17 - Setting up an IVF unit

Summary

The aim of this chapter is to guide the clinician in the steps necessary to set up and run a successful IVF unit. This involves planning, clinical aspects and laboratory set up.

Planning

Before setting up it is necessary to identify the need for the service. This will involve the identification of the population base that the unit will serve, the demographic details of that population and the aetiology of infertility. If an infertility clinic already exists it is possible to extrapolate the demographic details and aetiology from clinic statistics. There may be other IVF units already established in the area and it will be necessary to assess whether an additional unit will have a place. If treatment is only available privately there may already be a waiting list for state funded treatment. It may be possible to apply for state funding to assist these patients.

There are few data on the extent of subfertility. Approximately 80% of couples are pregnant after a year of trying, rising to 95% after two years. Failure to conceive after two years is a useful definition for health service planning because of the high spontaneous conception rate before one year. However, earlier access to specialist services may be indicated for some individuals where an underlying cause has been identified or because of increased age (Templeton et al., 1991).

The prevalence of subfertility is between 9% and 14%, of whom 70% will have primary infertility and 30% secondary infertility. A health authority (e.g. with a population of 250 000 with 46 000 women aged 20–44 years) with an established subfertility service can expect around 230 (0.5%) new consultant referrals each year.