New NHS guidelines on IVF treatment to extend age limit up to 42 - what do you think?

Who said there wasn't, stella? It still means you are not childless, which is the point. Unless you are saying that biological childlessness is different from childlessness in general ie those who adopted somehow don't count as proper parents, which you can possibly mean.

marylou I disagree with your financial comment. I'm paying for two children but couldn't produce 3k just like that!

Our daughter was born 6 years ago when I was 37 via an NHS funded cycle. It was a postcode lottery then and is even worse now. My local PCT has pulled all funding for IVF and I believe that any increased pressure on an overstretched service will lead other authorities to do the same. As these NICE guidelines are not binding I wonder how the newly formed Clinical Commissioning groups might interpret them.
I would say to anyone waiting for IVF,just find the money and get it done as soon as you can. Unfortunately if you can't afford a cycle of IVF you can't afford to raise a child. Very harsh but so true.

No one wants my rent a womb

Right there is a section about psychological impact of infertility in the guidance. This is the section in full because I think its relevant and since its not changed much since the 2004 version and its not a headline grabber:

The relationship between psychological stress and fertility problems is complex. Individual response to stress situations will vary. Three cohort studies have reported an association between work-related stress and a lower probability of conception in women. However, the association in men is less clear. Psychological stress can affect a couple?s relationship and libido, which may impact upon their chance of conception. A higher frequency of male sexual disturbances including loss of libido and a decrease in the frequency of sexual intercourse has been observed in couples undergoing fertility diagnostic and treatment procedures.

Infertility is regarded as an upsetting and difficult life experience for some women, with a subpopulation of women reporting elevated levels of anxiety and depression in some studies; however, another study did not find such an association. In one study, the psychological symptoms of anxiety and depression associated with infertility were found to be similar to those associated with other serious medical conditions such as heart disease, cancer, hypertension and infection with HIV. A study in Sweden reported that almost 50% of women said they needed professional help and support to deal with their anxiety and problems in their marital relationship two years after tubal reconstructive surgery.

Two RCTs have shown that group psychological interventions such as cognitive behavioural therapy and support prevent distress and improve pregnancy rates (55% in a cognitive behavioural therapy group versus 54% in a support group versus 20% in a routine care group) in women with less than two years? duration of infertility.

Psychiatric morbidity was reported to be positively associated with the experience of infertility and the number of treatment cycles, affecting more women than men. The psychological state of couples undergoing IVF may vary at different stages of treatment, the most stressful stages being waiting for the outcome of treatment and finding out that IVF has been unsuccessful.

An RCT that evaluated the use of information and information combined with counselling for couples undergoing IVF treatment showed no significant differences between the two groups in terms of psychological symptoms and satisfaction.

Four surveys have reported that most patients feel that access to a support group and counselling would be beneficial. Some felt that psychological support should be available at all stages of infertility treatment and investigation. An unpublished survey found that few GPs offered counselling or identified methods of support, but two-thirds of couples attending an infertility clinic said they would accept psychological assistance if offered.

In another study, 70% of patients said they would request counselling if it were available free of charge. Despite this, overall uptake of counselling is low at between 18% and 25%. It has been suggested that less distressed patients may not wish to receive counselling, and some may cope well with support from their spouses and family. Two-thirds of patients undergoing IVF treatment reported reading newspaper or magazine articles and watching television programmes about the psychological aspects of infertility, even though few participated in a support group or sought counselling before treatment. This suggests that, for some patients, information about local and national support groups and booklets on the psychological aspects of treatment, in addition to medical information, may be beneficial.

The emotional consequences of anxiety and stress can be reduced by adequate provision of clear information about all aspects of investigations and treatment, involving both partners as an integral part of the management plan. The impact of psychological stress should be acknowledged throughout the care of the couple with fertility problems with offers of counselling. Counselling involves a professional relationship between a qualified counsellor and a patient, who may be an individual, a couple or a group of people. This relationship is contained within a formal counselling contract agreed and understood by both parties. The counsellor has no other relationship with the client. Nurses, doctors and scientists in fertility clinics offer support and emotional help to couples as part of their professional role, but it is necessary to recognise this as using counselling skills within an existing role.

In considering the counselling needs of their patients, health professionals need to take account of evidence that suggests that couples may deny experiencing difficulties in their relationship, which may prevent them seeking help. People who experience problems with fertility are often very vulnerable. This may lead them to be overly compliant with suggestions made by their clinical team, for example, going ahead with treatments despite having reservations or simply requiring more time to reflect on all the implications.

The HFEA Code of Practice218 (HFEA 2008) identifies three distinct types of counselling, all of which should be clearly distinguished from information exchange.

Implication counselling aims to enable the client to understand the implications of proposed treatments and consequent actions for themselves, their families and for any children born as a result and anyone else affected by the donation or treatment.

Support counselling aims to give emotional support at times of particular stress, for example, when there is a failure to achieve a pregnancy. This may occur at any stage before, during and after donation or treatment.

Therapeutic counselling aims to help people cope with the consequences of infertility and treatment, to resolve problems which these may cause, and to adjust their expectations so that they can cope with the outcome of treatment, whatever that may be.

The HFEA Code of Practice states that people seeking licensed treatment or consenting to the use or storage of embryos, or the donation or storage of gametes, or the use of gametes or embryos posthumously, must be given ?a suitable opportunity to receive proper counselling about the implications of taking the proposed steps? before they consent.

Counsellors should have professional counselling qualifications and the ability to work in accordance with the Human Fertily and Embryology Act 15. They should abide by a professional code of practice, such as the Ethical Framework for Good Practice in Counselling and Psychotherapy used by the British Association for Counselling and Psychotherapy, with a commitment to regular supervision.

If there is need for genetic counselling an appropriate referral should be made to a qualified genetic counsellor. Genetic counsellors should have recognised training, either through a Masters Programme in Genetic Counselling or a nursing qualification with additional relevant academic qualifications.

Recommendations

• When couples have fertility problems, both partners should be informed that stress in the male and/or female partner can affect the couple?s relationship and is likely to reduce libido and frequency of intercourse which can contribute to the fertility problems. [2004, amended 2013]

• People who experience fertility problems should be informed that they may find it helpful to contact a fertility support group. [2004]

• People who experience fertility problems should be offered counselling because fertility problems themselves, and the investigation and treatment of fertility problems, can cause psychological stress. [2004]

• Counselling should be offered before, during and after investigation and treatment, irrespective of the outcome of these procedures. [2004]

• Counselling should be provided by someone who is not directly involved in the management of the individual?s and/or couple?s fertility problems. [2004, amended 2013]

Stella please. This is not a thread to start a fight on.

Frankley Unless you have been through the pain of infertility you cannot understand what it is like, so kindly keep your opinions to yourself.

Several short sighted women on this thread then. Yes, I have a child but there are other ways to have a child than by giving birth.

It's nice to hear success stories, HappyJoyful! And thank you :) There are a lot of infertile people on this thread and MN in general, and any support is welcomed.

FairyJen - I don't think I could do surrogacy or donation, though I've not really thought about it. Adoption is almost certainly the route we will go down if IVF fails us, but of course that takes years too - and we can't start any of it now as we're still TTC so not eligible even for adoption paperwork.

I imagine someone from MNHQ has been asked to be on a discussion programme about it later, and so they need to canvas thoughts to properly represent the opinions raised on the site. So it's sort of site stuff

evilgiraffe would you consider adoption or a surrogate/ donor? Sorry if I've misread your personal circs

Speaking of AIBU, why is this post in Site Stuff? It's an odd place for it, surely? In The News might be better?

evilgiraffe, couldn't run without posting a word of support. Wish I could wave a magic wand and take away the pain. I had 5 cycles of IVF and now am very blessed to have a 2 yr old DD but the knowledge of those feelings of longing and yearning are never far from my mind and the pain that women going through this are never far from my thoughts.

I have huge issues (and anger/rage) with people using the word 'entitlement' when it comes to IVF. Sorry, but as others say, anyone implying that's how someone having IVF feels or that that is what it's about - their entitlement to treatment as absolutely no idea whatsoever.

Friends who've had IVF tell me that, even though it didn't (for all bar 2 of 5) work, their MH was improved because they'd been able to try, every option possible.

Fortunately, given the arbitrary rule applied to deny us IVF (as said up thread, my DH had 2 older children from a precious relationship), I have one of the leading gynae's in the country caring for me. He has done my last 6 major surgeries (I've had 8 in total). At number 6 i lost an ovary. After number 7, he was able to clear my endometriosis-blocked tube and most of the endo. Despite this never impacting on fertility for us before, this time it did - and we were blessed with my beautiful DS.

It costs a damned site more to treat my endo (surgery every 18 months, at least 2 nights in hospital, follow up drugs that are insanely expensive) than 1 round of IVF.

1 round of IVF and a pregnancy would have helped my endo enormously.

And my mental health.

But you're quite right - those of us who face the heartbreak of infertility should just man up and stop feeling so entitled...

Curry, I believe RedToothBrush spoke to me, because I commented about mental health.

I am currently trying to write a book, as it happens. It is really fucking hard, but it doesn't even come close to the pain of being infertile. Comparing a career choice with a fundamental biological drive is laughable.

I have one DS conceived through IVF on cycle 4. Previous cycles resulted in 1 miscarriage, 1 failed cycle and 1 ectopic pregnancy, which had to be terminated with methotrexate. I'm also thrilled to be 38 weeks pregnant with DC2, a frozen embryo transfer, conceived and frozen after our first IVF cycle. In all, I've done 5 rounds of drug treatments.

I'm pleased that they are raising the IVF age limit, but feel it's a very hollow headline. NHS Trusts do not have to follow the guidelines, there is likely no money in the pot for this initiative and the postcode lottery will continue. Raising the age limit will not be as effective as speeding up the referral and testing process which is required prior to any IVF cycle and the waiting lists. Maternal age is the single biggest factor in IVF success. It takes months and months on the NHS waiting lists which many women in their late 30's do not have time for.

We were in Westminster PCT and were lucky to have 2 x NHS funded cycles, the others we funded ourself. We started TTC naturally when I was 31. In our case it was very clear cut - DH had very low sperm count and out chances of natural conception were virtually nil. I had clockwork cycles and no issues, but still had to go through over a year of NHS tests, which could have been completed (medically speaking) in 1 or 2 months to confirm that my reproductive faculties were perfectly ok. It then took 4 cycles to get DS - you can only do 2, maaaaaayyyybe, 3 at a pinch in a year. I'm now 37. It's a loooooong process.

Curry, it is not a biological imperative to write a book. I don't imagine you feel like a failure as a woman, because you haven't had one published.

I think the reason why stella's opinion was dismissed was because she was so dismissive of other people's opinion. Others have voiced similar opinions to hers and they didn't do it so brusquely in such brutal language. All opinions are welcomed in my opinion, as long as they are well thought out and give some thought to the audience, which is likely to contain a fair few women facing infertility.

It would be very nice if this very sensitive topic was discussed, well, sensitively, and not in your usual AIBU free for all manner.

curry, I think the "not qualified to comment" thing was more in relation to someone with children saying that people without children felt entitled. It's not that people with children don't have a valid opinion to offer, it's that that opinion isn't on the feelings and drivers of someone who is infertile - they simply won't know.

Thank you, gaelicsheep :)

RedToothBrush - I think the mental health side of it is largely ignored. Granted, we've not started in on IVF yet, but I have had lots of tests done and been to the infertility clinic many times. The closest we ever got to acknowledgement of the toll on mental health was being allowed to hide in a nurses' room after being told we were infertile - I could barely stand unaided and sobbed on DH for a long time before getting it together enough to walk away. Of course, the infertility clinic is part of the maternity hospital, which meant walking past innumerable pregnant ladies and small children. I am in tears now just thinking about how painful that was, and that happened last May. Any help would have been gratefully received, rather than "go home, keep trying, come back when you've been unsuccessful for three years".

It is quite a relief just to have been referred now, even though I have no idea what happens next and it's still a month until the initial appointment.

Curry, are you honestly comparing the pain and heartache of infertility to not being able to write a book??!!!

Agree that anyone who managed to conceive without intervention is not qualified to comment on women "feeling entitled to have children".

Do you have any idea how utterly all consuming infertility is? How it haunts your every waking thought? How it is such a primal, guttural desire to have a child and know that the odds are stacked against you?

Do you know what it's like to feel like a piece of you dies every time you see a negative test/your period shows up?

Unless you have been through the pain of infertility you cannot understand what it is like, so kindly keep your opinions to yourself.

redtoothbrush, it was me, and I totally acknowledge the link between infertility and mental health problems. which is why I said it. I think there is a very complex interface here between the mental, physical and the actually non-medical and I don't think this is being acknowledged.

btw it is stupid to say that someone with children can't have an opinion. Really? Do you think only the unwillingly childless people at NICE should be a part of making these decisions? Do you think that people who may or may not have children but don't really care can't be a part of it either?

You can't write policy based on feelings, certainly not the feelings of only some people. Which is what you are suggesting.

Lots of people aren't happy for lots of reasons. I want to write a book and it kills me that I will never ever have the time. I just can't earn a living and write. My heart bleeds. I have to look away from the facebook updates of my friends who are published. Every time I see another shit book marketed all over the place, knowing that mine would be better, I have to lock myself away and cry. Am I the only person who is allowed to make decisions about arts grants? If some author on a govt panel said, "frankly, curry, I do not think you are entitled to £12k for 6 months off to write your book" should I snap back, "Have YOU written a book? Yes? WELL YOU DON'T GET TO HAVE AN OPINION!"

stella, I'm not sure anyone is really "entitled" to anything, healthcare-wise. For example, if your child became sick, is she "entitled" to regain health, either naturally or through medical intervention? If she were deaf, would she be "entitled" to test and hearing aids? No-one has a God-given right to hear, yet as a society we chose to use some of our taxes helping people to do so. We as a society decide who is "entitled" to what, and that goes for your child's antibiotics as much as it does for my ivf.

I never felt entitled to IVF. I do however think that when one objectively considers all of the things the NHS funds (which goes far beyond the life saving cancer treatment that is always mentioned on these threads) fertiilty treatment should be funded. The reality is that because of the waiting that has been mentioned and the strict criteria, many people who need IVF will end up paying for it anyway. I'd love to know the % of IVF cycles in this country that are privately funded. I bet it is huge.

evilgiraffe, I'm glad you mentioned mental health.

I am mildly amused by the person upthread who said that mental health was a more important issue than fertility. Conveniently missing the link between mental health problems and infertility.

Why, did NICE recommend this? I haven't read it, but I'll put money on there being something about depression in the document and being a consideration that NICE made.

If someone does know if this is the case, I would be interested.