IVF funding in the UK: three years on and the waiting continues

It is now been an incredibly long three years since the UK's National Institute for Health and Clinical Excellence (NICE) published the clinical guideline on fertility. It is also an incredibly long two years since all PCTs should have made at least one cycle of IVF available in England and Wales. Yet that STILL has not happened.

To once again highlight this totally unacceptable situation in the House of Commons, on 31 January, Sandra Gidley, Member of Parliament (MP) for Romsey and a member of the All Party Parliamentary Group on infertility (APPGI), managed to secure a debate on Infertility Treatment in Westminster Hall in the House of Commons. I'd like to take this opportunity to thank Ms Gidley for her support demonstrated by calling for this debate.

This was a very informed debate with MPs showing an excellent understanding of infertility and of the fact that this country still has an unacceptable 'treatment by postcode' situation when it comes to funding IVF. Whilst some parts of England and Wales do now enjoy much better funding than before the publication of the guideline, others still do not. And why can virtually the whole of Scotland provide three cycles for couples where the female partner is aged less than 38 at the time of treatment yet Thames Valley will only fund one cycle of IVF for couples where the female is aged between 36 and 39? Thames Valley won't even allow people to be referred for IVF until they are 34 - irrespective of whether you perhaps know when you are 24 that the only way you can conceive is by using IVF.

There was clear cross-party agreement that the NICE guideline should be implemented in full as quickly as possible. Sandra Gidley maintained that it was 'a scandal that the Government have made no further progress in asking PCTs to implement NICE guidelines' (1).

As many people know, there is likely to be a big move towards single embryo transfer here in the UK. The debate discussed this issue, drawing on the report compiled by the Expert Advisory Group on Multiple Births, which was assembled by the Human Fertilisation and Embryology Authority (HFEA). In Sandra Gidley's words, 'The expert group concluded that 'the failure to implement the NICE guideline on fertility (three cycles) is the major obstacle to the acceptance by NICE and clinicians of introducing single embryo transfer policies in the UK. The National Infertility Awareness Campaign has pointed out that the cost savings that could be achieved in neonatal care as a result of such a move towards the NICE guidelines could be invested in funding more infertility treatment' (1).

The debate discussed why the Secretary of State for Health at the time of the publication of the NICE guideline added the criterion that priority should be given to couples that had no children living with them. MPs highlighted the fact that this was a social criterion and not in the NICE guideline, yet many PCTs were now adopting it (or variations of it). Sandra Gidley stated that she suspected that this had sent a signal to PCTs that they could then add further restrictive social criteria - which they have. She also made the following statement which Dari Taylor MP (Labour), Chair of the All Party Parliamentary Group Infertility (APPGI) also commented on in her participation in the debate: 'It was also clear that many trusts had added their own criteria that further diluted the NICE guidelines. One of the concerns often raised is that criteria are often social criteria, which almost suggests a degree of social engineering that varies around the country' (1).

Reference was also made by Ms Gidley to research being performed by the RAND institute which suggested that there may be a case for including fertility treatment as part of a population policy mix aimed at increasing fertility rates and asked whether there may be a case for 'a separate pot of money, ring-fenced for the prime purpose of boosting fertility' (1).

Some time was spent on a discussion about natural cycle/minimal stimulation IVF as raised by Dr Ian Gibson MP (Labour). My feeling is that this method of treatment should be included as part of the review of the NICE Fertility Guideline, which is due to happen in 2008.

These debates are time limited and sadly the Minister of State for Public Health, Caroline Flint MP, was left with only a short period of time in which to respond to the points that had been raised. She referred to the project the Department has asked Infertility Network UK (I N UK) to undertake: 'There seem to be different levels of expertise in the commissioning of services for infertility and, on the other side of the coin, good examples of PCTs getting together to commission in a wider area...What I have done to move the debate forward is fund Infertility Network UK to work with PCTs over a three year period to identify what is happening on the ground...' (1).

Ms Flint finished with the following: 'We are trying to create an environment, which might not be that well recognised, where the debate can go beyond fire fighting to something that is more sustainable for the future, more informed, more effective and more cost-effective' (1). I appreciate the fact that this statement is sensible. But please, how long will that take? On behalf of the one in six couples affected by difficulties in conceiving can I make a heartfelt plea? Please don't let it happen that in another three years' time we are still having similar debates. That is just too cruel. Let's all sit down around a table and agree and issue central guidance - because I think that that is the only way to get fair and equal access to a fully funded NICE Fertility Guideline.