Fertility patients’ satisfaction with treatment is high but room for improvement remains, says HFEA

Responses to the HFEA’s National Patient Survey have provided valuable evidence of the experience and views of 1,500 fertility patients.

The survey explored the patient experience of fertility treatment in the UK, highlighting how it has changed over the past decade. The findings will inform the HFEA’s future work, as well as wider conversations about UK healthcare.

Patient satisfaction remains high overall

The HFEA found that 73% of fertility patients were satisfied with their latest round of treatment, marking the third survey in a row where overall satisfaction was more than 70%. Patients in the North East of England reported the highest satisfaction levels (86%*) compared to the lowest in Wales (68%*).

While most fertility treatment in the UK is paid for by patients themselves, there weren’t many differences in overall satisfaction between NHS and self-funded patients. However, there were larger differences for Asian and Black patients, who were less likely to have reported being satisfied with their treatment (50% and 59%* respectively). This may be due to lower birth rates and NHS-funded treatment among these groups.

Patients’ satisfaction with the quality of information they received from their clinic also varied by ethnicity, with Asian and Black patients less likely to report being satisfied with the information given to them (both 66% vs 78% overall) and how the clinic answered any questions they had about their treatment (66% and 57% respectively vs 76% overall).

Although location was still the most important factor overall for patients when choosing a clinic (rising from 50% in 2018 to 62% in 2024), cost was particularly important to Black patients (47%* vs 29% all other patient groups combined) and single patients (50% vs 25% opposite-sex couples), which may relate to the lower levels of NHS funding in these patient groups.

Julia Chain, Chair of the Human Fertilisation and Embryology Authority said:

“We are pleased to see that overall satisfaction of patients undergoing fertility treatment has remained above 70% for the past ten years, particularly given how quickly the sector is evolving and the general public’s opinion on the state of healthcare in the UK after NHS satisfaction reached a record low in 2023.

“However, a significant concern is that Asian and Black patients are much less satisfied, as well as there being disparities in different parts of the country.”

NHS patients are experiencing longer wait times

HFEA data shows that the number of NHS-funded cycles continues to fall, reaching 27% in 2022. Some patients said finding it difficult to get NHS funding or being confused about what treatments would be available to them were reasons why they decided to go private.

Almost 80% of patients spoke to a GP about their options before starting treatment. Although satisfaction rates were similar, NHS-funded patients reported longer wait times in starting treatment than self-funded patients after speaking to a GP, with 53% of self-funded patients starting treatment within a year compared to 35% of NHS patients.

Most patients who reported delays attributed this to waiting for referrals, appointments, investigations, and/or needing further tests or surgery. These delays were likely to have happened before a patient’s referral to a fertility clinic and were again more common among NHS patients – potentially due to a knock-on effect of ongoing wait times for gynaecological services.

While patients most commonly began treatment between 7 and 12 months after seeing their GP (30%), 16% waited more than two years, which could have a negative effect on outcomes given that success rates from fertility treatment decrease with age.

Julia added: “We are also concerned that NHS-funded patients are waiting longer than self-funded patients to start fertility treatment. The delays faced by NHS patients highlight ongoing issues relating to the provision of specialist care for women.

“As part of our response to the government’s ten-year plan, we want to see a much shorter time for patients to begin fertility treatment once they have received advice or a referral from their GP.”

Three quarters of patients are using unproven extras

The HFEA found 73% of patients had used an additional test, treatment, or emerging technology in their latest round of treatment, despite the fact that most are not proven to increase the chance of having a baby for most patients.

Given the evidence, it is disappointing that over half (52%) of patients used an additional test, treatment, or emerging technology after their clinic explained its effectiveness, and that many (59%) chose to use one based on their clinic’s recommendation. Of similar concern is the fact that only 37% of patients said their clinics explained the risks of using an additional test, treatment, or emerging technology.

The use of different treatment add-ons varies. Use of endometrial scratching, when the lining of the womb is “scratched” before an embryo is implanted, has decreased. Despite there being insufficient evidence of its effectiveness at improving treatment outcomes, one of the add-ons that has seen the biggest increase is pre-implantation genetic testing for aneuploidy (PGT-A), the checking of embryos for abnormalities in the number of chromosomes.

Julia continued: “It’s disappointing to see a significant number of patients are still using add-ons and emerging technologies, and particularly disappointing that only half of patients had the effectiveness explained to them, let alone the risks.

“We regularly remind clinics that, according to our Code of Practice, they must give patients a clear idea of what any treatment add-on involves, how likely it is to increase their chance of a successful pregnancy, cost, risks, and link to our public ratings system. We will continue to remind clinics about improving clarity and communication for patients.”

Around half of patients needing donor sperm used overseas donors

Around a quarter of patients had used donor eggs, sperm, or embryos in treatment. Of the patients who had used donor sperm, 70% found this easy to access.

Around half of patients using donor sperm used overseas donors, saying this was mainly due to increased choice and more information about the donor available. Around a third of these patients reported a lack of clarity on communication of family limits for overseas donors.

This is disappointing as the HFEA’s Code of Practice sets out that clinics should explain the ten-family limit guidance on donation to patients, where one donor's sperm can only be used to create up to ten families in the UK, and make sure patients understand before starting treatment that donors may also have donated abroad where the ten-family limit does not apply.

You can read the full National Patient Survey report on the HFEA website.

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 contact the duty press officer on 07771 981920.

Notes to editors

• The HFEA ran the National Patient Survey 2024 from 2 September to 9 October 2024. The survey was open to anyone who had undergone fertility treatment in the UK, including patients, partners, intended parents and surrogates. The information obtained is a snapshot of the patient experience of various aspects the fertility sector from 2019 to 2024.
• The survey is broadly representative of the fertility patient population, with a few exceptions. More details can be found in the Quality and Methodology Report.
• Total counts are available in the underlying dataset of this report.
• Due to small base sizes for some sub-groups, the differences highlighted in the report may not be statistically significant. Where this is the case, we have flagged this with an asterisk (*).
• Over time, due to the evolving nature of the fertility sector and need for continuous improvement, there have been some changes to the way some of the questions have been presented and/or the answer options provided to patients. In some cases, this has meant that comparison between years is not possible.
• The report is based on responses from patients, partners, intended parents and surrogates. However, we use the term ‘patients’ throughout as an umbrella term to include each of these groups.
• The HFEA is committed to ensuring add-ons are used appropriately in treatment and launched an improved rating system in 2023. Developed with patients and professionals in the fertility sector, there are five categories giving detailed information for patients about whether they increase the chances of having a baby and other outcomes, such as impact on miscarriage rates.
• A report published in November 2024 by the Royal College of Obstetricians and Gynaecologists (RCOG) found that more than three quarters of a million women (763,694) across the UK are currently waiting for gynaecology care.
  

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 - and taking enforcement action where necessary - to ensure everyone accessing 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 collects and verifies data on all treatments that take place in UK licensed clinics which can support scientific developments and research and service planning and delivery.
• Around 4,100 children in the UK are born each year through the help of a donor (2019). The HFEA holds records of all donors and children born since 1991.
• The HFEA is funded by licence fees, IVF treatment fees and a small grant from UK central government. For more information, visit hfea.gov.uk.