The continuing 'postcode lottery' of IVF access in the UK

Lord Winston's critique of the funding of fertility treatment in the UK sparked controversy and press headlines earlier this month. As I wrote in a recent letter to the Guardian newspaper (1), whilst I welcome Professor Winston's comments on the cost of IVF in the UK, he fails to address the important point that one of the reasons for the high cost in the private sector is due to a lack of public funding of fertility treatment.

I have worked as an NHS clinician for almost 25 years. Practically every week I face the complex task of advising couples who we have not been able to help. I think we have a duty to these couples, to explain why it is so difficult for them to access treatment. Couples are often distressed by the fact that their long awaited pregnancy has not yet happened. As a team, which includes specialist nurses and a very skilled counsellor, we hopefully have the skills to deal with this distress - the result of our failure to help and their inability to give each other this wanted child.

Too often this final appointment is made more difficult because I have to inform them that, because of the policy in the area in which they live, funding for fertility treatment is either absent or wanting. Many of our patients come from the areas of Camden and Islington or Westminster and have the privilege of possible NHS access, within a  reasonable time, if they are young enough. Despite National Institute of Health and Clinical Excellence (NICE) recommendations that women under the age of 40 should receive three cycles of IVF (a fair chance) and ministerial assurances that all women under 40 will have access to one IVF cycle on the NHS, it is becoming very difficult to refer women in their 39th year. 

How can I explain, for example, to a 38 year old woman awaiting treatment that the NHS waiting list where she lives is at least two years? It is my duty to do so of course, and the only answer is with sadness and anger on their behalf, that the NHS to which I am committed is failing them. Some can afford to consider the private sector, and again it is my duty to guide them into that maze, but some cannot.

At a time when trans-border reproductive care is exploding, it is also my duty to know about centres abroad and to advise couples of this option, where there is often very little objective information to be guided by. The European Society for Human Reproduction and Embryology is starting to address this concern, and there are ethical and legal considerations in press on this subject.

We know that the UK is lagging behind many European countries with regard to the number of IVF cycles per million of the population. It is not because the British suffer from less infertility than other Europeans, nor is it because the clinical skills are lacking - the first IVF baby in the world was born in this country thanks to Steptoe and Edwards. The scarcity of access to IVF treatment is due to a lack of funding. I repeat my appeal to our politicians, who have not heard the pleas of infertile parents for so many years: address this inequity. IVF treatment is of proven efficiency and should be provided fairly not by postcode lottery as it is now.