Laura Slattery was just 19 when she was first referred for IVF after trying to get pregnant for a year. ‘We were told the tests showed I had poor-quality eggs and that my fiance Daniel had a low sperm count,’ she says.
Laura underwent two NHS-funded attempts at IVF, using a technique called intracytoplasmic sperm injection (ICSI), where a single sperm was injected into one of Laura’s eggs.
Both attempts resulted in failure.
‘Our wedding was coming up so we decided to give the treatment a break,’ says Laura, from Hertford Heath in Hertfordshire.
At the time she was 20 and Daniel (now her husband, who works for a pharmaceutical company), was 23.
Two months after the wedding, she found she was pregnant naturally.
Indeed, in the intervening decade she has produced no fewer than eight children with her ‘poor-quality eggs’. Her eldest daughter Bella is now eight. Her second baby Zack, now six, followed two years later, and since then she has donated ‘quality’ eggs that have been used in IVF procedures for other women and created a further six babies.
‘Once I had Zack I wanted to give something back because I know how it feels to be in that situation of desperately wanting a baby and not being able to have one,’ says Laura, who is now 30.
She says part of the problem was her ‘very irregular’ periods — ‘sometimes they were two or four months apart,’ she says. ‘I had two tests for polycystic ovary syndrome, which causes hormonal abnormalities. The first one showed I had it and the second showed I didn’t.
‘I don’t feel I was misled about my infertility because I saw the results of the tests myself,’ says Laura. ‘But I think I should have been offered ovulation stimulation drugs first. It’s surely better to begin with a cheaper alternative than to start straight away with ICSI.’
Her experience is hardly unusual, with a major new study finding that as many as one woman in six who was unsuccessful with IVF went on to conceive naturally. This follows previous research in 2016 which suggested that one woman in three conceived naturally after stopping fertility treatment.
Research and stories such as Laura’s raise the question of how infertility can be so comprehensively misdiagnosed — an issue that is only going to become more pressing as demand for IVF grows.
Although NHS budgets for infertility treatment are being reduced every year, providing it still costs taxpayers £68 million a year, according to a report published in The BMJ last year.
The Human Fertilisation and Embryology Authority, which regulates the sector, estimates a further £320 million a year is being spent on private treatment by desperate childless couples, and the industry is growing at 3 per cent a year.
YOUNGER COUPLES ‘HELP BOOST IVF SUCCESS RATE’
One IVF attempt can cost the taxpayer £5,000, while couples paying for their own treatment can pay up to double that amount.
But how much money is being wasted on treatment for those who could conceive naturally — especially on young couples who, some experts suggest, may be channelled into fertility clinics in order to improve their published success rates?
This comes as demand for IVF has been further boosted by changes in the definition of infertility, which the World Health Organisation now classes as a disease in which there is failure to achieve pregnancy after a year of unprotected sexual intercourse.
A spokesman for the National Institute for Health and Care Excellence (NICE) said couples should try to get pregnant naturally for two years before seeking treatment. But NICE’s own fertility assessment and treatment guidelines are ambiguous.
The 51-page document says in some places that treatment should be offered after 12 months of infertility, but elsewhere it suggests women should wait two years.
‘Clinics are treating young fertile women in haste because it is their only chance to inflate their success rates,’ says Gulam Bahadur, a consultant clinical andrologist [male fertility specialist] at North Middlesex University Hospital, London, and a longstanding critic of the fertility industry. He points to other studies showing that artificial insemination — the ‘turkey baster’ approach — often matches IVF success rates for appropriately selected women.
‘It would save a huge chunk of government money if all women had to wait two years before they could have NHS IVF treatment,’ he adds, ‘and it obviously benefits patients and their children for babies to be born naturally.’
The controversy has been fuelled by the first large-scale study in Britain to look at fertility patients in the five years following treatment.The study, published in July in the journal Human Reproduction, found that 185 of 1,073 women who did not get pregnant using IVF (17.2 per cent) went on to have a baby naturally.
Furthermore, 151 of the 1,060 who did have a baby with IVF (14.2 per cent) went on to conceive naturally in the ensuing five years.
In other words, 336 — or one in seven — of the total 2,133 women treated were quite capable of having a natural pregnancy.
The research was carried out at the University of Aberdeen — in Scotland, where three free NHS cycles of IVF are available to anyone under 40, and one cycle to 40 to 42-year-olds via a £12 million dedicated central treatment fund.
David McLernon, a research fellow in medical statistics, who led the project, explained its findings by saying they offered ‘a message of hope’ for those undergoing infertility treatment.
‘Our work shows there’s a group of people who have been unsuccessful using IVF but who still might get pregnant naturally,’ he says. ‘It could just happen that conditions are right for you to have a baby naturally when you didn’t with IVF. ‘Our work shows you shouldn’t give up hope because there’s still a chance.’
SIDE-EFFECTS OF FERTILITY DRUGS
And IVF treatment itself is not without risks, albeit rare.
Sarah Banks, a 37-year-old former buyer for Marks & Spencer, conceived her daughter Millie, three, naturally after a previous successful IVF treatment led to the birth of her son Jack, now six.
Sarah and husband Andy, 38, who runs a digital consultancy business, had been trying to have a baby for six years before going to their GP when she was 30. ‘A year later we started going through IVF treatment after being told Andy had a low sperm count and I had some ovarian cysts,’ she says.
‘I had one full cycle of ICSI but had to freeze the embryos because of ovarian hyperstimulation syndrome (OHSS).’
This is a recognised, but potentially fatal, adverse reaction to the drugs used in IVF to stimulate the ovaries to produce many more than the usual one egg from each monthly cycle, in the hope of maximising the chances of pregnancy by artificially fertilising lots of eggs. It causes life-threatening fluid retention and swelling of the entire body.
The drugs led Sarah to produce an alarming 45 eggs.
‘OHSS made me really bloated and sick,’ she says. ‘I couldn’t stand up, I was dizzy and constantly hot and cold. They had to monitor me very carefully for fluids moving round the body. For days I could barely move off the sofa.
‘Before I even had my egg collection they said I was at risk of OHSS because so many follicles were ripening. They said they couldn’t go ahead with the embryo transfer procedure because there was a risk of the condition getting worse.
‘Everything had to stop temporarily and the two embryos were frozen. That was in 2012, when I was 31. They did the first embryo transfer two months later but it didn’t work. Six months later I was very lucky that the second transfer worked.’
Sarah’s IVF and the cost of the two attempts to implant the defrosted embryos into her womb were paid for by the NHS. ‘We had always said we wanted two children and I thought I would have to go through infertility treatment again to have any chance of another baby,’ she says.
‘I was breastfeeding Jack so it was a year before I got my periods back. Two months after my first period I got pregnant.
‘After six years of failing to get pregnant naturally and never having so much as a positive pregnancy test result, it was incredible. I was told that natural pregnancy after IVF can happen.’
She adds: ‘No one ever put my infertility down to anything in particular.’
Jo Maidment also went on to conceive naturally after successful IVF — in her case the added twist was that the late pop star George Michael stepped in to secretly fund her infertility treatment after he saw her make an impassioned appeal on TV’s This Morning programme in 2010, about the lack of NHS funding for fertility treatment.
Jo, 42, a part-time psychology student who lives near Dover in Kent, is now the mother of Betsy, aged seven, born after two rounds of IVF, and Stanley, five, who was conceived naturally.
Jo, who was only in her mid 30s at the time, was told she was ineligible for NHS funding because her husband Will, 46, an HGV driver, had a child already. The couple have been together for 19 years and married for 17.
‘We were contacted after the TV programme and told that a businessman wanted to help us.
‘We did write him a letter after she was born to say thank you and sent a picture of Betsy, but we never met him and only found out it was George Michael after he died. We couldn’t believe it,’ she says.
‘The ‘unexplained infertility’ was really frustrating. They couldn’t say why I wasn’t getting pregnant naturally, I was told everything was on my side but it just wasn’t happening, there was no medical reason and nothing diagnosably wrong with either of us.
‘Nor could anyone explain why it subsequently happened.’
Like Laura and Sarah, Jo is immensely grateful for her children and anxious not to blame fertility clinics for leaping in prematurely in offering treatment.
So how are women able to conceive naturally after long-term ‘infertility’?
COULD IVF SPUR ON FERTILITY?
There is no easy explanation, according to Dr Samuel Marcus, a consultant obstetrician and gynaecologist at Queen Elizabeth Hospital, London.
In 2016 he carried out an internet survey of 403 previous IVF patients, which found that one in three subsequently became pregnant naturally. ‘One possibility is that as fertility treatments have become more widely available, they are increasingly utilised for less prolonged infertility and for less severe cases such as unexplained infertility, mild male subfertility and mild endometriosis,’ he said at the time.
(Endometriosis is a common problem where tissue from inside the womb grows elsewhere in the body.)
It may be that an IVF pregnancy somehow kickstarts the body’s reproductive system into action — or it may be that post-fertility treatment, couples take more care of their overall health, suggested researchers from Radboud University in The Netherlands who looked into natural pregnancy following IVF in a 2008 study involving nearly 9,000 women.
Jo has her own theory: ‘I think I was thinking about having a baby and wanting it too much. You think about it constantly when you want something so much and you don’t know why you can’t have it. You think about it when you wake up and when you go to bed.’
Sarah, who now markets IVF ‘positivity’ journals via her website, ivfpositivityplanner.com, agrees that the stress and anxiety associated with childlessness may prevent women getting pregnant.
‘I was so upset and anxious all the time about it not happening but I was in a much better place emotionally for it to happen naturally after we’d had Jack,’ she says.
However, experts say clinics and couples also need to give the natural process more time, particularly when there is no obvious cause for problems. As Jane Stewart, a consultant in reproductive medicine at Royal Victoria Infirmary, in Newcastle, and chair of the British Fertility Society, explains: ‘People do get confused about how long you have to wait to get pregnant naturally.
‘Two years is not unreasonable if there’s no evidence of a problem, but there’s no set time.’
In other words, it might take longer — and it depends on how often a couple are having sex. ‘About half of our prospective patients in Newcastle are turned away. We test them and if they don’t have a problem we send them away to carry on trying.’
But she adds: ‘In the private sector that might not happen. Very often people don’t get advice first before they buy IVF treatment.’
Gedis Grudzinskas, an ‘elder statesman’ of the infertility industry and former emeritus professor of obstetrics and gynaecology at St Bart’s and the Royal London Hospital, concurs: ‘It’s a bit harsh to say IVF is being oversold, but it is true that the pharmaceutical industry is in the background watching its sales and pushing hard to increase take-up of fertility drugs.’
He adds: ‘But going through the process may give couples insight into what they need to do — that they should have more sex. It is surprising how many of them don’t seem to get that.
‘We know 80 per cent of couples should get pregnant naturally in a year and 85 per cent in two years of trying. Maybe more people need to hold on to that fact.’