P-719 The fertility clinic landscape in England 2012-2017: a study of the impact of clinic size and environment on success rates
Authors: Imrie R , Baird F , Vigneswaran K , Tsironis A , Wang Y 
Published: July 2024

Abstract

Study question
How are fertility clinics in England distributed and has this changed over time? Does clinic size, geography and local deprivation level influence live birth rates?

Summary answer
A clinic’s size, urban/rural environment and local deprivation level shows no statistically significant impact on a clinic’s live birth rates.

What is known already
It has been established that children born through assisted reproduction are more likely to have parents from higher socioeconomic groups compared to those conceived through natural conception. However, studies examining the relationship between socioeconomic status and fertility treatment success rates have varied outcomes and occasionally conflicting results. There has so far been little research internationally as to whether geographical, environmental and socioeconomic markers influence fertility treatment outcomes on a national scale.

Study design, size, duration
Publicly available HFEA data from 2012 to 2017 for all registered clinics in England was accessed. The total number of IVF/ICSI cycles for all age groups and live birth rate per embryo transferred were recorded. 56 clinics (32,091 treatment cycles) were recorded in 2012, rising to 69 clinics (36,638 treatment cycles) in 2017. Clinic postcode was used to determine Rural-Urban Classification and postcode-level and local authority-level deprivation according to the Index of Multiple Deprivation (IMD).

Participants/materials, setting, methods
Statistical analysis was performed using R Statistical Software and Datawrapper was used to generate map infographics. Clinic size was categorised by the number of IVF/ICSI cycles conducted per year – small (0-499), medium (500-999) and large (&gt;1000). Clinic environment was classified as urban or rural and IMD was used to categorise clinics into deprivation quintiles. Weighted live birth rates were analysed to determine any difference in clinic success based on its size and environment.

Main results and the role of chance
The majority of clinics conducted between 0-499 IVF/ICSI cycles per year. There was no statistically significant difference in the live birth rate per embryo transferred based on clinic size with an average success rate of 31.8% in small clinics, 33.9% in medium clinics and 32.2% in large clinics (p-value 0.885). A large proportion of clinics were located in London (28-29% of clinics and 34-40% treatment cycles) between 2012 and 2017 despite only ∼16% of the population of England living in London. There were significantly fewer clinics (p-value 0.047) and treatment cycles (p-value &lt;0.001) conducted in rural, compared to urban locations.
There was a small, but not statistically significant, increase in success rate in clinics located in the least, compared to most deprived quintile. The difference in average live births/embryo transferred between the most and least deprived quintile across all years studied was 3.8% (31.1% in most deprived vs 34.9% in least deprived, p-value 0.227). There was also no statistical difference between the live birth rates per embryo transferred across the local-authority deprivation quintiles, although there was a trend for slightly higher success rates in the least deprived quintile compared to most deprived quintile. (30.3% compared to 33.9% (p-value 0.211)).

Limitations, reasons for caution
Clinic postcode only was used, therefore deprivation may not be representative of the whole population it treats. All IVF/ICSI treatments for all age groups were included, but some clinics may treat an older population of patients. Many IVF laboratories have satellite clinics in surrounding areas, whose postcodes were not included.

Wider implications of the findings
It is reassuring that local environment and deprivation do not significantly impact on clinic success rates. More detailed analysis of individual patient data on a nationwide level is required to understand this further either through access to primary care records or collaboration between clinics.

Trial registration number
not applicable