Mark Henderson, Science Editor
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Infertile couples could soon be offered wider and more consistent treatment on the NHS under the first proposals from the government panel that has the task of ending the IVF postcode lottery.
NHS trusts should give IVF a much higher importance when drawing up spending plans, by taking into account the effects of infertility on mental health and general wellbeing, the influential group will say today.
The advice from the Expert Group on Commissioning NHS Infertility Provision, which was convened by health ministers this year, will put fresh pressure on the 95 per cent of primary care trusts (PCTs) that do not offer the three cycles of IVF recommended by the National Institute for Health and Clinical Excellence (NICE).
Its interim report, which suggests several measures designed to improve access to IVF, comes as an NHS regional health authority has agreed for the first time to implement the NICE guidelines across all 14 of its trusts. The decision by NHS East of England means that infertile couples in Essex, Suffolk, Norfolk, Cambridgeshire, Hertfordshire and Bedfordshire will be entitled to three cycles of treatment from next April, provided that they meet eligibility criteria.
Infertility is a problem for between one in six and one in seven couples. Almost 45,000 cycles of IVF are performed in Britain each year, but limited NHS provision means that about 75 per cent of these are conducted privately, at an average cost of £2,000 per cycle. NICE, the value-for-money watchdog, recommended in 2004 that PCTs should provide three cycles to infertile couples in which the woman is aged between 23 and 39. It added that these should be full cycles, including the replacement of frozen embryos, should a couple fail to conceive with fresh ones.
A Department of Health survey published in June found, however, that just 9 out of 151 PCTs in England meet this standard. About two thirds offer only one cycle, and half of these do not replace frozen embryos. Three trusts offer no IVF at all.
In March, Dawn Primarolo, the Health Minister, asked an expert group to recommend ways of encouraging more trusts to implement the NICE guidance in full. Its first advice, seen by The Times, will be published today. It found that the main barrier to wider provision was the low priority that many trusts give to IVF. This needed to be reassessed in the light of evidence about links between infertility and depression, stress, relationship breakdown and quality of life.
“The provision of infertility treatment has not been seen as a traditional NHS service and, therefore, is often viewed as a relatively low priority compared to more visible conditions whose impact is well established,” the report will say.
“The group’s final report will seek to consider the often unseen consequences of infertility, including the impact on mental health and general wellbeing, which may draw on other NHS services for treatment, as well as the positive benefits of IVF.”
The group has also identified a “lack of knowledge and understanding of infertility and its treatment” among commissioning managers, and a poor grasp of what the NICE guidelines actually mean.
In the light of the group’s advice, Ms Primarolo will write today to all PCTs to clarify that NHS IVF cycles should include the replacement of frozen embryos as well as fresh ones. If trusts acted on this, it would significantly improve some infertile couples’ chances of a baby.
Ms Primarolo’s letter will also confirm that NICE will not review its guidance until 2010-11. Many trusts had been holding off from offering three cycles, as NICE had been due to reassess its policy as early as this year.
The expert group, made up of five NHS commissioning experts and a patient representative, will also recommend that the NHS set a fixed price that PCTs would pay for IVF. Such national tariffs already exist for dozens of medical procedures, such as heart bypasses, and help managers to plan their spending.
A spokesman for the Department of Health said that it was receptive to this idea. “It is appropriate for IVF to be considered carefully for inclusion on the national tariff,” he said.
Mark Hamilton, chairman of the British Fertility Society, which represents medical professionals in the field, said that it was right for PCTs to consider the wider health impact of infertility. “This is a positive development,” he said. “Clinicians and practitioners involved in infertility services are all aware that we are not just dealing with a physical pathology.
“Infertility is a disease, but it also has fallout beyond that for a significant proportion of couples, causing mental health problems, depression, stress-related illnesses and so on.”
Dr Hamilton welcomed the East of England decision, though he questioned whether other parts of the country would match it unless the Department of Health provided more dedicated funds.
“It is a tremendous step forward that a region has seen the value of doing this, and I would hope that others will do the same. But there is certainly a view in the sector that central funding would solve an awful lot of problems.”
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Has anyone stopped to reflect upon what type of illness causes one to believe that reproduction is a government sponsored entitlement? Emotional discomfort, like infertility, is a normal part of the life experience - the utter selfishness of the British public never ceases to astound.
cris, oslo,
Jane, of London, makes an interesting omment: "commitment phobic boyfriends are too busy drinking lager and moaning about not giving up their freedom." When sex was connected to the commitment of marriage, men, I think were perhaps a bit more motivated to commit..save sex for marriage.
CAtherine, Cairns, Australia
Can I just say I am disgusted by some people's comments. I am a taxpayer. The NHS can provide treatment to smokers and drunks who damage their bodies regularly. They even provide treatment to obese people. All of these groups could prevent their illnesses but are still treated free.
Michele, Birmingham,
Hmmm,lots of heartless people who have obviously nothing better to do with there time than sit and write thoughtless comments about a subject that has obviously not effected them!!
Vikki, Brighton,
Those saying that infertility is not life-threatening and should not be provided on the NHS should remember that a great deal of treatments carried out on the NHS are for non life-threatening conditions. Think breast reductions, ear pinning, broken limb repairs, cut stitching, delivering babies...
Mike, Harrogate, England
Simon, Beckermann, David, Abdul. Can I ask how many of you have experienced infertility? I suspect none. I suggest you don't make ignorant comments without actually fully understanding the issue being discussed.
Emma, Herts,
Again, another set of ignorant comments from people who obviously either down want or already have children, until you have suffered infertility I don't think you can comment on how hard it is. I am amazed by your lack of compassion some of you, how can you be so heartless?
Mary, Swindon, UK
yes i welcome it i think its a priorily for a lot's of couples who is longing for a child
nadine, brighton, england
Being infertile is NOT always due too woman putting there careers first. Many woman like myself may have missing ovarys, or fallopian tubes, they could of had Cancer, they possibly could of been in a terrible accident which has left them infertile!
We all have rights Simon, u should considerthat
Mel, Essex, England
Yesterdays news was that the population of the UK is rapidly expanding,approaching 61 million, due to high fertitity rates,greater logevity and immigration.
Do we still need more balmy schemes like this to add to the population growth ?
Abdul Jaleel (Dr. ), Darlington , United Kingdom
If the NHS would offer the programme that the charity www.foresight-preconception.org.uk offers, many of the childless couples would have healthy babies without need of IVF. Meantime you can go to the charity-their programme costs less than IVF, or if you do both, greatly improves your chances.
Dee, Bedford, UK
My husband and I are in the unfortunate position of needing IVF to have our own child/ren. It is heart breaking at times especially as so many of our friends and family have had babies in the last 4 years. I find some of the comments on here ignorant. Both of us have been in tears at times.
Cate , Omagh, Northern Ireland
Beckerman, London,
you are right infertility doesn't kill but if you think people don't suffer well you are very much mistaken
i think the nice guideline of 2004 should be brought in ASAP throughout england & wales.
kara, pembrokeshire, wales
I agree with Simon of York.
Infertility is not a priority.
Oh and by the way, it's not for women (feminist or not) to seek to exclude men from this discussion.
Men have a right to express opinions on this and any other subject.
It's called equality - get used to it.
Chris, Wokingham, England
I would ask How many of you have children? When having children is as easy as getting drunk and falling into bed with the nearest stranger then you would be totally against money being put into fertility. I work hard, a role model, its not just a tantrum!!! I hope you never have to go through it !
Jane , Norfolk, England
As a woman who has longed for a child, battled with infertility for 10+ yrs, & has been through 3 unsuccessful, stressful, very expensive IVF cycles, yes I KNOW I wont die from it, but do I suffer with it? In answer to those who think not, all I can say is, I hope you never get to know first hand!
Angela, London, UK
Err, what about all the cancelled operations mentioned in yesterday's papers?
Ian Burgess, Bristol,
I simply cannot believe this! With the NHS (seemingly) being underfunded, forcing NICE to withdraw life-saving treatment from cancer & Alzeimer sufferers, how can they even THINK of wasting OUR money like this? Especially with the world already so overpopulated - and getting worse! Just crazy...
MS, Staffs, UK
It's not a feminist society if young women have to delay pregnancy to protect their careers or because they can't afford to take time off and decent childcare if they return to work. A truly feminist (and egalitarian) society would have proper maternity and paternity leave provisions, and affordable
Sheila, London,
For many couples paying full rent/mortgage, council tax, etc, who would like to give any potential child a reasonably decent upbringing, having a child is financially inviable at least until they reach their thirties due to the UK's high cost of living and ludicrous nursery fees.Consider that, Simon
Rachel, Edinburgh,
it's not just women who are infertile Simon.
Paul, Dublin,
I don't think IVF should be available on the NHS at all. Infertility, although difficult for those concerned, isn't an illness, you're not going to die or even suffer from it. The priority for the NHS should be to concentrate on treating the many serious conditions that effect the wider population.
Beckerman, London,
Being infertile is not life threatening and should not be on the NHS!
sarah, london, uk
Simon, that is an astonishingly ignorant opinion. It is narrow to suggest that infertility is simply a result of "waiting too long" (if you read the article you will see there is indeed an age limit). Would you also advocate certain types of cancer go untreated if exacerbated by lifestyle choices?
Laura, London, UK
thankyou simon from york, now there a mans veiw who clearly knows nothing about infertlity, im someone who has had IVF myself and it not a dance in the park let me tell you, why dont you maybe do your homework on how infertility affects people, im not talking just ladies you know.
talie , rayleigh, essex
In an age of increasing overcrowding on this planet why are we wasting money pandering to the wannabe parents tantrums?
NHS money should be spent on real and not imagined illnesses, if these people absolutely MUST have a child then let them pay privately for the chance to do so.
David, London, UK
Simon, I find comments such as yours incredibly annoying. Most women I know (Im 30) have jobs because they need to pay the rent, but would be delighted to get married and have kids but cant because their commitment phobic boyfriends are too busy drinking lager and moaning about not giving up their freedom. But hey, women are always to blame for the wrongs of the world, right?
Jane, London,
There's something quite sick about the fact that our feminist society brainwashes girls into thinking a job is the b all and end all, thus increasing costs of infertility as a result of waiting too long. This money could have been spent on indiscriminate diseases - e.g. Alzheimers, Cancer, Blindness
simon, York, England