Fast Covid-19 recovery for fertility services but variation remains, reveals new report

Fertility services were the first elective health service to reopen during the pandemic with the hard work of healthcare professionals keeping fertility patients’ hopes for a family alive, says the fertility watchdog.

The Impact of Covid-19 on Fertility Treatment 2020 report, published today by the Human Fertilisation & Embryology Authority (HFEA), reveals that NHS-funded IVF treatments fell by 7%* across the UK (35%, 2019 to 28%, 2020), with almost 26,000 patients over 35 receiving IVF treatments; a group prioritised by clinics as the chance of having a baby following fertility treatment decreases with age. The HFEA say this latest data confirms that fewer patients experienced delays during the pandemic than initially feared^[1]. This actually shows, a very small drop in treatments given the far-reaching impact of the pandemic across healthcare.

Most fertility treatments were paused in mid-April with other elective medical treatments due to lockdown and the impact of Covid-19 on the NHS. However, with HFEA guidance, the UK fertility sector reopened after just a few weeks - with clinics quickly adapting and introducing new ways of delivering safe services. However, being the first elective health service to reopen was not without its challenges.

The Impact of Covid-19 on Fertility Treatment 2020 report found variation between UK nations as well as NHS and private services:

• Reopening: during the first week that clinics could apply to reopen, 83% of private clinics and 34% of NHS clinics had approval. However, that increased to 97% private and 95% NHS by the end of October 2020.
• Treatment recovery: Self-funded IVF cycles topped 2019 levels in July 2020, whereas NHS-funded IVF cycles had yet to reach 2019 levels by June 2021.
• Treatment cycles: There was a 38% decrease in the number of NHS-funded IVF cycles for patients aged 18-34 from 2019 to 2020, compared to a 13% decrease among privately funded patients aged 18-34.
• Patient type: Patients in heterosexual relationships had a 22% decrease in IVF cycles from 2019 to 2020 compared to a 6% decrease among patients in female same-sex relationships.
• National variation: The largest decreases in IVF treatment by nation were seen in Wales (-39%), followed by Scotland (-27%) and then England (-19%) from 2019 to 2020.

Julia Chain, Chair of the Human Fertilisation & Embryology Authority (HFEA) said: “Fertility clinic staff worked incredibly hard to re-open during the pandemic providing a safe service for patients. They showed great commitment coping with staff absences and dealing with the pressures of national restrictions both in their professional and personal lives. This has meant that while most normal life was put on pause, many patients’ hopes for a much longed for baby, was not.

“During this time, patients were prioritised based on clinical urgency and for the fertility sector, that meant prioritising patients who were coming to the end of their window of fertility. Fertility treatment can be emotionally and physically demanding and having treatment during the pandemic would have been even more stressful. We know that this would have been a very difficult time for many patients, particularly those whose treatment was paused.”

The HFEA say that variation between nations is likely linked to several factors including local restrictions, the speed at which individual clinics could reopen and higher proportions of private funding in some areas.

Julia said: “In comparison to private care, NHS clinics more commonly had staff redeployed to support other hospital services which could have led to NHS clinics being slower to restart treatment in 2020. High waiting times for tests or surgery may have delayed treatment too; an aftershock of Covid-19 that we expect will continue for at least another 12-24 months.

Understandably, many patients wanted to begin or continue fertility treatment during the pandemic and clinic staff went above and beyond to offer safe care. However, Covid-19 related measures did have an impact on some patients, as many appointments had to be provided remotely and those that were in person, were restricted in attendance to just the patient.

Jason Kasraie, HFEA Authority Member and Consultant Embryologist at the Shropshire and mid-Wales Fertility Centre, said: “Reopening our services during the pandemic meant that clinics could offer patients the treatment they desperately needed. This did not come without difficulties though as the risk of Covid infection had to be mitigated at all stages. We were helped by guidance from our professional bodies and the HFEA, which allowed us to deliver treatments as safely as possible. We also concentrated on prioritising those most in need of treatment, who tended to be older women over the age of 35. The initial closure of clinics was an incredibly stressful event for many couples, as every month of delay could reduce their chances of starting a family.

“Whilst we had to make some difficult choices, like asking couples to isolate and test during their treatments and to attend appointments as individuals when normally both partners would be present, clinic staff worked incredibly hard to mitigate these issues and offer additional support. Ultimately it is a credit to the hard work of clinic staff that the sector recovered so rapidly, and whilst we have not completely recovered treatment numbers for NHS services, colleagues in primary and secondary care are working hard to clear any remaining backlogs and normalise referral rates to specialist treatment centres.”

The Impact of Covid-19 on Fertility Treatment 2020 report also revealed:

• IVF treatments using fresh embryos decreased by 28% from 2019 to 2020, compared to an 10% decrease in frozen embryo transfer IVF.
• Embryo storage increased by 6% from 2019 to 2020 and was the only activity to increase from 2019 to 2020.
• IVF cycles decreased by 25% among patients aged 18-34 from 2019 to 2020, compared to a 15% decrease among patients aged 40-50 showing that clinics followed professional body guidance on prioritising patient groups.
• Patients in heterosexual relationships had a 22% decrease in IVF cycles from 2019 to 2020 compared to a 6% decrease among patients in female same-sex relationships.
• Registrations for new egg donors decreased by 23% from 2019 to 2020, compared to a 14% decrease in new sperm donor registrations.

Julia said: “The drop in egg and sperm donation could be due to a number of factors; local lockdowns, hesitancy in coming forward in fear of adding pressure to NHS services and there may have also been concerns around catching Covid-19. Additionally, when re-starting treatment in May 2020, clinics prioritised patients who had experienced delays to treatment rather than proactively seeking new donations.

“We know the number of patients wanting to use donor eggs and sperm is increasing, with the use of donor eggs doubling since 2009. In some areas, patients requiring a donor have long waits for a match, particularly if they are looking for donors from for example a specific ethnic minority background. We’re concerned waiting times are going to get longer, putting patients in a position where they must choose between losing links to their heritage or their chance of parenthood.”

Read the full Impact of Covid-19 on Fertility Treatment 2020 report.

ENDS

For more information or for interviews with a HFEA spokesperson, please contact press.office@hfea.gov.uk or call 020 7291 8226.

For out of hours requests, please call the duty press officer on 07771981920.

Notes to editors

• * When looking at all treatment cycles – NHS funded and self-funded - NHS-funded IVF treatments decreased across the UK by 7 percentage points from 35% in 2019 to 28% in 2020
• A number of anonymised quotes from patients are available in the report.
• Alongside all non-urgent elective surgery, UK fertility treatments were suspended on 15 April 2020 due to the impact of COVID-19 on the NHS. However, with HFEA guidance, the UK fertility sector reopened on 11 May 2020.

About the HFEA

• The HFEA is the UK’s independent regulator of fertility treatment and research using human embryos.
• Set up in 1990 by the Human Fertilisation and Embryology Act, the HFEA is responsible for licensing, monitoring, and inspecting fertility clinics to ensure patients and everyone born through fertility treatment receives high quality care.
• The HFEA is an ‘arm’s length body’ of the Department for Health and Social Care, working independently from Government providing free, clear, and impartial information about fertility treatment, clinics and egg, sperm and embryo donation.
• The HFEA is funded by licence fees, IVF treatment fees and a grant from UK central government. For more information visit, hfea.gov.uk.

1. National Patient Survey 2021, HFEA