Although the media frequently present stories about infertility, how aware are the public about infertility and what are their views on NHS provision of infertility treatment? It is well recognised that there is a 'post code lottery' for NHS provision of infertility services, but how is this regarded by the public? These are important questions particularly at this time. The National Institute for Clinical Excellence (NICE) is currently drafting clinical guidelines for the NHS in England and Wales for clinically cost effective and appropriate infertility treatment to be released later this year.
A study in 1998 revealed NHS service provision (measured as IVF treatments per million people) varied from a high of 213 in Scotland to a low of 3 in the South West of England. Since this survey, this disparity of service provision has increased. Not only has there been no increase in provision of IVF in the South West region, since July 2002, the most South West hospital, the Royal Cornwall Hospital in Truro, has closed the list to all referrals for infertility services including basic assessment and counselling. Similarly, in April 2003, the Bristol region closed the list for all infertility referrals pending the outcome of a review of infertility services.
In 2001, visitors to the main shopping complex in Bristol city centre were invited to complete an anonymous questionnaire in privacy entering their views directly into a computer. Subsequently, this questionnaire was transferred to the website for a highly successful and popular public science centre based in Bristol, called At-Bristol. The views on the website were consistent with the initial shopping centre poll hence the results of all the votes as of June 2003 are presented together. This article presents some of the findings of this survey and the full results are available on the website to view after completing the questionnaire. Not all respondents completed all questions hence in the tables below the total number of respondents for each question is indicated.
How many couples in the UK will visit hospital to seek specialist help for infertility?
1 in 6 (correct answer): 30.3%
1 in 16: 33.4%
1 in 60: 22.9%
1 in 116: 7.8%
1 in 600: 5.5%
Total Votes: 930
Do you feel that the NHS should fund IVF treatment for infertility in the same manner that the NHS supports treatments for other medical disorders?
Yes, definitely: 40.8%
No, definitely not: 4%
Total Votes: 795
At present each region in the UK sets its own criteria for the provision of IVF funded by the NHS. Do you feel that couples should have equal access to fertility treatment wherever they live in the UK?
Yes, definitely: 65.8%
No, definitely not: 2.9%
Total Votes: 787
Do you feel that couples who have a low chance of pregnancy with IVF (eg 1 in 20) should have equal access to fertility treatment as couples who have a high chance of pregnancy with IVF (eg 1 in 3)?
Yes, definitely: 36.6%
No, definitely not: 2.7%
Total Votes: 771
What do you feel is the oldest age that a woman should be able to get NHS-funded IVF treatment?
35 years: 11.1%
38 years: 11.1%
40 years: 37.9%
45 years: 26.9%
50 years: 8.4%
Treatment should never be free: 4.6%
Total Votes: 829
The results of the survey showed that respondents underestimated both the frequency of infertility and the effectiveness of IVF treatment for women in their early 30s. The survey supported a consistent approach to NHS infertility services throughout the UK treating infertility the same as any other morbidity. It was not generally felt that treatment should be denied solely due to a lower chance of success, but age of the mother was an important consideration with different views on the upper age limit. Overall the questionnaire was supportive of NHS funded infertility services and an end to the 'post code lottery' of provision.
Julian Jenkins is clinical director of the Centre for Reproductive Medicine , University of Bristol, UK. He has a particular interest in the use of information technology, especially the Internet, to support clinical care, research and education, leading to many innovative projects including a biomedical science degree delivered principally over the Internet.