Want a baby? Move to Glasgow

Couples with difficulty conceiving may be refused treatment unfairly. But how to decide what's fair in the fertility stakes?

Helen and Gary Nicholson should be the ideal candidates for infertility treatment. They are in their early thirties and, after several failed pregnancies, they are desperate to have a family. "I've never been much for a career," says Helen. "I've always just wanted to get married, have a house and a couple of kids. You know, a nice family." But Helen and Gary have been told that this simply is not possible. The reason? It could be that they live in Slough.

"Berkshire Health Authority have told us that unless we had some sort of genetic defect then there was no budget for IVF treatment," says Helen, aged 31. Unfortunately, though, Helen has a history of ectopic pregnancies and blocked fallopian tubes. Nothing genetic there.

So Helen and Gary have had to create their own budget for it. Money is tight. She is the office manager for a transport company and he is a lorry driver. All their spare cash goes into their "IVF Fund". So far they have managed to afford pounds 1,500 towards one attempt (which failed). They haven't had a holiday in five years.

"Now we've put our flat on the market here to try and sell it to move up to Glasgow," says Helen, who comes from Ayr. "We'd always planned to move back. We'd rather stay here for another few years but the health authority up there does fund IVF treatment. It is unfair, because now we will be a burden to the Ayrshire and Arran authority when Berkshire should have paid."

It is called the "babies by postcode" factor, and the truth is that Gary and Helen have a seven-times better chance of receiving IVF on the National Health in Scotland. Nor is their situation particularly unusual. "The fact remains that one in six couples experience difficulty in their attempts to conceive. Sadly, there are few signs that NHS provision to help them with their problems is improving," says infertility specialist Mr William Ledger.

Throughout the country, one couple living on one side of the street may find themselves eligible for infertility treatment while a neighbour living across the street (and in a different authority) is not. In Helen's case, for instance, a co-worker and his wife who live in the nearby town of Feltham (covered by Middlesex Health Authority) has just had a baby after receiving IVF on the NHS. "It's brilliant for them," she says. "It was lovely to see them succeed, but heartbreaking that I was not in that position."

No one - neither patient nor doctor - thinks the situation is fair. Yesterday, a survey by the National Infertility Awareness Campaign showed that nine out of 10 specialists believed couples are being unfairly turned away. Now the campaign has called for national guidelines to remedy a situation in which each of the 125 health authorities sets its own criteria as to who can receive infertility treatment.

"We think there should be guidelines on the level of treatment based on clinical judgement rather than rationing, which is what we have at the moment," said Clare Brown, president of the NIAC. She believes that current chaos stems in part from the fact that infertility is not seen as a "real" illness. "It's not taken seriously. Often people will put it alongside something like tattoo removal or liposuction."

This attitude is reflected in the patchwork of criteria that means that some authorities will not treat a woman who is, say, 36 while others will treat a 40-year-old. In addition, there can be criteria that insist a couple is married (though others look for something they call a stable relationship). Couples can also be turned away if they have any previous children, even if they are from an earlier relationship or adopted.

Health professionals believe that any national guidelines would have to set an age limit of some sort. "The success rate after the age of 43 can be rather dismal," says Dr Ian Craft, director of the private London Fertility Centre. "You would have to set an age limit or it would be a free-for-all." He would see the age of 40 as being an appropriate cut- off for women using their own eggs.

Dr Elizabeth Lenton is director of the Sheffield Fertility Centre which has both public and private patients. She agrees that there would have to be an age limit. "At the moment, some will not treat women over the age of 35 and not many fund women over 40 because of the biological decline in fertility. Of course, it isn't strictly related to age. Some women of 38 are more fertile than other women of 36." A reasonable national guideline, she believes, would be somewhere in between, say age 37 or 38.

Some authorities also place an age limit on men. There is no medical reason to do so but, in infertility treatment, the medical and the social often overlap. In this case it seems that many clinics believe that any child has the right to a father and that the chances of having one that is alive for very long decreases if a man is, say, aged 60.

Guidelines are bound to contain some form of social policing. Some authorities now require that a couple be married while others try to assess whether a couple's relationship is stable. The problem with this is obvious. "There really are no guarantees when it comes to relationships. How can you prove a relationship is stable?" asked Clare Brown of NIAC.

The question of whether the couple (or either partner) has had previous children is also difficult. "Is it appropriate, for instance, for a couple who have six or seven children and now want more to receive treatment?" asks Dr Lenton. Another fairly common request for infertility treatment comes from parents who have been sterilised but have now decided that they do, in fact, want more children.

The chances are, however, that in the future such couples will still have to go private. (A NIAC survey of 1,300 men and women who had undergone treatment recently found three-quarters had been forced to pay for some or all of it. On average each had spent pounds 3,240, excluding the cost of drugs. One in four were successful in having a child.) This is because the NHS will have to draw the line somewhere and Dr Lenton sees that line being drawn after two children. "I would be in favour of saying having one or no children would be fine in terms of the guidelines. I think you have to allow IVF to those who have one child. That's what all this is about. It's about making families, not just lots of single children."

The guidelines would also cover the extent and the type of treatment allowed. One infertility specialist suggested that a treatment with a 30 per cent success rate would be allowed on the NHS while one with a 5 per cent success rate would not. Nor would couples be allowed endless attempts at, say, IVF. "It should not be seen as a right but at the moment when it comes to IVF most authorities will only fund one treatment, which is grossly inadequate," says Dr Lenton. "But it would be inappropriate to say that all couples must have three treatments. It has to be a common sense approach. All things being equal, a couple probably should have three attempts at IVF."

This may all sound rather sensible, but experts are gloomy as to whether such guidelines can ever be agreed upon with current budgetary restraints in place. But it is also true that couples who are striving to have a baby may be under enormous financial and emotional strains which can cause a whole other set of problems. For instance, more than half the couples responding the NIAC survey had experienced depression and one in 20 had felt suicidal.

Clare Brown notes that the government has asked the Royal College of Obstetrics and Gynaecology for guidelines on infertility but that would be only the first step in a time-consuming process. And time is exactly what the likes of Helen and Gary Nicholson do not have. Biological clocks do not follow budgetary cycles. Certainly Helen and Gary will be keeping their flat on the market - and their fingers crossed.