Health Check: At home alone

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A MAN on the radio the other day said that having children had brought him and his wife "the greatest happiness we have known as human beings". He was speaking about his experience of in-vitro fertilisation, and his comment was intended as a jibe at heartless ministers who are planning to ration NHS treatment for thousands of infertile couples by imposing an arbitrary age limit, possibly as low as 35.

It struck me, however, as a comic observation about life on this planet. So children are fun for human beings but not, perhaps, for rush-hour commuters, or Arsenal supporters, or tapestry weavers. And while they clearly bring great happiness, it does not obviously follow that their absence need cause great misery. Why are we obsessed with reproducing ourselves?

These are not politically correct ideas to raise - especially by one who, having children of my own, has not experienced the pain of infertility. I do not need convincing that infertility causes pain - I have interviewed enough suffering couples to know that it does. What I question is whether the pain it causes is needlessly increased by social assumptions about the pre-requisites of a fulfilling life.

Years ago I interviewed a wise social scientist who had conducted a huge study of infertility, including about 4,000 couples. She started out with the view that having children was everyone's birthright and that every effort should be made to help those who could not conceive naturally. By the time she had completed her study, she had changed her view. She had been struck by how much emphasis women, especially, placed on having children. Instead of planning how to enjoy the freedom that childlessness brings, they embarked on a single-minded search for a medical solution.

Success rates for in-vitro fertilisation are depressingly low. The average failure rate is greater than 80 per cent.

The NHS spends about pounds 48m a year treating infertility. Initial investigation and treatment (eg with drugs to stimulate ovulation) is worthwhile and effective - and not conducted well in many parts of the country. Services are uneven and the Government is rightly committed to ending the postcode lottery which determines access to care.

But before extra millions are poured into a service - in vitro fertilisation - for which costs are high and the outcome uncertain the question must be raised whether other options, social as well as medical, have been properly explored. Childlessness is not hopelessness - it can spell liberation, too.