Budget demands tighten restrictions on access to IVF treatment

UK MPs have questioned the restrictive lower age limit policies practised by increasing numbers of NHS healthcare providers, which prevent women accessing IVF until they are in their late thirties - when chances for the treatment's success dramatically decrease to an average of 15 per cent. Meanwhile, some healthcare providers, such as Gloucestershire's PCT and North Yorkshire and York PCT are ceasing the provision of IVF altogether in order to ration their stretched budgets.

Thames Valley, now South Central Strategic Health Authority (HA), requires that women be 36 to receive IVF, while a spokesman from North Yorkshire and York PCT cited 'financial challenges' as the reason for their 'exceptions panel' - which evaluates extenuating individual circumstances that might exempt patients from the general IVF non-provision policy, such as 'where the female partner is nearing 40' the cut-off age limit.
Sandra Gidley, the Liberal Democrat MP for Romsey, who introduced the issue to the House of Commons said, 'People are kept waiting until they are 39 almost, and your chances do reduce then. It seems perverse to be delivering it at an age where it's less likely to work'.

Gloucestershire's PCT is phasing out its provision of routine IVF treatment by 6 April 2007, after careful deliberation of demands on its tight budget and public support for the move following a three month consultation entitled 'Future of Healthcare in Gloucestershire'. A mechanism to consider individual exceptions for IVF funding will remain, emphasised a spokesperson.

This growing trend to shut out younger infertile women or infertile women generally from public funds, contravenes guidance given in a 2004 directive from the National Institute for Health and Clinical Excellence (NICE). It recommended that up to three cycles of IVF should be provided to diagnosed infertile women aged 23 to 39. Health Secretary John Reid said that one free cycle of IVF would become available on the NHS, and trusts responded with restrictive access criteria to prevent drains on resources.

A Department of Health spokeswoman acknowledged the 'local variation' in the provision of IVF. She maintained that implementation of NICE guidelines must be decided by the 'NHS at local level' and flagged their new initiative to team up with the charity Infertility Network UK to scrutinise the decision process for fertility treatment provision to particular women.

Upper age limits are common and endorsed by NICE as justified on the grounds that there is a very low practical success rate for women in their forties. Lower age limits lack this justification. Instead, trusts argue that younger women have other alternatives like adoption and more time to allow nature to succeed but these options can be psychologically and personally straining, notes Gidley. One cycle of IVF can cost up to £5,000 with most women requiring repeat cycles. In 2004, the Thames Valley Strategic HA estimated that if all eligible couples in its area were to receive one free cycle, its IVF budget would more than double, according to Observer newspaper quotes of the HA's board minutes.