THE BLOG

Fertility Funding - The Good, the Bad and the Essex

05/11/2015 11:07 GMT | Updated 03/11/2016 09:12 GMT

We're justifiably proud of our National Health Service in the UK, but when it comes to fertility treatment, there's nothing very national about it. Whether or not you qualify for medical help from the NHS for a fertility problem depends entirely on where you live, and the postcode lottery for IVF treatment causes great distress to many patients.

To mark National Fertility Awareness Week, which is organised by the charity Infertility Network UK, the campaign group Fertility Fairness conducted an audit to find out more about the provision of fertility treatment. The audit revealed that fertility services have been reduced overall during the last year, and that two areas, North East Essex and Mid Essex, no longer offer any treatment to fertility patients at all. So if you need IVF and live in North East Essex or Mid Essex, you'll have to be able to pay for it yourself.

The National Institute of Health and Care Excellence (NICE) recommends that women under the age of 40 who have been trying to conceive unsuccessfully for two years, or who have known fertility problems, should be offered three full cycles of IVF. This recommendation is based on what is both clinically effective and cost effective. The Fertility Fairness audit found that only 18% of Clinical Commissioning Groups (CCGs) actually offer this, with many only offering one cycle and some offering two. This situation is very unfair for patients who may find that they are denied help for their problem simply because of where they live, while a friend who lives nearby but comes under a different Clinical Commissioning Group may be able to get medical treatment.

The audit also found that almost half of CCGs weren't using the definition of a "full" cycle of IVF set by NICE, which would include the freezing and transfer of any spare embryos from the treatment. This is important because transferring one embryo at a time and freezing the spare ones for future use in younger women who are more likely to be successful has led to a reduction in the number of multiple births after IVF. Multiple pregnancy is the biggest risk from IVF treatment, and encouraging clinics to put back one embryo at a time where appropriate has meant that the multiple birth rate after IVF has gone down by a third since 2008.

Anyone needing IVF will also face locally-set criteria for eligibility and there may be lower or upper age limits which narrow access beyond what NICE recommends. There may also be criteria about weight, smoking or length of relationship and is some places one partner having a child from a previous relationship will mean that NHS treatment is denied.

One in six of the population will experience difficulty trying to conceive and infertility is the second most common reason for women to visit their GP (the most common reason being pregnancy). Although some critics suggest that treating infertility is a lifestyle choice, the World Health Organisation classifies infertility as a disease which, like any other medical condition, is deserving of treatment. Infertility is lonely and isolating, and when left untreated can lead to stress, depression and anxiety.

When services are cut, the reasons given are usually financial but the Fertility Fairness audit found large variations in the amount that CCGs are paying for IVF, with a difference of as much as £4,600 in the cost of each individual NHS-funded cycle of treatment. Ending the wide price disparity could make all the difference here, and allow for more NHS funded IVF.

This week's National Fertility Awareness Week aims to raise some of these issues and to get people talking about fertility problems and treatment. All too often, the shame and stigma which infertility can cause means that it is a secret illness which people don't feel able to discuss. With more understanding of the difficulties those with fertility problems currently face when they try to access treatment, perhaps we will see a drive towards a more equitable system.