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

[JaneGMumsnet]

Good morning,

New IVF guidelines issued by the National Institute of Health & Clinical Excellence (NICE) say that women aged up to 42 should be allowed one cycle of IVF treatment so long as it is their first attempt. Previously Nice recommended treatment up to the age of 39.

The guidelines also suggest that all couples who are struggling to conceive should get fertility treatment more quickly ? after two years of trying to conceive naturally, rather than three.

We'd love to hear what you think.

Thanks,
MNHQ

Read that back. Do I win an award for most pointless post??

Agree Ariel,hardly went near the doctors/A&E until I had dc,this winter I realised I'd read all the Hello mags cover to cover 4 times over!

FairyJen

If fertility treatment is available on the NHS at all I agree that there should not be a 3 year wait for it, especially as there is an age cut off (whatever the age actually is)

However I think there are other more universally important things:

• Mental health services
• Nutritional or lifestyle stuff that can realistically assist with weight problems (I mean good, effective stuff, like a regular appointment with a clued up therapist who can take an overweight person through a months- or years-long process of learning to eat better and enjoy exercise - not a GP throwing crappy low-fat advice at you and then forgetting about you. Someone who is trained to look at the whole person and take their personal circumstances into account, and who is knowledgeable about a range of approaches, because the same things don't work for everyone)
• Dental treatment (costs an absolute fucking fortune!)

I think these three things are about enabling people to be healthy, whereas starting a family is not actually a part of one's own personal health. I know infertility is very painful and if there are non-invasive, inexpensive things that can be done to help, then they should be, and without shilly-shallying. But IVF is famously expensive and low-success.

I also wonder whether - tho this could sound very brutal - the emphasis that we currently have that almost all birth parents should be supported to look after their children, is misplaced. When things are seen to be irretrievably broken and a child is taken into care, it is often the case that the child is harder to place than a baby might have been. I know why we have the policies we do but it is desperately sad that while some children are damaged by long term poor parenting, at the same time, potential parents are suffering infertility and might love to adopt a baby. It is a tricky one though because how do you make the judgement that a person is not "good enough" to keep their baby and give it to someone else - realistically, someone posher and richer? Very sad

I had 6 rounds of privately funded IVF.

My attempt at obtaining NHS treatment was lengthy, fraught with difficulty and with a latent feeling that after a lot of effort I would be turned down (Kent).

With privately funded treatment you could essentially fit 2 attempts into a year.

After 6 months of various NHS appointments I hadn't even got to the egg stimulation stage. Frankly women just don't have that sort of time when they are facing fertility issues in their late 30's.

With privately funded treatment it was possible for me to get to know my consultant and together with his expertise and my observations of my body's reaction to treatment we were able to isolate the best combinations of drugs/treatment etc.

We finally achieved a pregnancy and DS. Elated doesn't even begin to describe how we felt.

I do not believe the age limit should be extended to 42. Given all the factors I would say 40 is the appropriate limit.

I believe the NHS should provide more effective, prompt, targeted treatment to get better results for women under 40.

But IVF is famously expensive and low-success

I have been told that the chances of success for people like me (no discernible problem in either partner) are relatively good, and the overall success rates are skewed downwards because of quite profound problems that other couples face. I don't know how true that is.

Someone has already said that one cycle costs about £3000, which compared to, say, a liver problem brought about through alcohol abuse, is peanuts. And long term, elderly people with no adult children I imagine "cost" more than those with children around. I am certainly not advocating procreation for the sake of having a nurse in your old age, but if we are talking about money, perhaps you should consider that.

Myself and Dh been trying for 4 years and have had two mcs! We were toldwe need Ivf but both conceptions although failed were natural! I can ony have one cycle of Ivf but can't as I've got raised bmi and insulin dependant diabetic! Sometimes nature is just against the odds

Freezing eggs isn't as good as freezing embryos.The thing with IVF is the fet rates are getting much better so one fresh cycle might bring some frozen too.My dc were frozen 9 years ago!

I think this is great news, it's great woman at this age get a go at ivf , all woman should have the right at one go of ivf

EnjoyResponsibly, I think that's an excellent post.

I am 38 in April, with a low AMH, and I have been dicked around by the NHS for nearly a year now. I first saw the specialist last summer. Only now am I about to start IUI, which I read this morning has actually no better chance of conception than actual sex, and I am entitled to four rounds of that before the actual IVF. And apparently I have been "fast tracked".

All the while, I am aware that time is trickling away.

Some posters have talked about the problems of being an older parent, even how this will increase the liklihood of dying whilst your children are relatively young.

But I just think you're only talking about a difference of 5 or maybe 10 years here. Life is unpredictable and 5 or even 10 years really makes little difference.
But someone in mid 30's is seen as at a perfectly normal age to become a mother and then by early 40's is seen as a much older mother.
Very silly really in terms of the relationship with the baby and child (though I know there is sadly a decline in fertility)

In the 60's my Mum was referred to as an elderly prima gravida (or whatever it is ?!) when she had me at 29 !!

Also Ariel sometimes IVF can be used in a diagnostic way,you could be trying for years and having the egg and sperm in the dish can rule out other things.

Couples also need to move on,they may want to adopt or just get used to living a childless life,having IVF helps with both,it can give closure and many adoption agencies( for those couples suitable for adoption,not all are,most I suspect)require it before the adoption process.

miemohrs I'm not sure why you think egg and sperm freezing is a lot less invasive than IVF - it is pretty much the same process, just spread over a longer period. You still need to have the eggs retrieved and any embryos put back later, but that than those processes being days apart they could be years apart. Also, the success rates for embryo freezing are a lot higher than for egg freezing. I will agree with you that IVF is a horribly invasive process though. I really struggled mentally with the whole thing.

In most cases, IVF is being used as a treatment for a medical problem - blocked tubes, low sperm count, ovulatory problems. If someone has paid into the NHS for years, why should those problems not be treated as they would be if they affected some body part other than the reproductive organs?

42 seems like a more reasonable cut off than 39. There are many natural pregnacies to women in their early 40s.

Great news.

I think there are both advantages and disadvantages to having older parents, personally I feel that the most important thing is to be part of a loving family regardless of age.

Very best of luck too to those on here that are ttc.

Good point polkadot, the knowledge that you have tried everything you can, could give you a point at which to say "Let's move on now."

Without doing that, you could well end up costing the NHS just as much through accessing its crappy mental health services!

Ariel my consultant at the top clinic at the time said to bypass IUI as it would waste time.As we would be paying for either he said it was more sensible to put the money towards IVF.He was right.Having said that I know people who have conceived with IUI including twins!

I think if IUI works then the chances of multiples are higher than with IVF because you can't control the number of eggs fertilised (if they are). It's one in three for twins and one in a hundred for triplets

Ariel could you scrape the £3k together for one round whilst waiting for the IUI or do you get removed from the NHS once you've gone down the private IVF routes.

Don't give up.

I decided to give it everything I had and gave myself a date to move on from and start living my life-then the dtwins (the very last extremely ropey embryos out of 36 eggs of which only 7 fertilsed,one of which they thought wasn't worth transferring )happened after being frozen for a year.it was literally last chance saloon,we had run out of cash,physical and mental drive.

I do wonder if the mentally moving on and knowing we'd thrown everything at it and were moving excitedly towards adoption helped.

It's the time factors that are one of the major pressures.

The longer an NHS round takes, the older the prospective mother becomes.

Fertility issues increase, plus the woman knows she's racing the clock.

I honestly don't believe your chances of an NHS shot of IVF being successful are improved under these circumstances. Add in the fact that many only get a single NHS shot and the odds are being shortened totally unnecessarily.

That's NHS funding and a patients emotional well being in jeopardy, caused by easily fixable factors.

Plus this cost figure is also a part I'm very cynical about. The costs are usually based on private treatment. Presumably the NHS has much better buying power and doesn't mark up the price of drugs. I'm not an expert but I'm betting IVF on the NHS doesn't come close to 3k.

My suggestion is provide 3 rounds of IVF. One every 6 months. Cut off age 40.

As a NHS manager these headlines make my heart sink a little - there will be no more money so more creative thinking needed about how this will be funded along with all the other priorities. As an infertile woman my heart lifts. We chose to go down the adoption route - the right choice for us and the deciding factor was that I wanted to be a mummy but did not necessarily need to go through pregnancy to do that. There is a huge difference and its down to personal cost.

Just off thread a little but weigh up the costs of rounds of IVF and the cost to the country of maintaining a child in the looked after system - another debate for another time

This is a very emotive issue for obvious reasons. My son and dil had an IVF baby some years ago, who has brought such happiness for us all.

Regardless of the age issue - I remember Prof Robert Winston stressing that IVF is not a cure for infertility, and quoted the succcess rate I think as 1 in 6. I think the success rate is higher now. It was 1 in 6 when my son and dil were having IVF.

I have no evidence to back this up, but I do think that couples have an expectation that it will be successful and the awfulness of that not happening must be horrendous, especially for people who have had a great many cycles.

I think an important issue as others have said is the likely success rate of a woman over 40 having a live birth and I think it is 5% which is very low.

I suppose this outcome has to be measured against expensive drugs for cancer etc and these are often with held on the basis of whether the drug is in fact going to extend life to a significant degree. All kinds of decisions are being made by NICE and I think I err on the side of looking at outcomes and the 5% chance of a live birth for a woman over 40, and would therefore not be able to support the decision.

I am trying to be objective about a very emotive subject, which is very very difficult.

Curryeater I must take issue with you about your last para. I was a social worker and tm mgr for a LA Fostering & Adoption team and have seen the anguish of couples who are infertile and long for a child. You are quite right that older children are far more difficult to place than a baby, but there are very very few babies (without medical problems/disability etc) available for adoption, as these days single parents are able to keep their babies.

I think you are maybe unclear about the reasons why children are removed from parents, which is understandable, but you say it is "tricky, because how do you make the judgement that someone is not good enough to keep their baby and give it to someone else - posher and richer." I don't want to go into much detail because it is hi-jacking this thread, but believe me a huge amount of work by many professionals are involved in care proceedings for a child and the judge makes the decision at the end of the day. Also careful matching takes place between prospective adoptors and children, rather than "giving it to someone else"

Yes Ariel re triplets they put 3 of my embryos in because they were so poor, I was so old and they couldn't store the last one because the adoption agencies wouldn't allow it(I couldn't just let it perish).

My hormone levels were sky high whilst waiting for the first scan-bricking it doesn't even begin to describe what we were feeling.

Sadly the third didn't make it but we gave it the best chance.

Hang in there and let us know how you get on.

Polka and Ariel I so agree with you. What can be harder than having to make that throw the towel in decision. Time and money; the fatal wounds to hope. Easing the burden of either must surely improve the process if only from a psychological perspective.