas clinics rising from 1,245 in 2014 to 2,602 last year.

Case study

Where others see a burden on the NHS, Harpreet Kular sees her beloved toddlers, Khivi and Nihal (Chris Smyth writes).

They were born two years ago after IVF treatment in Spain using an egg donor

After failures at both the NHS and private clinics in Britain Ms Kular, 36, turned to Spain as it offered a shorter waiting list for an egg donor, as well as a better chance of a child who shared her skin tone. “It’s really important that children fit in with their community. It isn’t appropriate to have a blond blue-eyed kid in the Asian community,” she said.

Ms Kular, an optician from Droitwich, in Worcestershire, said the Spanish clinic was “absolutely brilliant” and offered a better service than in Britain.

“I didn’t feel like I was on a conveyor belt. They had time for me. I had two and a half hours with a consultant — that would never happen in this country.”


IVF PROVIDERS – The Times letters 1st June
Sir, I write further to your report on the number of UK patients travelling abroad for IVF treatment (“Foreign fertility treatment raises pressure of multiple births on NHS”, News, May 31). This is a growing problem for patients and the National Health Service alike.

I see the solution as twofold. First, we need to increase NHS IVF provision by introducing a national IVF tariff and cap the amount paid to the IVF providers. The amount charged by the providers per cycle varies from £2,500 to more than £6,000. Allowing clinics to capitalise on these variations at the expense of the NHS and the public is unacceptable.

Second, we must review the government policy on egg-donation anonymity to encourage more treatments to take place in the UK. It is in the national interest for patients to have treatment in the UK, which benefits from a highly regulated IVF industry.

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This two-fold action would halt the worrying epidemic of “IVF tourism”.
Professor Dr Geeta Nargund
Medical director, Create Fertility

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This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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