First the good news, then the bad

Today is not the greatest day for those hoping that they might receive NHS treatment to overcome their inability to have children, nor is it for those who try to provide them with help. Doctors have struggled for years to provide good treatment for deserving patients with realistic results and today's rationing by the Secretary of State for Health of an exciting initiative by the National Institute for Health and Clinical Excellence (NICE) was only too predictable.

The development of guidelines for the management of infertility has been a brave undertaking by NICE and it should be congratulated on doing this in such a comprehensive yet timely way. We now have clear guidelines for the treatment of this distressing disease, including the removal of many costly and unnecessary procedures and tests. They are certainly not overgenerous; some would say that only three treatment opportunities is a bit tight and that an age limit of 24 to 39 years is too restrictive. We would all feel that a patient whose Fallopian tubes had been removed because of ectopic pregnancies deserves IVF but why only for one child? And why shouldn't a woman have treatment if her partner had a child by a previous wife but no longer has access to the children?

Despite these disappointing exclusions, the package would have been hailed as a triumph for a health service working in harmony with its own economic watchdog. But, in the event, we have outrageous rationing from the government to only one treatment cycle. The decision will certainly be cheaper for the government in the short term but it will be seen as very damaging in the long term.

Simply put, one cycle has a 22 per cent chance of letting a couple have a baby. With three cycles, this rises to 50 per cent. But there is more to it than that. We know from experience that patients are angry when they feel treatment has been unfairly denied and this anger is on top of that already felt because they have had to beg for help in the first place. They will know that they have been cheated. Further, those who have to explain all this to the angry couple also know that this is a mean and perverse decision.

We should have provided patients with fair treatment years ago and the time would have been right for the government to make amends now, simply by accepting good advice from NICE. The decision to ration not only fails to right past wrongs: it could even make things worse. Will those PCT's who at present fund two or three cycles take an unjustified opportunity to reduce their service? Will the NHS in Scotland reduce its own service from three cycles to one? God forbid.

And what about the risks of the procedure? Overstimulation of the ovaries is most likely to occur in the first cycle because it is not known how the patient will respond to the drugs. A cautious approach is needed in order to maximise the number of eggs available for fertilisation, whilst minimising the risk of overstimulation. But who will be prepared to treat cautiously when there is only one chance of a pregnancy? Madness!

And what about the reputation of NICE? Hopefully those professionals who put in so much work to bring together a workable guideline will still be prepared to give their advice when asked again. The only people who cannot afford to wait are the very people who saw a chance of help only to have it cruelly removed yet again. Or should they be used to it by now?

Dr John Mills, former chairman of the British Fertility Society, is a retired consultant obstetrician and gynaecologist, living in St Andrews