My inspiration to write The Fertility Promise has been my experience in assisted reproduction (or IVF) since it was first introduced to me at Bourn Hall Clinic in the early 1980’s. I was lucky enough to be one of the first Clinical Embryologists in the world. I have seen IVF move from the initial ideas of Bob Edwards, Patrick Steptoe and Jean Purdy, being carried out in a little village in rural Cambridgeshire, to a billion-Dollar (or Pound!) industry being delivered on a global scale. Many things have changed in IVF during that time. IVF technology has moved on to a certain extent (but with no tangible benefit to patients but with definite financial benefits to clinics and manufacturers) and regulation to ensure optimum quality and safety of all fertility treatments is now routine in most countries. Regulation is extremely important in an area such as IVF to protect both patient and societal safety. Patient expectations, in terms of what a fertility clinic can deliver, have undergone an exponential rise. Unfortunately, the technology in IVF and the people working in IVF have not really met these expectations. Without a change in mind-set these patient expectations will never be met.
IVF has, in my opinion, stagnated in the past 25 years to the point where great change is needed to make further progress and improve the service provided to patients. There have been few effective innovations or new ideas and the live birth rate (which, by the way, is the only thing which really matters to all fertility patients) has not really changed since 1978. There are IVF clinics whose sole purpose is to maximise financial profit. There is little or no thought for the well-being of the patients involved or for their hopes, wishes and fears. There are some IVF clinics who deliberately mislead patients to ensure that their profit goals are met. This is not how medicine should be practised and is a very sad reflection on the current practice of IVF.
All physicians and healthcare professionals, in any speciality, have a duty of care to their patients which means that everything which is done to, or for, the patient is in the best interest of the patient. This is sadly not the case in the medical speciality of IVF which is a very sad and depressing reflection on the legacy which was left to us by Bob Edwards, Patrick Steptoe and Jean Purdy. It also means that fertility patients are not getting the care they deserve and need. This is a scandal on a global scale for which everyone involved in these poor practices should be ashamed.
In general terms, the highly vulnerable fertility patient will do anything to make their treatment a success. This is no different to any patient with any sort of problem but over the years I have seen this to be more pronounced in fertility patients. If I told a fertility patient to stand on her head for one hour every day and this will increase her chance of becoming pregnant then I am sure that this patient would do this. If I did this, I would be a very questionable healthcare professional because there is, of course, no evidence that standing on the head will improve fertility treatment outcome and it is therefore not in the best interests of the patient. The combination of vulnerable patients and corporate (sometimes even personal) greed leads us to the present situation in fertility treatment around the globe. There is hype, false promises, deliberately misleading information, false hope, false advice, false science and sometimes even deliberately false claims and marketing. This is destroying the reputation of IVF and seriously inhibiting those who seek to improve the technology with a true focus on patient care.
This book addresses all of these issues using clear, truthful, experienced and unbiased language so that fertility patients can see the true state of IVF. It is not easy reading. You may find some of it shocking. You may find some of it unbelievable but please remember that I only describe what I have seen and know. I have no hidden agenda; my only agenda is to make fertility treatment better for patients. We can repair the damage which has been done to IVF and move forward in an ethical, truthful and professional way. In order to make these changes it will need co-operation from IVF clinics, the IVF equipment and reagent manufacturers, manufacturers of IVF related medication, the IVF regulators and anyone with a financial interest in IVF. These financial interests are often investors or financial giants with a clear vested interest in a fertility clinic or a group of fertility clinics. This is not intrinsically bad until financial interests overtake patient care, then we have a big problem. Staff who work in fertility treatments may well have to change the way in which they currently think to achieve progress. This means everyone in the clinic because if these changes in mind-set are not agreed upon across the clinic, then they will be ineffective. It will also need a clear understanding and critical analysis of IVF by fertility patients. This is a big challenge for fertility patients, because at present, it is very difficult for them to see who to trust. IVF patients need to move from being passive victims to becoming active, well informed people who have the knowledge and courage to challenge or question the activity or promises of their IVF clinic. If this book stimulates further debate and ultimate change, then it will be a success and IVF will become a trusted medical treatment once more. This is what I truly want to see, but at present, this is not where we are heading. We are heading towards more lies and profiteering in the name of IVF. The purpose for which IVF was invented, to give the opportunity of having a baby to infertile patients and not to generate excessive profit, will prosper. If not, IVF will continue to stagnate, patients will continue to be tricked and misled, and profits will continue to rise. I make no apologies for some of the hard truth and criticism of IVF in this book. I believe that the time is right for change and this book is the beginning.
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
The authors declare no conflict of interest, financial or otherwise.
Freelance Consultant Clinical Scientist