IVF and the NHS

Monday 4th of March 2013 | Category: Pregnancy News | Written by: Alice Edwards

The NHS plans to raise the age of publicly funded IVF treatment from 39 to 42 for eligible couples. Currently, IVF can be given to eligible couples who have been trying for a baby for 3 years without success, where the woman is between 23 and 39. Under the new plans proposed by the National Institute of Clinical Excellence (NICE), a single cycle of IVF could be given to women up to the age of 42, who have no other chance of conceiving and who have not previously tried fertility treatment.

Even with the new guidelines, it is up to each individual primary care trust (PCT) to decide whether or not to give an eligible couple IVF, in what critics call the 'postcode lottery'. Whether a couple are given IVF depends on the finances of their local PCT. Even if a couple are given a cycle of IVF, when the woman is over 40 the odds of conceiving by IVF are just one in ten (for more information on how IVF works, see our article.)

Should the NHS pay?

Questions have been raised over whether this is the right move for a cash strapped NHS, with opponents stating the NHS's priority should be saving lives, rather than offering expensive fertility treatment which has a low success rate. With some A&E departments closing down, and many cancer patients denied potentially life-saving treatment, it does beg the question of whether this is the right way to spend NHS funds. The Daily Mail reports that the guidelines are a reaction to concerns from the NHS that current rules might be breaking age-discrimination laws, while NICE states that the incentive behind the changes are the benefits they would give to women.

No-one can doubt the heartbreak infertility causes affected couples. Professor Adam Balen, of the British Fertility Society states in an article published by the BBC: 'infertility causes psychological harm for many of the one-in-six couples it affects, and is recognised as a medical condition by the World Health Organisation. He further defends the cost of the treatment to the NHS, which is £3000 a cycle, saying 'Furthermore, many treatments are simple, cheap and effective and even the most high-tech IVF therapies can be provided in a cost-effective manner through NHS clinics'.

What are the NHS's Priorities?

The Wright Show recently asked their panel and viewers whether raising the age limit for NHS funded IVF to 42 was an ethical thing to do when some children are denied cancer treatment, which could give them a 25% chance of success, compared with a 10% chance of success for an infertile couple. This is a valid point, and most people would agree that saving a child's life should be prioritised over fertility treatment. However, experts admit that these changes would actually affect only a minority of women, as there are still strict criteria that couples have to meet in order to be publicly funded, and it's up to the PCT's discretion whether a couple are given IVF. A small rise in the age of one cycle of IVF will not leave children without cancer saving drugs who otherwise would have been given them. The Guardian makes the point that most of NHS treatments are for non-life-threatening ailments, including an increasing number of self-inflicted problems. Muriel Gray states 'The number of individuals seeking fertility treatment, either from the NHS or privately, is relatively small. NHS Devon for example treated 396 people between 2008 and 2010, offering them one cycle of IVF, at a total cost of £1m over three years. In comparison to the amount the NHS trusts spend on emerging lifestyle ailments such as alcohol abuse, smoking or obesity, that figure is a drop in the ocean'. Put this way, perhaps the image of selfish career women snatching lifesaving drugs from the hands of sick children is an instance of critics over stating their case.

It seems that this debate has highlighted what many people seem to believe, that women who wait until their 40's to have babies are selfish, and that they somehow deserve any fertility problems they encounter for being 'career women', wanting to 'have it all' and for not having the foresight to have children during their peak child-bearing years, when it wouldn't be a burden on the NHS.

Will Women Be Encouraged to Wait?

Fertility experts believe the change might encourage women to delay having children, and critics have said some women will 'take advantage' of these changes. It's hard however, to imagine a woman deliberately gambling with her fertility when the odds are just 1:10 against her. Dr Gedis Grudzinskas, former emeritus professor of obstetrics and gynaecology at Barts and the Royal London NHS Trust, as reported in The Daily Mail, said the recommendations sent out 'the wrong message' and said 'Society shouldn't use this as an excuse to continue to delay looking for Mr Right, and economically speaking the NHS can't afford it.' Dr Grudzinskas implies that all childless 40-something women have deliberately chosen not to have children while they were younger. This seems to be a case of being ignorant of other factors that contribute to women not having children in their 20's and 30's, such as lack of meeting the right person, fertility problems such as endometriosis or polycystic ovary syndrome, and financial instability.

Opinion remains divided on whether this is a good or bad move for the NHS and its patients, and when faced with a publicly funded health service which is under enormous strain, there's no easy answer. The problem with the debate over this issue is that its concerns seem to be centred mainly on whether women deserve this, and the misogynistic voices that imply infertile 40 year old women only have themselves to blame and therefore shouldn't be helped, are burying the more fundamental issue this debate highlights, which is how to get life-saving treatment to everyone who needs it. If we start saying women shouldn't be helped as infertility at a certain age is self-inflicted, where do we stop? What about obesity, alcohol or smoking related illnesses, or broken bones after drink fuelled fights? These cost the NHS far more than fertility treatment. We need to keep things in perspective: these changes will mean a small rise in the age of one funded cycle of IVF, the amount of women they actually affect is tiny. As Muriel Gray states in an article published by The Guardian titled why all the rage over IVF?, If the raising of the age limit for fertility treatment helps mend broken hearts, it should be a cause for celebration not concern.'