IVF Treatment

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and I declare my interests as the lead author of the Lancet insight paper on IVF add-ons and as a board member of the Human Fertilisation and Embryology Authority.

My Lords, we are aware of the issues raised in the Lancet article regarding the effectiveness of IVF treatment add-ons. The regulator, the HFEA, provides information to patients on the effectiveness of fertility treatment add-ons through its website. In most cases, there is insufficient evidence to demonstrate that they improve treatment outcomes. The Government are considering a range of proposed reforms to fertility regulation, including the scope of regulator powers to regulate add-ons effectively.

I thank my noble friend the Minister for her reply. The concern about IVF add-ons is not only that many are unproven and ineffective but also that some can pose serious health risks to patients and unnecessary emotional and financial harm. The HFEA’s current traffic light system is guidance only and the regulator has no enforcement powers, which means that some add-ons with a red rating continue to be offered in clinical practice. Will she consider granting the HFEA interim enforcement powers for the use of red-rated IVF add-ons to protect patients from harm while the wider reforms to the fertility regulatory framework are being developed and implemented?

I recognise the situation that my noble friend describes and note that, while the relevant Act has provided a strong framework for over three decades, the fact is that treatment, science and societal expectations have all evolved very significantly since the last major reform in 2008. It is the case that the Act does not currently provide powers to ban add-ons. We are constantly looking at what we can do while we await and consider legislative change, but that really is the best way forward to tackle this.

My Lords, the reality is that patients in England are struggling to access publicly funded IVF, with only two out of the 42 integrated care boards in England complying with NICE fertility guidelines. Can the Minister advise whether the Government are considering following Wales and Scotland in centralising commissioning for IVF rather than the current postcode lottery?

We are not doing that, not least because, as the noble Baroness is aware, we believe that the needs of the local population are best served through local decision-making and through the integrated care boards. That said, I absolutely recognise that access to NHS-funded fertility services is variable, and we are reviewing the situation so that we can determine the next steps. I should emphasise that NHS commissioning organisations are expected to commission fertility services. They do have NICE guidance, which we are supporting them in following.

My Lords, we will hear from the Cross Benches next and then from the Conservative Benches.

My Lords, I declare an interest as a former chair of the HFEA. Does the Minister agree with me that we really must get on with modernising the Act, as more and more gaps are revealed? In the meantime, does she agree with me that the HFEA should collect data by asking clinics to supply it? Then it would get firm evidence about what works and what does not. It could then publish the data, and make sure that patients are informed by their clinics, or by leaflets in the waiting room, to go on the clinic website and the HFEA website to get the accurate information.

I would agree with the noble Baroness about the importance of ensuring that those who are considering accessing services—particularly the “add-on services”, as they are referred to—have the full information. The place for that is the HFEA website. The HFEA does make efforts, as do we in the NHS, to ensure that people are guided; however, it will be down to the individual. I absolutely agree with her about the need for reform for the reasons that I said earlier, and that is why we are looking at it.

My Lords, the HFEA has reported a 44% increase in the number of patients freezing their eggs from 2022 to 2024, yet data shows that very few women return to use those stored eggs and success rates decline with age. Given the frequent promotion of egg freezing to women without adequate reference to these limitations, will the Minister set out what steps the Government are taking to ensure that accurate information is widely available to those considering this procedure?

The noble Baroness is quite right to identify that this is not an insurance policy to be relied on to guarantee a baby in the future, no matter what suggestion there may be to the contrary. It is also worth knowing that, while egg freezing is the fastest growing fertility treatment, it is proportionately still small—comprising about 5% of treatments. To her point, there is a responsibility on fertility clinics to ensure that anyone using their services understands the risks—which I must emphasise—as well as the long-term impacts of any treatment decisions that they make. It is quite right and proper that they do that.

My Lords, with the abolition of NHS England, ICBs will be given many more responsibilities in the future. However, does the Minister agree that their record on IVF, where they are not following the clear, specific guidance that they have been given, does not induce confidence in ICBs’ performance? Inevitably, Ministers will be drawn to make decisions more centrally. Does the Minister think ICBs understand that the kind of rationing that they undertake at the moment in relation to IVF is utterly unacceptable?

I do find it unacceptable that people have different access to treatments in the way that noble Lords have described. I would expect that the move through the Health Bill will enable us to have a far more effective means, in all sorts of areas, to ensure that local populations are properly served. That is why we will be bringing the functions of the NHSE into the department. As my noble friend will know, that will ensure that we no longer have duplication and that we have the right resources. I very much expect and want to see adequacy of access and fairness, which is the basic thing in all NHS treatment, to be established in fertility treatment.

My Lords, I begin by thanking and paying tribute to the noble Baroness, Lady Nargund, and to her co-authors of this fascinating paper. Clearly, it shows that IVF is an area in which innovation is important but so too is the need for evidence. At a time when add-ons have sometimes quite fancy scientific names such as platelet-rich plasma, embryo imaging or intralipid infusion, it is understandable why patients may feel confused and think that this is a much-needed medical intervention. Are the Government aware of high-quality research into IVF add-ons that would give patients, clinicians and regulators greater confidence about which treatments generally improve outcomes for patients?

All of this is important, not least because noble Lords will have seen in the women’s health strategy that we want to ensure that every woman can access effective fertility services easily and safely. I would certainly agree that there are areas where the fertility evidence base could be strengthened, and we are looking at how we can best support research and data collection, which was another point raised by noble Lords. We are currently working with NHS England, which will become part of the department, because we want to support equitable commissioning but also the right evidence base so that information is properly available. At present, there is scant evidence that many of these add-ons are anything other than optional and not recommended.

My Lords, would the Government consider requiring the HFEA to share data on these inappropriate and harmful add-ons with the General Medical Council so that fitness to practise concerns can be acted on?

It is important that, where there are concerns, they are acted on. Perhaps the noble Baroness, with her experience, has a particular way in which that could be followed up, but certainly the GMC would be expected to take action if there was incorrect and unacceptable practice. I am not suggesting that in respect of add-ons to fertility treatment; I am focusing on the need for fair, equitable, NHS-funded fertility services and ensuring people know that there is not evidence that their chances of conceiving will be improved currently by any of these add-ons that are being offered, which is the worrying situation that we have.