23 June 2008
ByAppeared in BioNews 463
A British MP has raised more concerns about access to National Heath Service-funded IVF in the UK. It transpires that a number of IVF clinics in the UK are denying free treatment to women who smoke. Labour MP Sally Keeble identified the latest barrier to accessing IVF in a survey of IVF clinics undertaken by the Department of Health. The news is likely to re-ignite the debate on the provision of state-funded IVF in the UK, particularly on where the line is being drawn between medical 'advice' and 'restrictions'.
The survey report says that many infertile women and, also, in some cases their partners, are being required by up to 46 PCTs across England and Wales to give up cigarettes before they can even be considered eligible for fertility treatment. This comes despite official guidance that says all PCTs should be offering one fee cycle of IVF to every infertile couple.
In February 2004, health ministers in the UK recommended that all health authorities should follow guidance issued by the National Institute of Health and Clinical Excellence (NICE), which had recommended that three cycles of IVF should be offered to all infertile couples, subject to certain clinical criteria, to end the 'postcode lottery' of IVF provision. Shortly afterwards, the then health secretary, Sir John Reid, announced that all infertile couples where the woman was aged between 23 and 39, and fitting certain other additional criteria - including having no other children living with them - should be given just one free cycle of IVF on the NHS from April 2005, with a view to increasing provision further in time to match the NICE recommendations.
However, since that time, it has been shown that only a third of PCTs provide more than one cycle of IVF. In the past four years it has also emerged that many PCTs are setting their own social criteria for access to free cycles of IVF, further restricting the availability of treatment, and not going any real way to eradicating the postcode lottery. Many use age or weight as a way to restrict access, for example, but these factors are seen as having medical indications in that IVF success rates in obese women or those above a certain age are lower.
Sally Keeble, once herself an IVF patient, agreed that 'smoking is not a good idea if you are trying to get pregnant', pointing out that both smoking and IVF have been linked to an increased risk of miscarriage. 'I think there's no point in putting people through expensive and traumatic treatment if they are doing something which is likely to make it unsuccessful', she said, adding 'it's really important that the people doing it should give it the best possible chance of success. I think there's a whole lot of different issues about weight and people's ability to lose weight and maintain weight but, with smoking, it's such an obvious one. It's entirely in the gift of the person to stop smoking'. However, a spokeswoman for Infertility Network UK (IN UK) said that 'it's another way of rationing treatment', adding that 'PCTs are looking at different ways to cut down the amount of treatment they give people'.
Dr Kirsty Horsey is Contributing Editor at BioNews. She is coeditor of Human Fertilisation and Embryology: Reproducing Regulation (buy this book from Amazon UK) and coauthor of Tort Law (buy this book from Amazon UK) and Skills For Law Students (buy this book from Amazon UK).