Fertility Request

Summary

A request was made to Manx Care for detailed statistics on fertility clinic treatments, patient demographics, and costs over the past five years. The authority disclosed approximate referral rates and IVF cycle data but withheld specific breakdowns due to appointment scheduling methods and confidentiality risks.

Key Facts

• Approximately 60-70 new fertility referrals are made per year, a rate consistent over the last five years.
• Specific breakdowns of patient types (e.g., female-only vs. couples) cannot be provided because appointments are scheduled under the primary female patient.
• No referrals were made to an Isle of Man urologist for fertility issues in the past five years due to a lack of specialists.
• UK referrals for male fertility diagnosis were too few to report without risking a breach of patient confidentiality.
• Data on IVF cycles requiring sperm injection due to poor sperm function was provided annually from 2020 to 2024.

Data Disclosed

• 60 – 70 per year
• 1 in 6 couples
• 30% Male sub-fertility
• 30% Chronic pelvic inflammatory disease
• 10-15% Endometriosis
• 10-15% Ovulation disorders
• 30% Unexplained
• 2020 8 cycles
• 2021 10 cycles
• 2022 9 cycles
• 2023 10 cycles
• 2024 8 cycles
• 2025-01-27
• 2025-02-21

Exemptions Cited

• Risk of confidentiality breach due to low numbers of UK referrals
• Inability to distinguish patient types due to appointment scheduling under primary female referral

Original Request

I am wondering if I could help with a freedom of information request please? 1) How many patients yearly for the past 5 years have been treated via the Fertility Clinic? 2) Can the above be broken down into Female only, Male/Female and Female/Female or other? 3) How many Male Patients suffered only infertility issues when in a couple? 4) How many referrals were made to the UK/IOM for a Urologist specialising in Fertility to examine and diagnose a male patient? 5) How many Male Patients infertility issues led to IVF treatment without a Urologist attached to determine the cause of the issue? 6) How many Male Patients are treated under the Fertility Clinic? 7) How many Females / Couples have been treated over the last 5 years (broken down annually) for IVF? 8) How many Fertility Patients have been referred for Counselling from the Fertility Clinic in the last 5 years? 9) How many patients were transferred to the UK for fertility needs (broken down male / female) in the last 5 years? 10) What is the average cost for an IVF cycle, the average cost to send a patient to the UK for assessment / treatment and the average cost for having a regular consultant in fertility with specialism in Urology?"

Data Tables (1)

Data Tables (reformatted)

Full Response Text

Manx Care Noble’s Hospital, Strang Braddan, Isle of Man IM4 4R (01624) 650 000

Our ref: 4400485 21 February 2025

Dear

We write further to your request, received 27 January 2025, which states:

"I am wondering if I could help with a freedom of information request please?

1) How many patients yearly for the past 5 years have been treated via the Fertility
Clinic?
2) Can the above be broken down into Female only, Male/Female and Female/Female
or other?
3) How many Male Patients suffered only infertility issues when in a couple?
4) How many referrals were made to the UK/IOM for a Urologist specialising in Fertility
to examine and diagnose a male patient?
5) How many Male Patients infertility issues led to IVF treatment without a Urologist
attached to determine the cause of the issue?
6) How many Male Patients are treated under the Fertility Clinic?
7) How many Females / Couples have been treated over the last 5 years (broken down
annually) for IVF?
8) How many Fertility Patients have been referred for Counselling from the Fertility
Clinic in the last 5 years?
9) How many patients were transferred to the UK for fertility needs (broken down
male / female) in the last 5 years?
10) What is the average cost for an IVF cycle, the average cost to send a patient to
the UK for assessment / treatment and the average cost for having a regular
consultant in fertility with specialism in Urology?""

Response

Our response to your request is as follows: I have detailed below the information that is being released to you.

1) How many patients yearly for the past 5 years have been treated via the Fertility Clinic?

Exact data not available but approximately 5 – 6 new referrals per month so about 60 – 70 per year.
Referral rate has remained similar/year over the past 5 years
Nearly 1 in 6 couples will require some form of sub-fertility assistance

2) Can the above be broken down into Female only, Male/Female and Female/Female or other?

No - This is because all the appointments are scheduled to one woman as the primary referral so we can’t tell from the appointments list whether or not the appointment will be for
a. a lady attending with her male partner b. a lady attending with her female partner c. a lady attending as a single woman

3) How many Male Patients suffered only infertility issues when in a couple?

Exact data not available but in keeping with general statistics regarding causes of subfertility
A. Chronic pelvic inflammatory disease and tubal damage: 30%
B. Male sub-fertility: 30%
a. Genito-urinary infections
b. Undescended testicles
c. Sterilisation or failure of reversal of vasectomy
d. Hereditary or Genetic causes
e. Orchidectomy for testicular tumours
f. Past chemo or radiotherapy for cancers
g. Idiopathic

A male factor issue will be identified in about 30% of men but this includes those couples where there are additional female factors. Most male factor issues are idiopathic and very few identifiable causes for male factor issues are amenable to treatment.

C. Endometriosis: 10-15%
D. Ovulation disorders: 10-15%
a. polycystic ovaries
b. reduction in ovarian reserve
c. hyperprolactinaemia
d. thyroid disease
E. Unexplained: 30%
F. Miscellaneous:
a. Fibroids
b. Endometrial polyps
c. Auto-immune disorders
d. Past treatments such as chemo or radiotherapy for cancers
e. Sterilisation
f. Genetic

4) How many referrals were made to the UK/IOM for a Urologist specialising in Fertility to examine and diagnose a male patient?

In the past 5 years, no referrals made to an IOM urologist as we do not have a urologist with a fertility interest and too few UK referrals to be able to provide data without risk of confidentiality breach

5) How many Male Patients infertility issues led to IVF treatment without a Urologist attached to determine the cause of the issue?

Data is available from IVF cycles (not patients) where sperm injection necessary because of poor sperm function +/- additional female factor issues
2020 8 cycles
2021 10 cycles
2022 9 cycles
2023 10 cycles
2024 8 cycles
This data includes cycles undertaken on a satellite basis at CARE Fertility Leeds and includes both IOM funded treatments and self-funded treatments.

6) How many Male Patients are treated under the Fertility Clinic?

Male patients are seen with their female partner as a couple, not as individuals.

7) How many Females / Couples have been treated over the last 5 years (broken down annually) for IVF?

Data is available from IVF cycles (not patients)
IVF ICSI 2020 12 cycles 8 cycles (COVID)
2021 23 cycles 10 cycles
2022 29 cycles 9 cycles
2023 23 cycles 10 cycles
2024 24 cycles 8 cycles

8) How many Fertility Patients have been referred for Counselling from the Fertility Clinic in the last 5 years?

Counselling for couples needing IVF is available without referral at the UK IVF centre.

9) How many patients were transferred to the UK for fertility needs (broken down male / female) in the last 5 years?

None

10) What is the average cost for an IVF cycle, the average cost to send a patient to the UK for assessment / treatment and the average cost for having a regular consultant in fertility with specialism in Urology?"

The cost to the IOM for a funded IVF cycle undertaken on a satellite basis at CARE Fertility Leeds is £1514.

The cost to the IOM for a funded IVF cycle undertaken on a satellite basis at CARE Fertility Leeds is £2126
In addition, there are additional costs for medication, travel & subsistence
Couples not fulfilling IOM funding criteria treated through Manx Care on a private basis generate income for the Isle of Man Health Services (approximately £1000/cycle) and cover their own drug costs, travel & subsistence.
The average consultant salary is £110,000 per annum
In the UK, urologists with a special fertility interest and expertise are affiliated to an HFEA licenced IVF centre. This allows regulated practice for storage of sperm obtained by microsurgical urological techniques from men with obstructive azoospermia. Sperm extracted through microsurgical techniques can only be used through ICSI.
The majority of male factor problems are idiopathic with no specific treatments having proven benefit. The treatment therefore is to overcome the issue with IVF/ICSI.
Only a small number of men will have an identifiable cause for their fertility issues amenable to pharmacological intervention.
Isle of Man Law decrees that tertiary fertility treatments take place in an HFEA licenced centre and as the island is not part of the UK a tertiary centre could not be established here as it would not be subject to regulation. In addition, there are too few treatment cycles undertaken to warrant a local IVF centre, hence the need for UK referrals to tertiary centres. For comparison, the CARE Fertility Unit in Leeds will run 2000 treatment cycles per annum.

Please quote the reference number 4400485 in any future communications.

Your right to request a review

If you are unhappy with this response to your freedom of information request, you may ask us to carry out an internal review of the response, by completing a complaint form and submitting it electronically or by delivery/post.

An electronic version of our complaint form can be found by going to our website at https://services.gov.im/freedom-of-information/Review . If you would like a paper version of our complaint form to be sent to you by post, please contact me and I will be happy to arrange for this. Your review request should explain why you are dissatisfied with this response, and should be made as soon as practicable. We will respond as soon as the review has been concluded.

If you are not satisfied with the result of the review, you then have the right to appeal to the Information Commissioner for a decision on; 1. Whether we have responded to your request for information in accordance with Part 2 of the Freedom of Information Act 2015; or 2. Whether we are justified in refusing to give you the information requested.
In response to an application for review, the Information Commissioner may, at any time, attempt to resolve a matter by negotiation, conciliation, mediation or another form of alternative dispute resolution and will have regard to any outcome of this in making any subsequent decision. More detailed information on your right to a review can be found on the Information Commissioner’s website at www.inforights.im.

Should you have any queries concerning this letter, please do not hesitate to contact me. Further information about freedom of information requests can be found at www.gov.im/foi.

I will now close your request as of this date.

Yours sincerely