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The future of NHS funding for infertility services

1 July 2010
Appeared in BioNews 565
When the UK's National Institute for Health and Clinical Excellence (NICE) was asked to produce a clinical guideline on infertility back in 2000, it was with the aim of creating fairer and faster access to services for patients. At that time, the vast majority of couples seeking treatment for infertility had to pay for it privately. What was available to them on the NHS often depended on where they lived and varied significantly in terms of the services funded, eligibility criteria and waiting times.

Pledging an end to this 'postcode lottery', the Government asked NICE to develop a national guideline on fertility. Published in 2004, this set out recommendations on the clinical and cost effectiveness of a full range of services for the investigation and treatment of infertility. Amongst other areas, it recommended that up to three full cycles of IVF be made available to those meeting its clinical criteria.

Couples undergoing the distress of infertility had their hopes raised by the Government's call for immediate action to implement the guideline, asking PCTs in England to fund at least one full cycle of IVF by April 2005, with significant progress to be made over the longer term. A similar pledge was announced in Wales and progress was made to fund at least one cycle in Northern Ireland. National guidance had also been developed in Scotland to encourage a similar approach by health boards there.

For many organisations involved in infertility treatment and support, this was welcomed as a positive step for the one in seven couples affected by fertility problems. Infertility can be hugely isolating and have a significant impact upon couples' mental health, wellbeing and relationships. Moreover, infertility is defined by the World Health Organisation as a disease of the reproductive system and is, therefore, worthy of investigation and treatment on the NHS. In fact, excellent results can be achieved in treating infertility if couples receive timely investigation and referral for appropriate treatment.

Since the publication of the guideline, the National Infertility Awareness Campaign (NIAC) has been campaigning for its full implementation. There has been some good progress over the last six years: around half of PCTs in England now fund more than one cycle of IVF, with nearly a quarter funding three full cycles. From April this year, the Assembly Government announced that all eligible couples in Wales would have access to two cycles and in Scotland, most health boards now fund three cycles.

In England, the Department of Health established an Expert Group to produce advice to PCTs on the commissioning of infertility services. The Group's report, launched earlier this year, followed the publication in 2009 of a commissioning aid for infertility and a set of standardised access criteria to support more equitable access to services. A national approach has already been adopted in Wales and Northern Ireland and similar work is being supported by the Health Department in Scotland.

However, there is still a long way to go. Significant variations continue to exist in the number of IVF cycles funded, the inclusion of frozen embryos within a full cycle and the access criteria applied to couples seeking treatment, particularly criteria that fall outside the NICE guideline. For example, on the issue of childlessness, there is considerable variation around whether couples that have a child from a previous relationship should be excluded from funding. The majority of PCTs are still not funding the recommended three cycles of IVF and there have even been parts of the country where treatment has been suspended or is simply not funded.

Set against this is the considerable pressure the NHS now faces to deliver efficiency savings. Sadly, this could produce the temptation to halt further progress towards implementing NICE and even to reduce funding from its current level. This could dash the hopes of many couples seeking treatment and undermine the progress achieved since 2004. Recent studies have also shown that this may also be cost-ineffective, with some estimates showing that in economic terms children conceived by IVF may represent an eight-fold return on investment by governments.

As NICE reviews its guideline in 2010, the message remains clear: infertility is a disease area for which NHS services were intended to be provided but which, for many couples, remain available only if they have the ability to pay. The NHS Constitution commits to the value of fairness: using resources for the benefit of the whole community, to make sure nobody is excluded. Let's ensure that couples with infertility are not among those left behind.

NIAC is an umbrella body formed in 1993 as a development of National Fertility Week. It was established with support, which it continues to enjoy, from a wide range of organisations involved in the field of infertility, including infertility charities, patient support groups, healthcare professionals and the pharmaceutical industry.

If you are aware of any issues around NHS funding of infertility services or would like to support NIAC's campaign, please contact niac@infertilitynetworkuk.com

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