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More than 70 per cent of NHS trusts break rules to deny IVF – and save money
Women unable to conceive naturally are being denied IVF on the NHS because they are too young, too old, too fat, smoke or live in Wales – in flagrant breaches of the guidelines.
The arbitrary nature of the restrictions placed on NHS fertility clinics around the country is revealed today in research which shows that more than 70 per cent of primary care trusts are ignoring guidance from the National Institute for Clinical Excellence (Nice) to offer infertile couples three free cycles of IVF.
Five of the trusts – Warrington, West Sussex, Stockport, North Yorkshire and York, and North Staffordshire – do not provide IVF on the NHS at all.
Most trusts restrict the number of free cycles to one or two, even where they offer them between the ages of 23 and 40. However, women living in Wales have to wait till they are 38 years and six months in many health trusts before qualifying for treatment and must quickly complete their two free allotted cycles – one less than the three recommended by Nice – by the time they are 40. Success rates for IVF decline sharply with age. For every 100 women treated aged 35 and below, 20 will get pregnant; between 36 and 38 around 15 will get pregnant; and at age 39 around 10 will get pregnant.
In 2004, Nice said couples should be given up to three cycles of IVF on the NHS, where the woman is aged 23 to 39.
But despite repeated government reminders, the guidelines have never been fully implemented across the NHS. The latest reminder was sent to trusts (PCTs) by the NHS deputy chief executive, David Florey, in January.
The All Party Parliamentary Group on Infertility sent Freedom of Information requests to all 177 PCTs in England and Wales in March and received 171 replies. Gareth Johnson, Tory MP for Dartford and chairman of the group, said the variation in the criteria showed the Nice guidelines had been "taken out of context and used to place arbitrary restrictions on the provision of IVF".
He added: "IVF treatment was invented in Britain and so, more than any other country, we should be championing its use."
IVF has always suffered from the perception that, like Wayne Rooney's baldness cure, it is a lifestyle choice. NHS trusts searching for savings have seen it as an easy cut which can be made along with cosmetic enhancements.
Infertility is borne in secret. Couples often do not tell their friends and families they are having difficulty conceiving so are unlikely to make a fuss if the service is cut. Yet the distress it causes is deep and real.
Claret Lewis-Jones, chief executive of the patient group Infertility Network UK, said: "It is totally unacceptable that some PCTs are still failing to fund fertility treatment for patients despite the Nice Fertility Guidance issued in 2004. Some PCTs which do fund treatment are only providing one fresh cycle and failing to fund frozen embryo transfers, with many others implementing restrictive access criteria which means eligible patients are denied access to treatment which would be available if they lived elsewhere."
Tony Rutherford, chairman of the British Fertility Society, said: "Infertility is a devastating condition which affects one in six couples in the UP. The World Health Organisation recognises infertility as a physical illness that requires treatment; however, it can also cause significant emotional and psychological harm to patients. By not being given fair access to fertility treatment on the NHS, patients are being denied the opportunity to start a family of their own."
The Health minister, Anne Milton, said: "Many PCTs have made good progress towards implementing the Nice recommendations on the provision of IVF treatment. I am aware, however, that a small number of PCTs with historical funding problems have temporarily suspended provision of IVF services. I have already expressed my concerns about this approach and would encourage all PCTs to have regard to the current Nice guidance."
Couples' distress can be amplified when they find that a neighbouring town gives access to NHS treatment while theirs doesn't – as an accident of geography. The unambiguous Nice guidelines were intended to solve that problem and restore the "national" to the National Health Service. But trusts have continued to ignore it.
As the parliamentary group's report points out, IVF was pioneered in the UP – Professor Robert Edwards received the Nobel Prize for his work with infertile couples – but because of our parsimony and lack of vision we provide less of it than neighbouring countries. Moreover success rates have risen from 14 per cent live births in 1991 to 24 per cent in 2008, so investment in the treatment is delivering more babies for the bucks.
A history of IVF
The world's first In Vitro Fertilisation (IVF) baby, Louise Joy Brown, was born weighing 5lb 12oz at Oldham and District Hospital in Greater Manchester on 25 July, 1978.
Thirty three years later and more than 12,000 IVF babies are born in the UK each year, with approximately four million born globally as a result.
The technique involves removing or harvesting eggs from a woman's body, fertilising them in a laboratory and then placing them back inside the womb after the woman is given hormone drugs in preparation. The treatment was developed by gynaecologist Patrick Steptoe and Professor Robert Edwards who met in 1971. In 1975 a human embryo was replaced successfully in the body of its mother, but the pregnancy developed in her Fallopian tube and was unsuccessful.
Lesley and John Brown had tried and failed for nine years to have a child before visiting Edwards and Steptoe.
IVF was carried out, and when the fertilised egg became an embryo, it was returned to Mrs Brown. Louise was born through Caesarian section after a full-term pregnancy in 1978. She has since had her own child, conceived naturally.
In 1980 Edwards and Steptoe established the Bourn Hall Clinic in Cambridge, the world's first centre for IVF therapy. One quarter of all IVF treatments are successful in the UK each year, but it can cost thousands of pounds to go private.
Case study: 'I was refused IVF for being too young'
Clare Dando had been trying for a baby with her husband, Matthew, for three years before she discovered her tubes were blocked and she needed IVF. She was 33 but at the time – 2006 – Hampshire PCT, where the couple live, only provided NHS treatment to women aged 36 to 39. Clare was too young.
"We appealed on the basis that I had been misdiagnosed on the NHS – they thought I had polycystic ovary syndrome and never checked my tubes. We thought they might offer IVF as some small compensation. But they turned us down."
The couple paid for treatment privately and after two miscarriages, Alex was born in June 2008.
"It was devastating after trying for three years to be told I had needed IVF from the start. Everyone knows fertility declines with age. There was no way I was going to wait."
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