LEADING ARTICLE:Make fertility free

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The Independent Online
It is amazing that the Catholic church and now senior Labour politicians - according to yesterday's Independent - are against in-vitro fertilisation (IVF), albeit for different doctrinal reasons. It is sad that these bodies are so out of touch with the relevance of modern IVF treatment. Sixteen years after the first test-tube baby was born, cumulative conception rates from IVF are now the same as nature.

The moral questions raised are whether IVF should be freely available throughout the UK and free of financial cost to couples. Certainly this has public support, shown by the response to a Channel 4 People's Parliament debate last autumn which approved the motion "Fertility treatment should be available on the NHS" - a philosophy I support, but not to the extent that all people should receive free NHS treatment irrespective of age, since there is a high natural conception rate in couples without an obvious cause of infertility within two years of trying.

The NHS abortion service is neither freely available nor free of financial cost almost 20 years after the Abortion Act, but the philosophy has tacit approval with early admissions being favoured to reduce the number of late abortions with their greater risk. Doctors are even paid for performing sterilisations.

It is a different matter where fertility services are concerned. What services do exist are geographically patchy and there is an overwhelming need for regional centres of excellence. At present enormous sums are wasted on unproven treatments. What is required is improved organisation rather than additional finance. The management of male infertility is another case in point, accounting for at least 30 per cent of infertile couples. Widespread use of drugs and operations to increase sperm counts are of doubtful value and yet these infertile couples now have the same chance of conception as those with normal sperm by injecting a single sperm directly into an egg. We can even obtain pregnancies by using sperm aspirated directly from the testis - something quite impossible just two years ago, yet few NHS fertility programmes are aware of this fact.

Comprehensive fertility services should be an essential prerequisite for any government, as is efficient obstetric care. Perhaps the key issue is whether this should be free of cost to the patient. I do not believe it is acceptable for patients to be charged significant amounts towards the cost of NHS IVF since there would be a public outcry if similar charges were made towards the cost of delivering children or having abortions. Tony Blair's office moved quickly to distance itself from yesterday's report, and it seems unlikely that the Labour Party will ever remove fertility treatment from the NHS. But there is still no Labour commitment to free treatment in areas that presently deny it, nor any sign that provision will be built up. The infertile deserve better.

Professor Ian Craft is director of the London Gynaecology and Fertility Centre, a private IVF clinic.