Mr Rehan Salim
Fertility treatments in private practice are booming. Gynaecologist Mr Rehan Salim, subspecialist in reproductive medicine at the new Lister Fertility Clinic at HCA Healthcare’s The Portland Hospital, shares his perspective.
Fertility and related services have been seeing an ongoing growth and rise in demand.
This has lead to an increase in the number of fertility clinics, as well as associated services, including alternative medicine practitioners such as acupuncturists and fertility nutritionists.
This growth would imply there is a rise in fertility-related medical problems and that, as a species, we are increasingly becoming less fertile. The theory is appealing, but it is unlikely to hold true.
Overall, data suggests that for age matched populations, we are no less fertile today than we were in previous years.
However, society has changed, certainly in western societies and increasingly in the developing world as we are choosing to delay childbearing.
This choice is driven by societal and economic change. Fundamentally, as we face common challenges and choices around careers and our personal funds, individuals now prefer to wait until they are best placed both professionally and financially to have a child.
This makes sense: why bring a child into the world when we cannot guarantee it a good life?
But this societal shift is not without consequences for some, especially women. Biology dictates they are most fertile in their youth and with advancing age comes depleting fertility rates.
This paradigm forms the basis of an unfair and unjust situation, where biology has not kept pace with society. Thus, as women delay childbearing – as is often seen in many developed and now developing societies – their chances of conception unfortunately decline.
This leads to them turning to fertility treatments to help, which is the main driver of the increase in fertility services we see today.
But, human nature, being what it is, who wants to admit the decline of their youth; especially when you have achieved career and life success?
As a result, many women turn to alternative medicine before seeking science-backed medical fertility treatment such as IVF.
There is also the patchwork provision of fertility services within the NHS. While NICE has provided a clear and unequivocal set of recommendations for provision of fertility treatment, most clinical commissioning groups are non-compliant.
The driver for this divergence from recommended good medical practice is undoubtedly public finances. Full implementation of NICE guidelines would enable couples to have their medical needs met by the NHS. But, in an era of limited public finances, no one should be hasty to judge the prioritisation of other services over fertility treatments, as something has to give.
This situation also drives patients to seek private fertility treatments. The range and quality of services available privately has meant that increasingly, when given the option between an NHS provider of private fertility treatment and a full private clinic, the patient chooses the latter.
Private providers have the freedom to invest in technology, staff and premises. This undoubtedly gives a better patient experience, driving more people to use them and resulting in the continuous growth of private fertility treatments, which we will see for years to come.
Given the demand and rewards for private fertility providers, it has allowed for investment into the advancement of technology and quality equipment, allowing outcomes to continue to improve.
The Human Fertilisation and Embryology Authority dataset shows that over the last 10-20 years of licensed fertility treatment in the UK, pregnancy rates continue to grow for most patients.
Given the returns on investment, there is a strong driver for research and innovation within the private fertility clinics, many of whom are at the cutting edge of reproductive medicine. This will continue to differentiate the high-quality clinics from the rest.
Future growth in private fertility services will come from patients choosing clinics providing quality medical care and novel technologies that may ultimately improve outcomes.
The latter has been controversial, with a Competition and Markets Authority investigation making recommendations around transparency.
Ahead of the curve
Greater transparency will improve information provision in the best clinics – which are probably ahead of the curve with this anyway – and separate a market within which quality clinicians are better placed to explain and deliver best practice. Demographics and NHS provision will also drive the market further.
Society will change and, especially for women, awareness of potential fertility issues will allow access to fertility preservation and leave open options for delaying motherhood.
The NHS has an important place in the delivery of fertility treatments and should continue to provide this.
However, as the provision of NHS-funded care develops, there is undoubtedly a place for private providers of NHS-funded care.
And this equity of provision will also drive the growth of fertility clinics that are able to invest and deliver the very best outcomes for patients.