The baby lottery

This woman narrowly escaped jail after stealing pounds 20,000 to fund her infertility treatment. Now she's expecting triplets. How long will it be before IVF is so cheap that it could be freely available on the NHS? Glenda Cooper reports
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The Independent Online
Michelle Darby is lucky not to be in jail this morning. She stole pounds 20,000 from her employers, a finance company, over a year ago. An accountant, she took the money by falsifying cheques. In many cases such a theft would have led to a prison term. But the judge in Ms Darby's case told her he found himself "unable" to send her to prison, adding "many would shed tears for your history".

That history was all too familiar to thousands of women, although few go quite as far as she did. Mrs Darby stole the money to pay for fertility treatment after a failed pregnancy. She said her depression following her inability to conceive had made her "lose all sense of right and wrong".

Whether desperate mothers-to-be should be able to escape punishment in this way is highly questionable. But the case throws into sharp relief the capacity for in vitro fertilisation to provoke controversy, about how it should be paid for and who should be eligible for it. Should Michelle Darby have been in a position to have to steal money to pay for a treatment that could be available on the NHS?

On one side of the debate there are harrowing stories of parents desperate for a child who could not afford to pay for private treatment. This is an area in which technology has altered our moral sense. It is difficult not to feel sympathy for childless couples desperate to have a baby, when we know that advances in medical science have brought a treatment which could help them. Once childless couples were quietly pitied; they suffered in silence. Now, quite understandably, they demand treatment.

Yet that immediately raises questions of cost and priorities. On the other side, people argue infertility is not an illness and money diverted into IVF should go into other, more needy areas.

The cost of IVF treatment varies widely, from pounds 700 per cycle on the NHS (paid for by the health authority) to up to pounds 2,500 per cycle at the top private clinics. Most couples usually sign up for three cycles, although some despairing ones will try as many as nine or ten.

Around 90 per cent of treatments are paid for privately at the moment. Figures for NHS spending on IVF are not held centrally, but it has been estimated by health economists at about pounds 25m.

It is 18 years since Louise Brown, the world's first test-tube baby, was born in Britain. Yet the chances of getting IVF are still a lottery; the outcome can turn on which side of the street you live.

Not all health authorities will fund IVF: only 52 per cent do so. And even if you live in an authority that funds treatment, there are widely differing criteria. That was the experience of Julie and Michael Seale from Sheffield, whose treatment eventually was paid for by an anonymous donor.

Mrs Seale, 38, was told two years ago she was too old for IVF treatment on the NHS. Had the couple lived in Wakefield - just eight miles away and covered by a different health authority - Mrs Seale would have been eligible for free treatment until she was 42.

Those who cannot get free treatment face a further lottery - in the amount they pay. A private treatment can cost anywhere between pounds 1,500 and pounds 2,500. But they are able to charge such a high price because demand for treatment so outstrips supply. A better indication of the real cost of treatment was provided by the Chelsea and Westminster Hospital earlier this year, which said it would charge patients who did not qualify for free treatment pounds 800. Other hospitals, such as St Thomas's, King's College and Walsgrave Hospital, Coventry also charge below pounds 1,000 to those who fail to qualify.

Most people agree that the present system is arbitrary and capricious. But Warwickshire Health Authority, which took the decision three years ago not to fund IVF treatment, says there are no easy solutions.

Dr Greg Wells, director of public health, said it was "not an issue of the moral worth of IVF. But we worked out that it would cost us pounds 1.5m a year to cope with the demand. And we just didn't have pounds 1.5m to spend on a new service.

"It was a difficult decision. But you are not talking about a lifesaving procedure."

Not surprisingly, Susan Rice, the chief executive of Issue, the National Fertility Association, disagrees with that kind of calculation: "You can have a baby if you can afford to pay for it. It's an attitude that makes me angry. You can't treat a baby like a commodity." Issue demands free IVF treatment on the basis of clinical need. Its argument is that the dramatic rise in costs could be met by increases in efficiency.

"Many treatments fail because people have to wait so long - say three or four years - and then, naturally, they are older and the operation has less chance of success," it says.

But Issue's position is the most radical. Most people believe rationing could never be fully eliminated. The challenge instead is to make sure that more people can afford treatment.

Dr Peter Bromwich, medical director of Midland Fertility Services, a private clinic, suggests practices need to change to make the treatment more affordable. One focus of this might be the fertility-stimulating drugs usually prescribed by GPs. These cost about pounds 600 and many GPs are under pressure not to prescribe to keep down their drugs bill. So quite frequently a couple cannot take up the health authority's offer of treatment because they would have to pay for the drugs themselves.

Dr Bromwich argues that the drug should be free - in the way the contraceptive pill is free - and this could be achieved by giving the responsibility for prescribing over to the hospital.

However, the main problem is that not all authorities fund infertility treatment. Chris Ham, professor of health policy at Birmingham University, thinks the Department of Health should issue a national framework which recognises infertility as a medical condition and makes IVF a treatment that should be available in all authorities.

He argues that every authority should publish their policies: "If that happened I think you would find that there would be more convergence and the wider discrepancies would be ironed out."

But Dr Peter Brinsden, medical director of Bourn Hall in Cambridgeshire, the private clinic which pioneered IVF, and Professor Robert Winston, professor of fertility studies at the Institute of Obstetrics and Gynaecology, Hammersmith Hospital, west London, agree that a radical overhaul of IVF services around the country would make them far more efficient by creating larger units.

As Professor Winston, who today publishes a book on IVF, Making Babies, argues that larger units will provide more expert treatment and so cut down on waste.

Dr Brinsden argues that similar centres have been successfully established for neurosurgery and cancer treatment.

The future of IVF could well change dramatically by the next decade if a research trial at Hammersmith succeeds in growing the eggs outside the woman's body. That would lower drug and surgery costs. If successful, Professor Winston estimates the cost of IVF could fall five-fold, opening the treatment up to more people.

At its most optimistic, Professor Winston's vision could mean that women like Michelle Darby may never again feel they have to steal to have a child.