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The picture doesn’t have to look like this

30 March 2015
By Vicky Whitehead
Policy advisor to Fertility Fairness
Appeared in BioNews 796

Today, Parliament is officially dissolved in advance of the General Election. Every seat in the House of Commons becomes vacant, and all business in the House comes to a close.

However, for Fertility Fairness this is a beginning as much as it is an end.

For over 20 years Fertility Fairness has been campaigning for equal and comprehensive access to IVF treatment, and while any election may mean the loss of allies in Parliament, it also represents a massive influx of potential new supporters. Besides which, with the end of the coalition, no matter which party wins on 7 May, there will be new ministers in the Department of Health.

With all this in mind, last week Fertility Fairness hosted a Parliamentary Reception. Sponsored by Ian Austin MP, the reception ran under the heading 'The Picture Doesn't Have to Look Like This' and looked at where England now is in terms of IVF provision, and how we could do better.

Fertility Fairness' most recent annual audit revealed that only 18 percent of Clinical Commissioning Groups (CCGs) are providing the three cycles of IVF nationally recommended (see BioNews 772). If the audit were performed again today, this figure would most likely not have changed, and the reception highlighted the inequity of this situation.

In England, the IVF postcode lottery impacts on every different level of a patient's NHS treatment in myriad ways. Not only is there widespread variation in who can access treatment and the number of IVF cycles available, but even in how a cycle is defined. At a time when the devolved nations have long since standardised their access criteria, and when the Scottish Government is considering mandating three cycles of IVF nationally (see this edition of BioNews, this inconsistency remains incredibly disappointing.

As Fertility Fairness has previously highlighted (see BioNews 740), the reason for the troubled provision of tertiary fertility services is its perceived unimportance compared to other NHS treatments. Putting aside the fact that this attitude ignores the heavy emotional and economic burden of infertility - most clearly demonstrated by the cost of associated conditions such as depression - this trivialisation can also lead to false economies. This point was aptly demonstrated by the reception's headline presentation.

Tim Child, a world-renowned specialist in reproductive medicine, presented data on patients from the Oxford Fertility Unit. His results showed that the provision of three full cycles of IVF - including frozen embryo transfers - had led to an 80 percent cumulative success rate in this cohort, at an average cost of £8,300 per birth.

Importantly, this data demonstrated that a frozen embryo not only has a high relative success rate compared to a fresh transfer, but is also cheaper for the NHS, and safer for the patient.

As so many commissioners do not see the value in IVF treatment, one corner that they frequently try to cut is the number of frozen embryo transfers available. Doubtless this is seen as a cost-saving measure, but as the real-life data demonstrates, this is clearly counter productive. Worryingly, Fertility Fairness has previously only been able to find 68 CCGs out of 211 using the appropriate definition of a cycle.

This kind of commissioning position is but one example of the ill-informed decisions that can plague IVF policies. However, there is also considerable cause for optimism.

The second key presentation came from Gill O'Neill, a consultant in public health who advises the North East Commissioning Collaborative. This group of 13 CCGs have joint policies on a variety of controversial services, such as IVF, each of which are subject to extensive consultation.

Here, not only do all 13 CCGs offer the National Institute of Health and Care Excellence-recommended level of IVF treatment, they have also standardised access criteria across the region. As the speaker noted, this 'majority rule' not only allows for a careful consideration of the evidence, but also prevents the marginalisation of fertility treatment by individual commissioners. It is to be hoped that, given time and continued engagement, more commissioners will come to follow this kind of diligent and informed example.

Which brings me back to my opening point. MPs can play a crucial role in affecting CCGs' policies, and a new Parliament represents a wealth of new opportunities. Now it is up to all of us to campaign for what we believe to be important.

The current patchwork provision of fertility services presents a picture that is at best ineffective, and at worst inequitable. The evidence that things should be different is unequivocal; and all that remains is to spread that message.

If you would like to help to get involved in the Fertility Fairness, the website provides information on what you can do to make a difference.

13 June 2016 - by Antony Starza-Allen 
Scotland is set to expand the provision of publicly funded IVF, increasing the number of cycles for eligible patients from two to three...
2 November 2015 - by Rebecca Carr 
The number of CCGs in England offering the recommended number of IVF cycles to its patients is falling, with two CCGs in Essex decommissioning their assisted conception services altogether...
8 December 2014 - by Sean Byrne 
The NHS Vale of York Clinical Commissioning Group has agreed to fund one cycle of IVF, having at one time been the only CCG not to offer the treatment at all after funding was suspended in 2010....
27 October 2014 - by Sean Byrne 
The National Institute for Health and Care Excellence (NICE) has published a quality standard that aims to bring an end to a 'postcode lottery' in the provision of fertility services on the NHS, which it says is restricting access to treatment....
29 September 2014 - by Siobhan Chan 
Mid Essex Clinical Commissioning Group has announced it will no longer be funding IVF except under 'clinically exceptional circumstances'...
22 September 2014 - by Vicky Whitehead 
In the UK, clinical commissioners seem to view the national recommendations on fertility treatment as a sort of à-la-carte menu from which they can pick and choose; altering the definition of a cycle, the age requirements, the number of cycles available, and the access criteria at will...
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