Monday 28 September 2020

big egg

Inside ‘Big Egg’

From the first IVF baby to now – how the fertility industry grew

By NIMO OMER AND ELLA HILL

It has been 42 years since the birth of Louise Brown, the first IVF baby, irreversibly changed the way we view human reproduction.

Whilst the suspicion and moral panic around assisted reproductive technologies died down fairly quickly, people are becoming increasingly concerned about the commercialisation – and cost – of reproductive medicine.

More experimental treatments are being recommended to patients. This is the world of IVF add-ons – therapeutic or diagnostic tools that are supposed to improve the chances of having a baby. These treatments almost always come at an additional cost with little or no guarantee that they will work.

It has been 42 years since the birth of Louise Brown, the first IVF baby, irreversibly changed the way we view human reproduction.

Whilst the suspicion and moral panic around assisted reproductive technologies died down fairly quickly, people are becoming increasingly concerned about the commercialisation – and cost – of reproductive medicine.

More experimental treatments are being recommended to patients. This is the world of IVF add-ons – therapeutic or diagnostic tools that are supposed to improve the chances of having a baby. These treatments almost always come at an additional cost with little or no guarantee that they will work.

The Human Fertilisation & Embryology Authority (HFEA) created a traffic light ratings system that has reviewed these add-ons, examining the scientific accuracy of these treatments through an independent body.

Red is given to treatments that show no evidence they can improve live birth rates – or to indicate there is evidence to show that the add-on is unsafe…

Amber is given to add-ons where there is conflicting or inconclusive evidence that a technique can improve live birth rates, or to signify that the add-on is safe for patients to use…

And green is ascribed to an add-on where there is more than one good quality randomised control trial which shows the procedure is effective at improving live birth rates and is safe for patients to use. There are currently no add-ons which have been given this rating.

Despite their questionable value, these treatments aren’t cheap. Pre-implantation genetic screening (PGT-A), which was reclassified from amber to red by HFEA last December, can cost up to £3,000.

The fertility business is booming – and investors have started pouring money into companies.

Venture capital and private equity investments in fertility companies increased from $200 million in 2009 to $624 million dollars in 2018. Future Family, a fertility financing company, raised $114 million in venture capital funding and debt financing for its fertility loans business.

A report by Grand View Research indicates that by 2027, the global IVF market is expected to reach a value of $37.7 billion. In 2019, Progyny, a company which helps employees of large companies navigate their fertility benefits, went public, valued at $130 million and shares have grown in value from $15.94 to $27.43 in the eight months since. Just last month, Carrot Fertility, a startup managing fertility benefits for other companies, raised $24 million bringing its total capital raised to $40 million.

So who is paying for these treatments?

White British women have the most IVF cycles in comparison to every other demographic, but the number of Indian women opting for IVF has significantly increased in the last decade, going from 860 IVF cycles in 2008 to 3,068 in 2018. There have also been less dramatic, but nonetheless significant, increases in the number of IVF cycles in other ethnic groups as well, the number of IVF cycles by Pakistani women, for instance, quadrupled between 2008-2018.

There have also been changes in the providers that women use for their first IVF cycle, with fewer women turning to the NHS and instead opting for private treatment.

The average age of IVF patients has generally stayed the same over the past two decades, at around 34 for women, 35 for men and 40 for those who have no partner.

Finally, how is the industry’s safety record – in terms of care for eggs, embryos and patients’ data?

 

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