Guest post: "We must end the IVF postcode lottery"

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Women and couples are losing out on the chance to become parents, often by virtue of where they live and what their Clinical Commissioning Group (CCG) is paying per cycle of IVF. This is because of dramatic regional variations in the availability of IVF on the NHS. This has to change.

Equal and fair access to treatment is one of the founding principles of our National Health Service - but it's not something we're currently delivering when it comes to IVF. I see the devastating impact infertility can have on many women, couples and families every day. I also believe it would be possible to level the playing field without any extra cost to the government.

At the moment, the number of IVF cycles offered to people varies depending on where they live. A small change to the current system would make a huge difference to people's lives by doubling the number of IVF cycles in some regions and thus increasing access to IVF.

Fertility problems affect one in six couples in the UK. With a growing trend for women to have children later in life, coupled with an increase in male subfertility due to various lifestyle factors, this figure will rise.

At present, couples trying to conceive can access IVF treatment on the NHS – but a range of caveats exist for them to qualify. These include a woman's age, whether either partner has a child from a previous relationship, or whether a woman's egg reserve is normal enough to merit treatment.

The National Institute for Health and Clinical Excellence (NICE) guidelines recommend that women with fertility issues should be offered three full cycles of IVF on the NHS. But, due to a postcode lottery, less than 80% of Clinical Commissioning Groups (CCGs) in England meet the recommended standard of three cycles.

The cost to the NHS of providing fertility treatment is significant, with figures of more than £200 million per year cited for IVF alone, and this cost is likely to keep rising. Within the current system and with the known pressures on NHS budgets, offering a fair level of treatment around the country is almost impossible. The result is that women and couples are losing out on the chance to become parents, often by virtue of where they live.

However, I believe the solution to end this discriminatory postcode lottery is to introduce a national tariff for IVF. At present there is a wide disparity in the price paid per IVF cycle by CCGs in different areas - with the price ranging from £2500 to over £6000 per cycle for the same treatment.

The cost of a cycle has a direct bearing on the number of couples who can access treatment within a CCG budget. This price differential is not only unjustified, but is needlessly preventing thousands of couples every year from becoming parents.

A national IVF cap or tariff that sets an upper limit for the price any CCG pays for IVF treatment would not only save the NHS money but would also give more couples around the country access to treatment within the existing budget.

The NHS already uses this kind of national price cap with medical treatments such as hip replacements and other operations, so that wherever you are in the country your local CCG will pay a standard set cost for your treatment. An upper limit per cost of IVF treatment cycle is already employed across other European countries such as Belgium, where it contributes to a broader level of access to fertility treatment for those who need IVF.

I believe that the national cap per IVF cycle should not exceed £3000-£3500 (all inclusive), which is significantly below the price many CCGs are currently paying. With a cap in place, CCGs will be able to use their collaborative purchasing power to make sure they receive the best value treatment.

This principle already enjoys broad support amongst many patient support organisations, charities and professional bodies in the sector. Following my letter sent to Health Secretary Jeremy Hunt earlier this year I have now been granted a meeting to discuss the benefits a National IVF Tariff would bring – a great first step to levelling the playing field and helping our NHS to help more people. The time for action is not tomorrow, not someday in the future, but now.

lego
What the hell is a 'serious case of infertility'?
You think some of them are lighthearted cases of infertility?
You can't categorise it. Either there is infertility or there isn't.

And to your point of infertility being upsetting but not making you ill.
A) tell that to the people with diagnosed depression caused by infertility.
And b) will you confirm you also support the total withdrawal of NHS funding for the treatment of acne and eczema, which are also upsetting rather than something that would make you ill?

I dunno. The UK is really centralised compared to most countries, and I don't think it's necessarily a bad thing to allow local NHS trusts (or whatever they're called now) to make some of their own decisions to take in account local circumstances. Though of course it would be better if this was tied in with local democracy across the board.

The figures released recently show ‘9 out of 10 people struggling with fertility problems show signs of depression.’ (Source, Fertility Fairness)

I was very lucky that when we needed IVF I was in an area that offered 3 rounds of IVF (and it took two of them), whereas less than a mile away in the next area, I would have only got one. Unfortunately, for those living in my area now, they've slashed it to one round.

I really hate the 'it shouldn't be offered on the NHS' argument. Other people have responded with much more eloquence than I can on why it should be offered. But infertility made me want to die and I am grateful that the NHS facilitated the arrival of my DD and the return of my life. Of course, not all people get lucky with IVF (success rates for my age are currently 43.7% at my clinic), but actually just doing something made me feel much better (I felt so much more positive after my first failed round, even when I was considering not continuing, than I had done in the previous 3-4 years).

At my worst points I was depressed to the point of borderline suicidal. Its not actually that uncommon to feel this way. So I think we can pretty well discard the idea that infertility doesn't make you ill.

Quite a lot of counselling, a period signed off from work and ultimately a succesful second round of IVF made me better.

We're in Essex and IVF has been completely withdrawn from the NHS
The irony of this is that I live in Suffolk and had three fully funded rounds, for which I had to go to Essex!

Also, my tube are blocked, they did what they could to unblock them but it doesn't work like that.

If funding should be offered on the NHS or not is a matter for other debate but the same funding should be offered across England.

It certainly SHOULDN'T be tied to local democracy! PCTs have had consultations before where they've asked people if IVF should be funded and they always say no! The vast majority of those voting would be fertile people who've had babies when they wanted - they would have NO understanding of the agony of IF.

No one has ever asked me about my health priorities - I would rather see acne meds prescribed on the NHS than have free treatment for drunk drivers who injure themselves in car accidents tbh. But who cares about my priorities?

I think it's disgusting that ivf criteria and funding is not a completely level playing field, it should be at least two rounds for every childless couple.

Especially as, on the NHS, they won't perform an operation which will unblock my tubes (and therefore allow me the chance to conceive more than one baby naturally) because they have a better chance of achieving one successful pregnancy with IVF, but if I only get one funded round, that's my entire chance to become a mother and a family over at the age of 26!!

I would remove all IVF from the NHS.

That's very understanding of you itsmeohlord. I would stop NHS treatment for all self inflicted injuries. However it's neither your decision or mine how NHS money is spent - thank fuck for that eh?

This has been very interesting to read. I am in Australia and fertility treatment isn't funded 100%. You pay for your treatment privately and then get 40% of the cost rebated from medicare so you are out of pocket about $2500 depending on the clinic and what other services you need (ICSI, freezing etc costs more). The government here is wanting to reduce the rebate so it will cost many more $1000's to try.

I think that it should be funded by the NHS (and that rule about not getting it if your partner has a child is ridiculous). Infertility is classified as a disease by the WHO so should be treated as such. If an alcoholic drug user who destroys their liver can get treatment and a transplant on the NHS then why can't a person who did nothing wrong and is infertile not get anything?

Itsmeohlord is an example of how mumsnet can sometimes be used as a platform to provoke reaction. Lol, whoever you are you certainly have not had fertility issues, or any empathy with those that have, and therefore your commentary is completely invalid.

I agree with several of the above comments: those who have said that IVF should not be available on the NHS either do not (desperately) want children or have had no problems getting them. They would not have such callous attitudes if they had been through what many of us have had to go through.

Infertility absolutely affects your health. The stress and despair and loneliness of it all has taken me to some very dark places and I now suffer from depression as a result of the struggles me and my other half have been through. To add to our stress, we will probably need to find £6,000/£12,000/£18,000+ to pay to put ourselves through IVF hell to TRY and have a child. This is something most people get for free. While we are struggling to make ends meet to try and afford IVF, a huge amount of "our" money will go towards taxes to pay for other people's medical care while pregnant and to pay for the medical costs of their children when they're born and to pay for other people's children's education until they're 16/18. I do not begrudge this, but it is pretty galling that some of those people (people who will never appreciate how lucky they actually are) will complain about the NHS giving me one round of IVF.

As for the need to have IVF (and I mean NEED), I have not given myself infertility. Many people give themselves diabetes, heart disease, liver disease or similar illnesses by making poor life choices despite knowing the consequences of their actions. Many people cause accidents by getting behind a wheel when they have been drinking. Many people have been violent and caused fights with terrible consequences to themselves and other people. Many people have taken drugs and had bad reactions or have run out in front of a car. Why should I not be entitled to one thing on the NHS which could change my life for the better, when I have to pay so much to help other people out for things that many of them could have prevented?

Additionally, we should not withhold treatment because people think something is more of a "want" than a "need". The NHS funds many things which are "wants" not "needs" and many of those things cost more than a round of IVF and have lower chances of success. For example, back surgery for back pain costs over £10,000 for the surgery itself (excluding the costs of the hospital stay and any follow up care). In cases of back pain specifically, this surgery hardly ever has any long-term (or often even short term!) benefit to the patient, but it will be done on a regular basis anyway because the patients want the surgeons to try SOMETHING to give them a better quality of life.

IVF absolutely should be on the NHS and the postcode lottery needs to end.

I don't think it should differ around England. Also I don't agree with no prescription charges in places like Wales and no tuition fees for students in Scotland. We all pay taxes. We should have one united kingdom. Same for grammar schools what is so special about the children of Bucks that they get grammars that the children of the NE where I am from lost them in the 1970s? Why not the same state provision everywhere?

Well said flatwhite.

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