HFEA Fertility Treatment 2017: Trends And Figures

Fertility treatment 2017: trends and figuresIn 2017, 54,760 patients underwent 75,425 fertilitytreatment cycles. Donor insemination (DI) and invitro fertilisation (IVF) made up the majority oftreatments.In 2017, IVF accounts for 93% of treatment cycles,but different kinds of fertility options are also beingmade available via fertility clinics. These treatmentoptions include pre-implantation genetic diagnosis(PGD), egg freezing, egg sharing and surrogacy. Inthis report, we show the trends for different fertilitytreatments and options that occurred in 2017,focussing on: patient characteristics types of treatments birth rates, and where and how fertility treatment is funded inthe UK.Human Fertilisation and Embryology Authority 7OutlineWe’ve divided the report into four main sections:patient characteristics, types of treatment, birthrates and funding by region. The first sectionprovides the characteristics of patients seekingtreatment: notably patient age (a critical aspect offertility and fertility treatment success) and typesof partners (heterosexual, same-sex, no partneror acting as a surrogate). This section providesa picture of the kinds of people seeking fertilitytreatment as well as the particular fertility concernsthat affect specific age groups and types offamilies seeking treatment.In the second section, we look at types oftreatment, which describes the different kinds offertility treatments available and their rates of useover time. This section is important for developinga sense of how fertility treatments are changingand the different options available both in the pastand now.In our third section, we provide details of the birthrates for the types of treatments available. Birthrates can be seen in terms of age, frozen and freshcycles, egg and sperm source, and treatment type.Finally, in our fourth section, we look at nations,regions and funding, providing data and graphslooking at the ways fertility treatments and fundingare distributed across the nations and regions ofthe UK, as well as sectors (public and private).This section also examines the relationship betweenfunding and locality; the decrease in NHS fundingfor fertility treatment in England and the rise in NHSfunding in Northern Ireland, Scotland and Wales.

8Fertility treatment 2017: trends and figuresHuman Fertilisation and Embryology Authority1. Patientcharacteristics

Fertility treatment 2017: trends and figuresKey statistics35.5Average patient age has increased for both IVFand DI treatments from 33.5 and 32 in 1991 to35.5 and 34.5 in 2017, respectively.65%Patients aged under 37 make up 65% of peoplehaving IVF treatment cycles and 73% of thoseundergoing DI treatment cycles.90.7%Most treatment cycles (68,380; 90.7%) wereundertaken by patients with male partners.The remaining patients were listed with a femalepartner (4,463; 5.9%), no partner (2,279; 3%)or as a surrogate (302; 0.4%).12%Treatment cycles for patients in same-sexpartnerships have increased by 12% from 2016 to2017 and 4% and 22% for patients with no partneror surrogates, respectively.IntroductionPatients seeking fertility treatment are typicallypeople in heterosexual partnerships and this grouprepresents almost 91% of people seeking fertilitytreatment in the UK. The remaining 9% of patientsundergoing fertility treatment are those in samesex relationships, in no recorded relationship andthose using surrogacy.Human Fertilisation and Embryology Authority 9The majority of people seeking treatment do sodue to infertility. For this group, age is a criticalaspect of both the cause of infertility (as thegeneral population delay starting a family), kindsof treatments used and success rates (becausea patient’s fertility declines with age). As such,age is an important patient characteristic andmost of the data we record is linked with age.Likewise, fertility clinics also offer patients ‘fertilitypreservation’ treatment whereby eggs are collected/embryos created and stored for future use. Therefore,patient age is important in these instances too.For the remaining patients, infertility is notnecessarily the reason for seeking treatment andrather, it’s the social contexts which do not allowfor ‘natural’ conception. These circumstancesinclude being in a same-sex relationship, nothaving a partner or acting as a surrogate.Therefore, patient characteristics include therecording of ‘partner status’, as this factorindicates why a person may be seeking treatment.Additionally, about 1% of cycles are for patientsundertaking PGD treatment to prevent anypotential children from carrying life-threateningand/or debilitating diseases.In this section, we present the data on the age ofpatients, their partner status and sources of eggsand sperm. These characteristics show changesover time and reflect the social trends of havingchildren later in life and changing family formations.AgeAge is a key indicator of fertility and this is reflectedin the change in the ages of people seeking fertilitytreatment and could partly account for increasednumbers of fertility treatments since we beganrecording data. In 1991, the average age for DItreatment was 32 and 33.5 for IVF cycles. In 2017,the average age for DI was 34.5 and 35.5 for IVF.

10Fertility treatment 2017: trends and figuresHuman Fertilisation and Embryology AuthorityThe majority of patients undergoing fertilitytreatment (some 55%) were aged between35 and 44. Figure 2 sets out the percentageof patients by age divided into six bands. Whileit does show that patients under 35 representthe largest group undergoing fertility treatments,it should be noted that this is the largest age bandcompared to other age bands which only holdone to two years. The under 35 range alsoencompasses a higher proportion of patientsseeking fertility for non-age related reasons,such as being in a same-sex relationship andthose having genetic testing.Figure 1: Average patient age by treatmenttype, 1991–20173635343332Figure 2: DI and IVF patient ages, 9971995199319913050%DIThe general population are delaying parentingand therefore, as people’s fertility declines withage, the need for fertility treatment potentiallyincreases. The age of DI patients has continuedto decline since 2011 (see figure 1) and this changecould be attributed to: the decrease in NHS funding for DI treatments(see section 4) criteria for DI NHS funding (ie, many people nolonger meet the criteria for NHS-funded DI), and an upward trend in the use of IVF by patients insame-sex partnerships and with no partner andclinicians recommending trying IVF before DI.45%40%35%30%25%20%15%10%5%0%IVFUnder 3540-4235-3743-44DI38-39Over 44

Fertility treatment 2017: trends and figuresFigure 3 indicates that the highest number ofpatients using own eggs and partner sperm(OEPS) and own eggs and donor sperm (OEDS)are those aged under 35. Again, this reflects theimpact of age on egg quality because most peoplewho are able to use their own eggs are at the agewhere egg quality is still high (35 and under). Thisis not to say however, that older people cannotconceive using their own eggs and sperm, asshown in section three.Interestingly, donor egg and donor sperm cyclesare mostly undertaken by the under 35 age grouptoo. This is in part due to the high percentage ofpatients with female same-sex partners usingdonor eggs and donor sperm who tend to beyounger. As can be seen in the graph, using donoreggs with partner sperm is mostly used by thoseaged 44 and over, as the chances of successfulpregnancy after 44 using one’s own eggs are nothigh (see section three).Human Fertilisation and Embryology Authority 11Figure 3: Patient age by source of egg andsperm, 201750%45%40%35%30%25%20%15%10%5%0%DEPSUnder 3540-42DEDSOEPSOEDS35-3738-3943-44Over 44Most people who freeze their eggs (and sperm)do so for fertility preservation – either becausethey would like to delay having a child, they arehaving treatment for cancer, or they are transgenderand may wish to use their eggs and sperm at alater stage.As such, there were 479 egg freeze cycles forpatients under 35, making up the highest proportion(33%) of people using this treatment. They wereclosely followed by the 35–37 age group at 426cycles (29%).

12Fertility treatment 2017: trends and figuresBy way of contrast, in the thaw cycles, the highestproportion of people using frozen eggs are aged44 and over (206 cycles, 35.5%), with a reverseincline for the other ages as well. The reasons forthis include over 44-year olds needing to use theirfrozen eggs or frozen donor eggs more so thanother age groups, as well as the fact that youngerage groups may never need to use their frozeneggs because they become pregnant withoutfertility treatment.Human Fertilisation and Embryology AuthorityPatient ages are broadly the same across partnertypes, with under 35s again being the largestgroup due to the width of the age band. Patientswith a female partner are much more likely to beunder 35, with 80% of patients below 37, whilepatients with a male partner or surrogates havevery similar trends in ages. In contrast, patientswith no partner are more likely to be above 40(50%) than other partner types.Figure 5: Patient age by partner status, 2017Figure 4: Patient age at egg freeze or thawcycle, reezeUnder 3540-4235-37Over 43Thaw38-39Over 44MalepartnerUnder 3540-42FemalepartnerNo partner Surrogate35-3743-4438-39Over 44

Fertility treatment 2017: trends and figuresPartner statusPartner status offers insight into both why fertilitytreatment is sought as well as how the kinds ofpeople using fertility treatment may be changingover time. Figure 6 shows that the majority ofpeople using IVF are people in heterosexualpartnerships. On the other hand, as figure 7shows, it’s clear that more patients with a femalepartner used DI in 2017 and, when combined withpatients who have no partner, they make up themajority of DI patients.While only about 9% of treatment cycles wereundertaken by patients in non-heterosexualpartnerships – female same-sex (5.9%, 4,463),no partner (3%, 2,279) and surrogates (0.4%, 302)– there have been increases in treatment cycles of12%, 4% and 22% for patients in female same-sexrelationships, with no partner or surrogates,respectively. In contrast, treatments for patientswith male partners make up about 91% oftreatment cycles (68,380) but only increased by2% in the last year. This indicates a shift in thekinds of families making use of fertility treatment 13Human Fertilisation and Embryology AuthorityFigure 6: IVF treatments by partner 20092008200780%85%90%95%Male partnerFemale partnerNo partnerSurrogate100%Figure 7: DI treatments by partner 2009200820070%20%Male partner40%60%Female partner80%100%No partner

14Fertility treatment 2017: trends and figuresThe source of the egg and sperm used intreatment cycles is linked to the types of peopleseeking treatment, as seen in figure 8. Wheredonor sperm is used, the patient is more likelyto be in a non-heterosexual partnership (55%compared to 45% in heterosexual partnerships).Figure 8: Partner status by source of egg andsperm, 2017Human Fertilisation and Embryology AuthoritySources of egg and spermFigure 9 shows that the majority of peopleundergoing treatment use their own eggs andpartner sperm. However, use of donor eggs and/orsperm has been increasing each year and madeup 13% of treatment cycles (an increase of threepercentage points since 2012).Figure 9: OEPS treatment cycles, 5No partner2003Female partner10,0002001Male partner100%199980%199760%199540%199320%19910%

Fertility treatment 2017: trends and figuresHuman Fertilisation and Embryology AuthorityIn figure 10 we can see that treatment cycles withpatients’ own eggs and donor sperm are increasingat the fastest rate; increasing by almost 2,000treatment cycles since 2012 (although proportionallystill small at 5% of users). This increase is mainlydue to an upsurge in use from patients in same-sexpartnerships which has increased as a proportionof own egg and donor sperm treatment cyclesfrom 10% in 2005 to 32% in 2017.Figure 10: DEDS, DEPS and OEDS treatmentcycles, 019911,000 15

16Fertility treatment 2017: trends and figuresHuman Fertilisation and Embryology Authority2. Types of fertilitytreatment

Fertility treatment 2017: trends and figuresHuman Fertilisation and Embryology Authority 17Key statisticsIntroduction69,822The types of fertility treatment available havegrown since we began recording them in 1991.Fertility treatment does not only attempt to resolveinfertility; it now offers families who would notordinarily be able to have children due to socialreasons an opportunity to do so.There were 69,822 IVF treatment cycles and 5,603DI treatment cycles undergone in 2017, increasesof 2.5% and 3% respectively since 2016.2%Fresh IVF treatment cycles have decreasedby 2% in the last year, whereas frozen haveincreased by 11%.3%Use of ICSI has decreased by 3% in the last year.10%The fastest growing fertility treatment type is eggpreservation (freeze cycles), which have increased10% in the last year.690PGD has decreased from 712 in 2016 to 690in 2017, the first decrease since 2004.It is also used as a means to prevent seriousinherited genetic illnesses and allows youngwomen as well as cancer patients and transgenderpatients the possibility of preserving their fertility.In this section, we focus on the kinds of treatmentsavailable and the shifts occurring.

Fertility treatment 2017: trends and figures60,00050,00040,00030,00020,000All 001999Fresh and frozen cycles, while steadily increasingin line with the general IVF trend, are showing ashift. IVF using frozen embryos is increasing inuse, in part due to changes in clinical practices toreduce the likelihood of multiple births, while freshembryo use is declining. Importantly, this shift hascoincided with success rates for frozen cyclescoming in line with fresh cycles in recent years(see section three).70,0001997ICSI, a newer technology (where a sperm cell isplaced directly in the egg) that was reserved forspecific kinds of male factor infertility, has increasedin use since 1994. It continued to increase until2014, but it is now in decline, possibly due to clinicalopinion that it’s not needed in all contexts of IVF.80,0001995When we began recording fertility treatment in1991, DI was used more frequently than IVF. Thisbegan to change however, and as figure 11 shows,IVF has increased every year and it’s now the mostcommon treatment. One reason for the increase inuse could be the increase in the number of clinicslicensed to perform IVF across the UK, making iteasier for patients to access fertility treatment.Figure 11: Total IVF, frozen, fresh and ICSItreatment cycles, 1991–20171993IVFHuman Fertilisation and Embryology Authority199118FreshICSIDIIt’s clear that DI as a treatment option hascontinued to decrease since it was first recorded.A slight upswing from 2009 onwards may beattributed to both increases in patients in samesex partnerships and with no partner using fertilitytreatment, as well as Scotland’s increase in NHSfunded treatment cycles (see section four), whichrecommends using DI before moving to IVF.

Fertility treatment 2017: trends and figuresHuman Fertilisation and Embryology AuthorityInterestingly, while PGD treatment cycles havebeen increasing in numbers since records beganin 1999, 2017 is the first year in which there hasbeen a decrease since 2004. Although thisdecrease is minor across the UK (712 to 690treatment cycles), the decrease was mainly seenin England (661 to 619 treatment cycles).Figure 12: Total DI, stimulated, andunstimulated treatment cycles, 1991–201730,00025,000Egg sharing has been declining in use since 2011and has now reached its lowest usage rate sinceour records began in 1999 (909 treatment cyclesin 2011 to 447 treatment cycles in 2017).20,00015,00010,000Figure 13: Egg freezing cycles, and eggthawing, egg sharing and PGD treatmentcycles, 1999–20175,000Other fertility treatmentsFigure 13 serves as a useful indicator of thenewer technologies available in fertility treatmentand how these have changed over time. Whileboth egg freezing and egg thawing treatmentcycles have been increasing in numbers sincethey started being recorded in 2010, egg freezinghas experienced a much steeper incline in use.There were 1,462 egg freezing cycles in 2017(410 in 2012), while there were 581 egg thawcycles in 2017 (159 in 2012).The number of people delaying childbearing is onereason for an increase in egg freezing. In addition,more education on fertility preservation couldaccount for part of this upward trend, particularlyfor patients with cancer or transgender 017200920171,2002013No Stimulation20111,40020072015All 0 19ShareThawFreezePGD

20Fertility treatment 2017: trends and figuresHuman Fertilisation and Embryology Authority3. Birth rates

Fertility treatment 2017: trends and figuresHuman Fertilisation and Embryology Authority 21Key statisticsIntroduction22%Birth rates remain a critical factor for patients andclinicians: having a healthy baby (either now or inthe future) is the goal of all people seeking fertilitytreatment. In this section, we look at the birth ratesfor different kinds of treatments – fresh and frozenIVF treatment cycles and stimulated andunstimulated DI treatment cycles – as well asmultiple birth rates.The overall IVF birth rate PET was 22% in 2017and the overall DI birth rate per treatment cyclewas 14%, which is similar to 2016.23%Overall birth rates PET for frozen cycles exceededthose for fresh cycles for the third year in a row at23% compared to 21% ( 0.5 and -0.2 percentagepoints from 2016).30%For patients using their own eggs, IVF birth ratesPET were highest for the under 35 group, with30% for fresh and 27% for frozen treatment cycles,similar to 2016.30%Use of donor eggs and donor sperm recordedthe highest birth rate PET for all gamete sourcesat 30% ( 3 percentage points from 2016).10%Average multiple birth rates met our 10% targetfor both fresh and frozen treatment cycles for thefirst time.Birth rates for DI and IVF have continued to riseover the last 20 years, which may be attributedto better technologies, improved clinical practice,t

insemination (IUI) A treatment where partner or donor sperm is placed directly into the womb. We only collect comprehensive data on IUI using donor sperm. In vitro fertilisation (IVF) A treatment where a patient’s eggs are fertilised with sperm in a laboratory. Unless stated o