PERFECT little toes on a fluffy knitted blanket – that was the image that accompanied this week’s story in The National about IVF on the NHS. Scotland is to have the UK’s “fairest and most generous” provision, the government announced this week, having accepted some of the key recommendations of its National Infertility Group.
IVF makes babies, so it makes sense to illustrate news about it with one such miniature human, but it’s worth remembering that use of the technique can have other outcomes that are harder to convey using visual shorthand, such as emotional devastation, relationship breakdown and financial ruin.
The likelihood of the last of these is reduced when the NHS is picking up the tab for treatment, but state provision of IVF has helped distort how our society views infertility. It is no longer a fact of life with which couples must come to terms in their own way. Instead, it is an obstacle to be overcome against the odds.
The move towards three cycles per couple will help with those odds, but the chances of IVF resulting in a baby are tricky to grasp. There is a bamboozling amount of data out there on success rates: some adjusted for age and prognosis; some reporting pregnancy rates and others “live birth” rates; some relating to multiple reproductive technologies, others only to the use of fresh eggs and unadulterated sperm. Some figures are published by regulatory bodies, others by private clinics with a strong motive to present the data in a particular way.
State provision of IVF has helped distort how our society views infertility. It is no longer a fact of life with which couples must come to terms in their own way. Instead, it is an obstacle to be overcome against the odds
The latest figures from the Human Fertilisation and Embryology Authority show that in 2012, “live birth” success rates for women under 35 were nearing 33 per cent. It must be tempting for couples desperate to conceive to think of this as a straightforward one-in-three chance for each attempt – and that only the least lucky will be left without a child after three cycles – but unfortunately that’s not how it works. The success rate for three cycles isn’t 99 per cent – in 2014 the National Institute for Clinical Excellence said it was between 45 and 53 per cent (the wide range being the difference between optimum and conservative estimates). The chances of success diminish with each attempt.
However, the very fact of the Scottish Government offering three cycles sends a powerful message that this should be sufficient for couple embarking on treatment, and many other factors help support such a belief. Not least of these is the sheer strength of a couple’s desire to have a baby and a perhaps corresponding sense that this is their true destiny; that a neglectful mother nature has made a mistake that must – and can – be remedied.
IVF is no longer an extreme measure, undertaken only by those with the strongest desire to reproduce. Instead it’s the default fall-back, perceived as an insurance policy
While those undergoing fertility treatment tend not to shout about it, these days talk of the technology is far from taboo. Mentioning that Jane and Rob are trying IVF is no more likely to raise an eyebrow than observing that Tom and Fiona met through an internet dating site. In both cases this might not be the scenario those involved envisaged, but it’s one that our modern world has made possible and increasingly to opt out is seen as the stubborn, eccentric or old-fashioned stance. IVF is no longer an extreme measure, undertaken only by those with the strongest desire to reproduce. Instead it’s the default fall-back, perceived as an insurance policy for those who either choose to delay or simply aren’t in a position to try for a baby at the time when they’re at their most fertile. The more people reassure themselves “there’s always IVF”, the more demand will grow.
Media coverage of assisted reproduction tends not to focus on failure, or the gruelling and invasive nature of the procedures involved. Where these aspects are discussed, the problems are often tied up in neat little bow at the end, with those involved saying yes, the struggle took a huge toll, the house is remortgaged, the IVF merry-go-round is difficult to jump off, but it was worth it in the end. The article will generally be accompanied by a photo of the quoted couple beaming, with an apple-cheeked twin on each lap.
One woman going though her second round said that in many ways she wished the technology did not exist, because of the potential for built-up hopes to be cruelly dashed
When the BBC ran a story online about failure rates of IVF a few years ago, it received a flood of responses from those who had struggled to use the technology to conceive, or were still trying. Many wrote about being advised of the success rates yet still experiencing crushing disappointment each time a pregnancy failed to result. One woman going though her second round said that in many ways she wished the technology did not exist, because of the potential for built-up hopes to be cruelly dashed. “It feels like a raffle,” she wrote. “How many tickets do you buy?”
If the NHS is paying for treatment then the practical cost is taken care of, but the emotional stakes remain high. There’s a fine line between saying you can have three shots at conceiving and suggesting you should take up the offer. There was a very important caveat to the Infertility Group’s recommendations about widening IVF access: that the Scottish Government must be “content that IVF funding is sustainable”. With more and more people seeking access to treatment, and the latest study warning couples to prepare themselves for six cycles, questions must be asked about how far we are willing to go.
A version of this article first appeared in The National