Last week, nurses in the UK decided to take action and lobby the British government to demand uniform eligibility criteria for infertility treatment and for the provision of up to three cycles of NHS-funded IVF be implemented by all UK fertility clinics, replacing the arbitrary 'postcode lottery' system presently in place. The nurses voted nine to one at a Royal College of Nursing (RCN) Conference in Bournemouth to petition the government to put an end to the insufficient provision of infertility treatments by most NHS trusts.
State-funded IVF has remained at the bottom of the resource allocation pile, viewed more as a luxury or lifestyle choice than a medical necessity. Yet, one in six UK couples experience infertility and it can be a profound 'personal tragedy' for women who find they cannot have children, according RCN board-member of the Lothian branch in Scotland Geoff Earl. 'If women are denied access, they will often suffer depression, anxiety and stress which feed back onto the NHS', he said.
In 2004, the National Institute of Health and Clinical Excellence (NICE), a government body that evaluates and decides resource allocation guidelines, recommended that three cycles of IVF should be provided to infertile women between 23 and 39 for the administration of effective treatment. Despite regulation requiring primary care trusts to phase-in NICE guidelines as far as possible, few have actually done so, according to a Department of Health survey last year. Former health secretary, John Reid, supported the guidelines and promised that all PCTs would offer at least one funded cycle of treatment by 2005, with a view to moving towards the full three cycles over time. The RCN thinks it is high-time that most PCTs stop ignoring the guidelines and causing unnecessary personal and financial anguish to infertile couples.
Jane Denton, from the RCN's fertility group, provided a statistical overview of the current situation at the conference which revealed that those seeking infertility treatment often face an 'enormous battle' to overcome the 'stigma of infertility'. A majority (98) of the 151 trusts surveyed provide one cycle of IVF but commonly have strict criteria restricting access: 73 trusts have a weight limit, 45 trusts consider lifestyle choices including smoking and alcohol, and 59 trusts deny state-funded treatment to those who already have children from previous or current relationships. There were 32 trusts that provided two cycles of treatment and seven said they would fund three cycles providing eligibility conditions are met. Fourteen either do not provide public-funded IVF or did not provide details of the number of cycles they would fund. The provision of alternative treatments had similar distribution figures. Claire Brown, chief executive of Infertility Network UK is 'delighted' by the RCN's decision: 'Four years on from the NICE Guideline it is totally unacceptable that patients are still facing inequalities in eligibility criteria and being denied treatment', she said.