Ok, so they might be right about London where competition is fierce and prices are high, but we disagree about clinics here in Scotland. We know we're not over-endowed with IVF clinics up here but the ones we do have are mostly good and are patient, rather than money, focused. NHS IVF clinics, generally, do not offer many, or any, 'add on's' such as Assisted Hatching or PGD (except where genetic disorders are present). Most will offer Blastocyst transfer, which I would suggest is now the norm rather than an 'add on', and Uterine 'scratching' but we know from many years experience that they don't by any means push these on patients.
The one private clinic of note in Scotland, the GCRM (based in Glasgow but with satellite clinics in Dundee and Edinburgh), are very careful with what they advise couples. Our experience with them is that they look very carefully at the research and only recommend a treatment or technique if they think there is enough evidence to support it. We sometimes get frustrated when we read about, and have patients who successfully try, other interventions (such as immune system testing, which the GCRM is now providing) in London or abroad, but we appreciate that clinics here proceed with great care and we value that integrity.
From the perspective of our patients, we know many like to gain a wider perspective and have the options laid out in front of them. Here at the clinic we see it as part of our job to inform people about what's available both in the UK and abroad. Sometimes, a couple is happy not to find out more and would rather just go with what they've been offered but we're always here to provide information about alternative clinics or techniques to interested patients.
The BMJ also says in its report, that IVF is often offered to patients who don't need it and this we have found to be true. Conventional 'bio' medicine sometimes seems to bypass what we see as common sense and go straight to interventionist options. We have seen many, many couples where an irregular menstrual cycle, overwork (leading to high levels of stress hormones) or missing the time of ovulation is really all that's going against them and, although IVF can overcome the first and last of these, it need not be the first point of call. I have spoken to IVF nurses who say the same .... many of the couples they see do not actually need IVF at all. On the other hand, we have seen couples who, despite all the fantastic nutrition, acupuncture and other 'complementary' interventions, do not go on to conceive naturally but do conceive with IVF. In those cases, you can be sure that there is some physical or hormonal barrier which remains un-diagnosed but which IVF overcomes.
So all in all, we would say this BMJ report has some value if it makes patients more aware of being led up the garden path by unscrupulous clinics but, here in Scotland, our experience is that add-ons are carefully considered and offered in appropriate circumstances.