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NHS provision of IVF: the fight goes on

28 August 2007
By Clare Lewis-Jones MBE
Chief Executive, Infertility Network UK
Appeared in BioNews 422
The continuing lack of public funding to help many UK couples affected by infertility was highlighted recently by a new survey, carried out by Infertility Network UK (I N UK) (1). Both as patient organisations CHILD and ISSUE, prior to our merger in 2003 to form I N UK, and since, we have worked for over 14 years leading the National Infertility Awareness Campaign (NIAC) to end the unfair, unacceptable and unjustifiable situation relating to NHS funding for infertility treatment - in particular assisted conception treatments such as IVF and ICSI.

Those of us familiar with the issues - especially those patients deserving of NHS funded fertility treatment - are only too aware of the fact that implementation of the National Institute for Health and Clinical Excellence (NICE) Clinical Guideline for fertility treatment is patchy (to say the least) throughout England, and that there is wide variation between the eligibility criteria being used by PCT. We were therefore pleased to be asked in 2006 by the Department of Health to work with PCTs to help share good practice and more recently to extend the project to try to develop, in partnership with the NHS, social access criteria to ensure a standardised approach across the country.  

The inequality of NHS funding for fertility treatment is, as I've said, well known. However, the latest survey, conducted as part of our project work also highlights other disturbing statistics.

The results so far confirm once again that whilst some areas have made progress towards implementing NICE's recommendations, a considerable number of others have failed to take any further steps towards meeting them, whilst some have reduced, suspended or cut services altogether.

Disturbingly the survey also reveals significant variations in PCTs' interpretation of implementation, showing that over a quarter of respondents to date believe that they are meeting NICE's recommendations in full, despite less than five per cent indicating that they are providing up to three full cycles of IVF.

PCTs in England are failing to adopt a consistent definition of a full cycle of IVF treatment, despite clear guidance in the NICE Fertility Clinical Guideline, with over 60 per cent of the PCTs that have responded to the survey so far indicating that they were not funding frozen embryo transfers as part of their IVF cycles, or that they did not know whether this treatment was included in their service provision. The NICE guideline clearly states that a full cycle of IVF should include the transfer of both fresh and frozen embryos.

We find it totally unacceptable that more progress has not been achieved in implementing the NICE guideline. We are angry that this survey shows that many PCTs are not including frozen embryo transfers as part of their IVF cycles. This is vitally important given the move towards single embryo transfer (SET). We believe SET is an important step towards reducing the health risks associated with multiple births but it is absolutely vital, to give patients a real chance of success with SET, that both fresh and resulting frozen embryo transfers are open to patients. In fact we can't believe that some areas, some parts of the NHS, are happy to fund a treatment which brings about something as special as an embryo, but only allows them to be transferred if the patient has the ability to pay. We challenge that decision wholeheartedly. It is therefore crucial that the correct definition of a full cycle is employed by all PCTs and that the NICE guideline is implemented in full, so that patients have access to up to three full cycles on the NHS.  

Our survey also showed a distinct lack of patient involvement by PCTs in their decision making process in relation to providing fertility treatment locally. How can they really know what suffering from infertility is like and therefore the very real need to treat this disease if they don't hear from patients?

On announcing the results of our survey we were delighted to hear that the Public Health Minister Dawn Primarolo was writing to all the Chief Executives of PCTs in England informing them of these results, stating that the Department was looking to PCTs to move towards the provision of three full cycles of IVF. She also announced that the Department of Health is going to begin monitoring the IVF provision across the country to further identify where the NHS may need further assistance. My obvious hope is that this, plus our project, will put further pressure on PCTs and let them know that we are not going to go away - that they cannot continue to simply not fund fertility treatment and not expect a fight on their hands.

The project aims to prepare and disseminate good practice guidance and standardised social access criteria to PCTs for them to use. I N UK will continue to work hard on this project to help PCTs, to ensure they are aware of infertility as a disease, an illness; to help them implement the FULL guideline and to end this totally unjust situation which continues to be 'treatment by postcode' or 'treatment by bank balance' or 'treatment depending on what eligibility criteria your PCT has decided upon'.  It simply cannot go on!

SOURCES & REFERENCES
1) Danielle Hamm, 'Fertility treatment in UK remains inadequate'
BioNews |  13 August 2007
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