The Ivfworld.com Success Series   
         7 June 2006 - Number Three


The Leading Fertility Clinics:

Hull IVF Unit comes right at the top of Ivfworld.com’s latest survey, scoring 96 per cent overall. Stephen MaGuiness, the Medical Director, is well placed to set an example to the rest of the industry. He is also a clinic inspector, but this is not an easy place to be. There is a lot of ill feeling towards the HFEA, the fertility watchdog, within the medical profession, as there is among patients. Doctors are unhappy with the watchdog’s feudal approach and, like patients, many are fearful of expressing their outrage. One question Stephen MaGuiness is asking is: “Why should we be funding what the HFEA was not set up to do.”

Lord Winston, the charismatic TV presenter who is also carrying out ground-breaking research into stem cells, is not afraid to voice his opinions. He no longer works at a clinic and he has always been a trail-blazer. “The HFEA is a complete failure. It’s badly run and it doesn’t serve the interests of patients or doctors,” he told Ivfworld.com. The general view is that the HFEA has steam-rollered the majority and is attempting to push through changes through a small minority, which has created a very dissatisfied industry indeed. Dr Ian Gibson MP referred to the HFEA as a “fiefdom” when he spoke to IVFworld.com. He added: “Democracy is not served by unelected quangos taking decisions on behalf of Parliament.”

Lord Winston said that the bureaucractic and dictatorial manner in which the HFEA is run “inhibits research and academic work.” The industry has also complained about the HFEA’s frightening lack of knowledge.  Lord Winston added: “The figures they publish need much more careful scrutiny and it is a disappointment that the HFEA continues to publish league tables when virtually everybody accepts they are seriously misleading." Some patients have been led astray by the HFEA's tabloid approach.

The real leaders are fertility clinics that ensure the care patients have at a clinic meets or exceeds their expectations. Clinics cannot guarantee patients will walk out with a baby, but they can guarantee the type of care they receive during treatment. Dr Gibson MP welcomes the Ivfworld.com Success Series. He said: “It’s amazing. We should be working to make all clinics world class.”

Which brings us back to Hull IVF Unit’s impressive performance, which has not come about by chance. The Unit has worked hard to achieve its status. Mr MaGuiness points out that each area of Britain has its own cultural flavour, which needs to be taken into account and this is particularly the case in Hull. Not a place you would choose to move to maybe, but those brought up there tend to stick around for generations giving it a unique feel.

Fertility clinics, said Mr MaGuiness, are driven by the culture of the area they are based in, which varies widely, so trying to apply blunt rules to the whole of Britain doesn’t always make sense. Doctors need to be able to tailor treatment to the local population.

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“Hull is so different from London and other parts of the country, “ said Mr MaGuiness. “Women in Hull tend to have their first child at twenty and there is a very high rate of teenage pregnancies. We have lots of grannies aged around 35 – there’s a long tradition of young girls who got pregnant and were looked after by their mothers while the men were at sea. The girls got married later.”

So the Hull IVF Unit tends not to offer treatment to people over fifty, although there are exceptions. One example, said Mr MaGuiness, is “a mother who acted as a surrogate for her daughter after her daughter had lost her uterus due to cancer. She fell pregnant with twins at 52.” The mother had some blood pressure problems, but the treatment worked and she gave birth to twins.

Some say the risk of pregnancy can increase after the age of fifty, yet there is nothing that categorically supports this theory. Taking an arbitrary age of fifty, because it is an easy cut off point to remember, assumes that every individual is the same, but this of course is not the case. The biological age of a woman can be quite different from her natural age. For example, some woman face the menopause in their twenties whereas other women do not reach this milestone until their late fifties. Thus, applying a catchall for the whole of the British population is a very unsatisfactory tool. Doctors need to be given room to personalise strategies for individuals.

“The problem with the HFEA is it is ineffective,” said Mr MaGuiness. It is steam-rollering through changes without the support of the majority, failing to focus on what really matters and extending its work into areas it was not set up to control.

One problem is that the HFEA has not listened to the stakeholders in the industry, remarked Mr MaGuiness. “They didn’t listen on the issue of sperm and egg donor anonymity and caused huge problems. It was pushed through Parliament by a relatively small group with huge protest.” The HFEA has also failed so far to consult with Ivfworld.com, the largest independent fertility patients organisation in this country with members who are patients all over Britain as well as in other parts of the world. 

Mr MaGuiness then moved on to question the way success rates for the industry are recorded by the fertility watchdog which can be misleading. This is extremely worrying for patients who often believe they are the be all and end all in this industry. Making a decision on which clinic to go to, based on questionable statistics which may be out-of-date can lead to the sausage machine effect – piling patients into waiting rooms, an overstretched chaotic environment and very little personal care.

Some units are known to be playing games in order to push up their success rates and they’re getting away with it, said Mr MaGuiness. For example, “when a patient starts injecting drugs that cycle should be recorded.” However, some clinics “start a patient on injections and if that patient does well they go on to do IVF and if they stop treatment the clinic calls it a trial stimulation,” so it is not recorded as a failed cycle which helps to push up the clinic’s success rate.” He adds: “The clinic should be upfront about it, but the HFEA hasn’t dealt with this issue.”

The medical community are also “upset” by the HFEA’s secrecy and the fact it is moving into areas beyond its remit. “Why should we be funding what the HFEA was not set up to do,” declared Mr MaGuiness.

Despite this view, Mr MaGuiness is doing what he can under the circumstances. He is working in a long established unit. It was set up by John Robinson, the Scientific Director and lecturer in biomedical sciences at Hull University, with the aim of researching into whether IVF could be done in district general hospitals. He got a grant to do the research with Alan Gordon, who is now retired. “They decided the only way to do IVF was to build their own unit on the Old Princess Royal Hospital site. We’ve left that now and are in the new Women’s and Children’s Hospital, where we rent space from the trust. Now that the primary care trust can deal with us direct and contract with private providers, it will reduce admin costs.” 

As Hull is in an isolated area with a fairly stable population, this creates a fairly stable staff turnover. Senior members have been at the unit for nine or ten years. John Robinson’s wife Liz is still the office manager  and has been since the start. Sue Gray, the Senior Embryologist, has been with Hull IVF Unit for fifteen years, Head Nurse Denise Holland has worked there since she was a junior in the 1990s apart from a short interlude and is currently training to extend her skills to embryo transfers.

“We generally consider ourselves a crowd of softies,” commented Mr MaGuiness. If a patient is not happy about something we call them in. For example, last month someone’s treatment caused a bowel disorder to flare up which was addressed rather than ignored.

He said Hull IVF unit is fairly conservative and believes that “all the business of doing immunology tests is extremely dubious. “We trialed steroids in 1998 to 1999 and found it didn’t work. We let our results speak for themselves.”

An Award-Winning Team
in the latest Ivfworld.com survey

Hull IVF Unit***** A top twenty UK fertility clinic in Ivfworld’s March 2006 survey

The Winning Team Stephen MaGuiness, Medical Director John Robinson, Scientific Director Alan Gordon, now retired as a Gynaecologist Paul Marshall, Financial Director Sue Gray, Senior Embryologist Denise Holland, Head Nurse Liz Robinson, Head of Administration

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For news about other winning teams in the Ivfworld.com survey of the top fertility clinics,

watch The Ivfworld.com Success Series page! 

Click here to read Ivfworld.com Success Series (1)
Click here to read Ivfworld.com Success Series (2)