LEADING ARTICLE:A league table too far

For the thousands of anxious couples struggling to negotiate the complicated procedures of in-vitro fertilisation, yesterday's Patient's Guide published by the Human Fertilisation and Embryology Authority will be very welcome. But the statistical league table of clinics that accompanies the guide should carry a health warning.

In-vitro fertilisation is generally the last resort for desperate couples who have tried every other means to have a child. Few would-be parents are medical experts and they are almost bound to be baffled by the battery of medical explanations and treatments that are offered them. Then there's the problem of where to go: the worry that the clinic down the road with the shorter waiting lists and lower prices may not be as good as the hospital in the city 50 miles away. The success rate in terms of babies per IVF treatment varies from nil to 20 per cent depending on which clinic you go to. The Patient's Guide is a welcome aid to help couples through the confusion.

But if information is to help couples or to provide an incentive for bad clinics to improve then it cannot be misleading. And that is where the HFEA report fails. It gives a figure for the "live birth rate" - the number of births for every treatment attempted - for every hospital. It supposedly takes into account both differences among the women treated and the fertility problems that are tackled in each clinic. If one hospital specialises in predominantly older women who have less chance of getting pregnant than their younger counterparts, the hospital success rate will be adjusted to take that into account.

There are three main problems. First, the number of patients treated in one-third of the clinics is simply too small to be statistically meaningful. The Chiltern Fertility Unit, for example, only treated 40 couples. Second, the fact that in such a fast-moving area patients depend on tables that are already two years old (the latest figures are for 1993) must render them of limited value. Finally, it is virtually impossible to include every important difference between hospital treatments, especially as the better clinics are constantly innovating. Certain forms of genetic screening of embryos, for example, reduce the chance of a successful pregnancy because some of the embryos have to be destroyed. On the other hand, they do increase the chance of bearing a healthy child. It would not be sensible if hospitals felt pressured to give up genetic screening in order to boost their "live birth rate" and so their position in the league table.

To be fair to the HFEA, it does say clearly that the league tables should not be used as the only guide to choosing a fertility treatment centre. But when information is so powerful and so vital to those dependent on it, the purveyors of the facts and figures have an even greater responsibility. Publishing the information is a good idea, but the comparisons need to be handled with considerable caution.