The cut-price fertility boost that childless couples are not told about: IUI versus IVF ‘comes down to profit margins’, say doctors
Lois Rogers The Daily Mail 27 July 2015
- Tracy Hedges, 36, from Dudley, was convinced she’d never conceive
- She’d been through four years of failed attempts to get pregnant and IVF
- Tried much more basic process known as IUI (intrauterine insemination)
- Helped her and husband Keith to have baby Maia, who is now two
- Just 2,000 women a year have IUI compared with 50,000 who have IVF
After four years of failed attempts to get pregnant, Tracy Hedges was convinced she’d never conceive. An ultrasound scan after her first attempt at IVF had revealed she had one solitary egg rather than a cluster of mature eggs as would be expected.
Her ovaries had failed to respond to nearly a month of twice-daily injections of powerful fertility drugs designed to stimulate egg production and her doctors told her she was an ‘IVF failure’.
‘I felt no hope, no emotion at all,’ recalls Tracy. ‘I’d reached the point where I thought nothing would succeed.’
After taking out the £350 cost for the fertility drugs, the clinic said it could refund the rest of the £2,500 Tracy had so far paid towards the IVF – or charge her £700 for a much more basic process known as IUI (intrauterine insemination).
‘In my mind the money that had been put into IVF was already spent, so I had nothing much to lose by letting them have one last try with this other process, even though they said it probably wouldn’t work either,’ says Tracy, 36, who lives in Dudley in the West Midlands.
IUI involves inserting a sperm sample that’s been washed in a super-charged transport solution to promote sperm swimming speed directly into the womb. This is done on the precise day of the month that an egg has been released.
Women are generally also given a low-dose egg-stimulation drug to ensure the one egg naturally produced in every monthly cycle is in perfect condition. It costs £600 to £700 per attempt, compared with £6,000 to £7,000 for IVF.
The technique is seen as old-fashioned and has been superseded by high-tech IVF – just 2,000 women a year have IUI compared with 50,000 who have IVF. No doubt the fact that the treatment is not recommended by the National Institute for Health and Care Excellence (NICE), while IVF is, is significant.
According to official data from the Human Fertilisation and Embryology Authority, which licenses Britain’s infertility clinics, 22 per cent of IVF patients have babies compared with 6 per cent of those having IUI.
But new results call this figure into question. An IUI programme at the North Middlesex University Hospital in London found that 20 per cent of IUI patients have babies, and other clinics abroad have reported similar success rates. Not only is the treatment cheaper than IVF, but the drug regimen is much lighter.
Yet IUI is not being promoted to women – some doctors believe this is because the more expensive IVF is more profitable for clinics.
Despite the doctors’ bleak predictions that IUI wasn’t likely to work for her, Tracy decided she couldn’t bear to destroy the one chance – the single mature egg – she had at conceiving.
Tracy, who manages a chain of children’s nurseries, and her husband Keith, 48, who works for a paper wholesaler, have an older child, Alexa, now six, who was conceived naturally when Tracy was 29, but when they started trying for a second child six months later, nothing happened. She had blood tests, hormone tests, exploratory surgery, ovulation drugs and more tests for four years before she and Keith scraped together the money for IVF.
‘What we were presented with in terms of information was that IVF was our best chance,’ she says. ‘IUI was ruled out because they said the chances of it working would be very much slimmer than IVF. We just went along with what we were told.’
But in late 2011, three days after being told she had no hope with IVF, Tracy went back to the clinic for IUI. ‘Keith didn’t need to be there. They just had a tube with the sperm he had provided before he went to work that morning.
‘I was convinced it wouldn’t work. The doctors had also already said they didn’t think it would work, so I got up, got dressed and decided to get on with the day.’
Tracy was told to come back a fortnight later to see if she was pregnant, but couldn’t resist doing a pregnancy test the morning before – and was amazed to discover she was.
‘I just could not believe it. I sat staring at it for about an hour before I woke up Keith to show him.’ Their baby Maia is now two.
Theirs is not a unique success story. Doctors from the successful IUI programme at North Middlesex recently reported in the journal Human Reproduction that 20 per cent of their infertile women got pregnant from each IUI attempt, compared with a 22 per cent national pregnancy rate per cycle of IVF.
Among the band of delighted new mothers is Georgina Manly, 38, a quality manager in an electrical company, from Muswell Hill, North London.
‘I had a stillbirth 17 years ago and was told I could never get pregnant again,’ she says.
‘Then eight years ago I started trying for a baby with a new partner, but I was told I wasn’t releasing eggs. I was referred for IUI on the NHS and it worked on the second attempt.’ Her baby, Isobel, was born in April 2014.
Barbara Lasocka, 36, a lab technician from North London, was similarly successful. Her baby girl Jagienka is 18 months old.
‘I had been trying for a baby for three years, but nothing was happening,’ she says. ‘They couldn’t find any reason. I was referred for IUI which didn’t work the first month, but the second month I was pregnant.’
One woman, who did not want to be identified, had two unsuccessful IVF attempts at top clinics before successful treatment with IUI. ‘I don’t know why it worked when the IVF didn’t, but it might have been because I felt more relaxed. Although it is not natural, it is not as unnatural, invasive and uncomfortable as IVF.’
Dr Gulam Bahadur, who leads the IUI programme at North Middlesex, says in the past year his team carried the technique out 184 times on 109 women and 34 per cent of them got pregnant. Even among those aged over 35, 39 per cent became pregnant. All were treated on the NHS.
Dr Bahadur says: ‘The only people benefiting from these NICE guidelines recommending only IVF are people offering privately funded IVF.
He adds: ‘The NICE guidance against offering IUI is based on one study from 2008, which suggested it has a success rate of only 6 per cent. That is not true. NICE is only receiving advice from people who do IVF and I don’t think it is handling conflicts of interest very well.’
His comments have been endorsed by Roy Homburg, professor of reproductive medicine at Queen Mary Medical School in London, who told an international meeting of infertility experts in New York in March that for the one-third of patients with unexplained infertility – those without a diagnosable mechanical problem in either partner – IUI was just as good as IVF.
‘I completely agree with the suggestions that IVF may be inappropriate and is exploitative of many patients,’ Professor Homburg said.
‘There is no evidence whatsoever for the NICE recommendation.’
Earlier this year, a 17-centre Dutch study, where couples with unexplained infertility were randomly assigned to IVF or IUI, showed similar pregnancy rates in both groups, and Liv Bente Romundstad, a Norwegian specialist writing in the British Medical Journal in January, said IUI should be the first-line treatment for infertility.
IUI versus IVF comes down to profit margins, says Dr Gedis Grudzinskas, a former emeritus professor of obstetrics and gynaecology at St Bartholomew’s & The Royal London Hospitals.
‘The clinics can make more on IVF, so that’s what they do, but also patients often think they are more likely to get instant results with IVF because mostly the sperm is injected straight into the egg, so that’s what they ask for.’
NICE said its guidance is based on ‘the best available evidence of what works and what it costs, and is developed by an independent and unbiased committee of experts’.
A revised version of its guidance on IUI treatment was due out last February, but nothing has been published. Dr Bahadur has made a Freedom of Information request to discover the reasons for the delay.