Members of the Centre for Reproduction Research (home to the EDNA project) have recently commented on news stories in which reproductive technologies have once again come under the media spotlight. These stories – two relating to the efficacy and funding of social egg freezing and one about IVF cash back schemes – represent a recent surge of interest in the commercial character of IVF and its related technologies. We are seeing increasing attention and scrutiny given to what Deborah Spar termed back in 2006, ‘The Baby Business’, and with good reason. With a shrinking of public funding for healthcare more generally in the UK (and an NHS in increasing long-term jeopardy), funding for infertility treatment is facing renewed pressures meaning fewer people who need financial help to create a family are able to receive it.
The political battle to win funding for fertility treatment and for its recognition to be defined and treated as a disease has a long and precarious history. For more than 20 years in the UK, the campaign for ‘Fertility Fairness’, spearheaded by patients and professionals, has argued for equitable access to fertility treatment across the UK. Despite these voices, currently only 12% of CCGs in England commission three full cycles of IVF in line with NICE guidelines. There are still parts of the country where no funding for fertility treatment is available and most egg donation treatment takes place in the private sector. Many have already pointed out the ironic position we find ourselves in in the UK, where we recently celebrated Louise Brown’s 40th birthday, against a backdrop of one of the lowest levels of public funding for IVF in Europe.
It is therefore not surprising to see a flurry of new IVF finance schemes appear as people who would not otherwise be able to easily afford treatment try different means to achieve their dream of a ‘take home baby’. These schemes are based on the premise that you pay an upfront fee (for example £9,000), receive unlimited IVF within a restricted time (2 years), and get your money back if treatment fails. On the other hand, if you are successful on the first attempt, you may find that you have paid a considerable amount over the odds for a single cycle of IVF (expensive fertility drugs and any treatment ‘add ons’ are not included in the upfront fee and are additional and non-refundable). The schemes are selective, in that you must be under a certain age and meet specific medical criteria (ruling out those who need donor eggs, for example) in order to qualify, factors which already imply a higher chance of success within a short treatment window.
Concerns about their use revolve around the additional pressures they add to the treatment process (as much IVF as you can manage in 2 years seems attractive on the face of it until you factor in the emotional and physical toil, pressure on jobs, relationships, social life, holidays- the list goes on), as well as the fact that offering these schemes potentially creates an environment in which there maybe a inducement to over-treat; if clinics receive financial incentives for more rapid successes.
In terms of the possible implications for egg donation, given that around one third of new egg donor registrations in the UK each year are from women who share their eggs in return for reduced price treatment, if more patients opt for ‘cash back’ schemes instead of ‘egg-share’ schemes will there be a knock-on effect on the availability of donor eggs in the UK?
Ultimately, the schemes have raised concern because they represent the potential commercial exploitation of patients’ most deeply held hopes and desires. No doubt these schemes will offer for some, a more manageable way to arrange the financing of the hefty costs involved in IVF. And sadly, for those for whom IVF is not the miracle solution, at least there is solace in recouping some of that (financial) cost. However, for such schemes to be fiscally successful someone loses out, so we must ask the question, does this particular business model capitalise on people’s anxieties?
Social egg freezing also hit the news twice last week – both because the RCOG released a statement warning women about the relatively low success rates, high costs and side effects associated with egg freezing, and because leading clinician, Prof. Geeta Nargund, argued that egg freezing should be offered for women 30-35 on the NHS. Social egg freezing currently costs a prohibitive £5000 per cycle (that is before the costs of follow up IVF treatment are added), and is therefore another example of what social scientists have referred to as ‘stratified reproduction’ – the idea that some are facilitated to reproduce, whilst others are inhibited from doing so. Prof. Nargund’s suggestion to fund egg freezing on the NHS potentially offers one solution to this issue. However the suggestion has also come under scrutiny as commentators have pointed out that we are already battling to secure access to funding both for IVF patients with a diagnosed fertility problem of some standing, as well as the need for adequate funding for egg and sperm freezing for all patients with a medical need.
These recent debates draw our attention to new and pressing questions regarding the funding and growing commercialisation of fertility treatment in the UK and internationally. We need new ways to think about and explore how the socio-politics of hope and commercial interests shape this field and we need to continue to make the demand for improved funding and access for all within the NHS – no small feat within the current UK political environment.
By Prof Nicky Hudson
Links to related DMU media interviews: