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King's College London - Health: More than a medical matter






Infertility treatment in the UK: Implementing the NICE guidelines

16 January 2006

By Professor William L Ledger

Jessop Wing, Royal Hallamshire Hospital, Sheffield

Appeared in BioNews 341
Many years ago the then Minister of Health, Frank Dobson, drew attention to the unfairness of the 'postcode lottery' of provision of infertility treatments in the UK. Following his initiative, a subsequent Minister, Alan Milburn, later commissioned the National Institute for Health and Clinical Excellence (NICE) to look into this topic, and NICE published its conclusions in guidelines entitled 'Fertility, assessment and treatment for people with fertility problems', in late 2003. A third incumbent in the Ministerial post, John Reid, responded to this in February 2004 with a public statement: 'As a first step, I want all PCTs, including those who at present provide no IVF, to fund one full cycle for all those eligible. In the longer term I would expect the NHS to make progress towards full implementation of the NICE guidance'.

Implementation of the guidelines was planned to put an end to the lottery, with fair and equal provision in all corners of the country. It is a sad fact that the lottery remains alive and well some 18 months after John Reid's promise. Whilst funding for IVF has increased in some areas, it has remained static or even declined in others. There is also a lack of national consensus on eligibility criteria. A recent survey coordinated by Infertility UK and the National Infertility Awareness Campaign has clearly shown the major differences in amount of funding, and in eligibility criteria for NHS treatment, that exist between adjacent PCTs in England and Wales. These include provision ranging from no treatment to two cycles, including frozen embryo transfer. With regard to differences in eligibility, there are significant variations in provision to couples with children from a previous relationship, or to couples in which the woman is older, or overweight. In addition, some PCTs persist in only funding IVF treatment when the woman reaches a 'cutoff' age, often at a point beyond the optimum age for a chance of IVF success. The continued paucity of help from the NHS for infertile couples in UK contrasts poorly with the more generous State provision in most of Western Europe (see table below).

COUNTRY / NUMBER OF STATE-FUNDED ART CYCLES / AGE LIMIT

Spain / 3 / Up to 37

Belgium / No limit / Up to 43

Slovenia / 4 / Up to 42

Portugal / No limit / Up to 42

France / 4 / Up to 43

Israel / No limit / Up to 45

Italy / No limit / No limit

Sweden / 2 / Up to 38

UK / None to 1, rarely 2 / Up to 40

SOURCE: European Society for Human Reproduction and Embryology Advisory Committee, September 2005.

New drivers for increased State provision include a move to single embryo transfer for NHS funded IVF patients. We have shown that this policy would produce substantial cost savings, since the costs associated with long term care for twin or triplet pregnancies and offspring are substantial. We have suggested that this saving could be used as a 'cost-neutral' means of improving NHS funding for IVF, although it would obviously require a Government initiative to do so. At the time of writing, the three full cycles of NHS funded IVF recommended two years ago by NICE remain a distant dream. If NHS funding is not improved than I feel it is unlikely that patients will be willing to adopt a 'single embryo transfer' philosophy, since most wish to optimise the chances of pregnancy from one cycle if they are investing in treatment from their own resources.

 

SOURCES & REFERENCES

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

28 May 2012 - by Greg Ball 
The National Institute for Health and Clinical Excellence (NICE) has published a draft updated guideline on fertility that would see same-sex couples and women aged up to 42 eligible for fertility treatment on the NHS... [Read More]
29 October 2009 - by Ben Jones 
The Labour party is urging the Scottish parliament to take action to standardise IVF provision across Scotland, after Labour MSP Jackie Baillie discovered wide disparities in provision between the 11 Scottish NHS boards. Ms Baillie contacted all of the boards after having been approached by a constituent who was upset about the length of IVF waiting lists where they lived.... [Read More]
13 August 2007 - by Danielle Hamm 
A survey conducted by the Infertility Network UK (I N UK) and sponsored by the UK Department of Health (DH) has shown that the provision of IVF treatment in the UK does not meet government guidelines. The survey indicated that provision of NHS fertility treatment is patchy... [Read More]
26 June 2006 - by Dr Kirsty Horsey 
BioNews reporting from ESHRE conference, Prague (sponsored by Planer cryoTechnology): By Dr Kirsty Horsey: Data presented at the annual conference of the European Society of Human Reproduction and Embryology (ESHRE) has shown that more than three million babies have been born using IVF and other assisted reproductive technologies (ART) since... [Read More]
20 June 2006 - by Dr Kirsty Horsey 
BioNews reporting from ESHRE conference, Prague (sponsored by Planer cryoTechnology). By Dr Kirsty Horsey: Research presented today at the annual conference of the European Society of Human Reproduction and Embryology (ESHRE) in Prague, Czech Republic, suggests that the benefits that would come from the UK's government providing free fertility treatment... [Read More]

16 January 2006 - by BioNews 
UK researchers say that an additional 10,000 cycles of IVF per year could be provided free on the National Health Service (NHS), if clinics took action to reduce the number of multiple births following IVF. It is common for women undergoing IVF to have two embryos implanted at a time... [Read More]
21 October 2005 - by BioNews 
Figures released this week by the International Committee for Monitoring Assisted Reproductive Technology (ICMART), show that IVF success rates in America are almost double those in Europe. The finding was reported at the American Society for Reproductive Medicine (ASRM) conference that took place in Montreal, Canada. American fertility specialists pointed... [Read More]
20 August 2005 - by Professor Ian Craft and Dr Alan Thornhill 
The UK's Human Fertilisation and Embryology Authority (HFEA) recently announced that it is to review its rules on how many embryos can be implanted during IVF treatments. Transferring fewer embryos to all patients inevitably results in fewer multiple pregnancies, and we fully support measures making IVF safer. However, we recommend... [Read More]
01 August 2005 - by Clare Lewis-Jones MBE 
The Human Fertilisation and Embryology Authority (HFEA) has announced that it will be reviewing the clinical practice around the number of embryos transferred during fertility treatment. It will look at whether the UK should follow the practice of other European countries that have a single embryo transfer (SET) policy. Infertility... [Read More]
29 July 2005 - by BioNews 
The UK's Human Fertilisation and Embryology Authority (HFEA) is to review its rules on how many embryos can be implanted during IVF treatments. Currently, over 90 per cent of IVF cycles in the UK involve transferring two or three embryos to increase the chances of success. However, this also leads... [Read More]

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