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

[maamalady]

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.

[SteIIaBeIIa]

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.

[ArielThePiraticalMermaid]

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

[RedToothBrush]

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]

[FairyJen]

No one wants my rent a womb

[Marylou2]

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.

[FairyJen]

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

[Northey]

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.

[ArielThePiraticalMermaid]

MaryLou2, people are paying upwards of £6000 for a cycle of private IVF. There are lots of people who are parents who do not have that kind of money kicking around that can just be "found". When do you have to shell out that kind of money in one go for a child? Yes they cost an awful lot more than that in the long run, but not in one go.

[BalmainMummy]

I think that every woman should have the right to a treatment of IVF for their first baby. Im 24 and it took me 6 months to fall pregnant and those months were some of the most stressful of my life. Its gutting not falling pregnant when your heart is set on it and you cant think about anything else but falling pregnant. Its all consuming. I know that time was on my side, but some women dont feel that consuming need until later on, or dont meet the right man to have babies with. And i think its better to wait until you meet the right person and can have a proper family environment.

People bash older mothers all the time but my mum had me at 39 after trying for almost two years, she waited until she met the right man and they have been together for 27 years and I had a stable family life. Id much prefer an older mother to have a baby in a stable family environment than a younger mother who was jumping between boyfriends. My mum was the best mother and still is the best and at 63 she is still very active and we have a fantastic relationship. If I hadent met my husband at 21, then I probably would be have been an older mother too. And would hope that Id have the right to IVF

[HappyJoyful]

evilgiraffe, might have missed something, but just grasped you are just at the point of referal to have IVF.. there is tonnes and tonnes of hope and possibility for you that it will work. Feel free to send me a pm if you need any advice or support. You have lots of chances of success too just like the women on this thread that are saying they have had IVF babies.

marylou, sorry, think it's a bit flippant to say that if you can't afford a cycle of IVF that you can't afford to raise a child.. IVF requires lump sums of hard cash- I've got a 2 year old and we certainly don't have £5k sitting around to 'raise' her loads of people live hand to mouth and successfully raise children. I don't however, disagree with the sentiment that I'd try to 'find' the money if I could - credit card, re-mortgage, beg/borrow friends or family.. loans, take in lodgers, I know people that have done all of that.

[RedToothBrush]

Yes they cost an awful lot more than that in the long run, but not in one go.

Quite. And if you find out at a certain age that you need IVF then you may not have the time to raise that money.

My personal circumstances are, that we could definitely afford a child, given we have a higher household income than most of our friends with children and most of them aren't badly paid. We could not raise £6000 like that, if we did ever need IVF. Realistically I think it would take a year or two to really save hard to get that kind of money - all the time reducing your chances of success.

We might be able to take out a loan, but thats not the way to start a family either, is it? And doesn't that in itself add to the stress and therefore may make it harder to conceive anyway?

[FairyJen]

Look at it from the other side, abortion is available for women of any age... I know the cost is higher for ivf but I think if your desire for a child is so great that you would go through the process help should be there for you.

[maamalady]

FairyJen you made me giggle at "rent-a-womb" I have never even considered surrogacy - not having any sisters or SILs it's never occurred to me as a possibility.

RedToothBrush - really interesting info there, thank you. Much of that is depressimgly familiar. I was particularly shocked by levels of anxiety/depression due to infertility being comparable to those due to heart disease, cancer and HIV in one study. That's terrifying.

[EuroShagmore]

I also disagree with marylou's comment. How many couples conceiving the old fashioned way do you think have a spare lump sum of £3-10k sitting around the month they conceive?

[FairyJen]

I was signed up to a clinic a couple of years ago. No one wanted me! I then pulled out as fell pregnant but it did feel a bit like joining a dating website and getting no dates

I try not to take it personally

[ArielThePiraticalMermaid]

[RedToothBrush]

evilgiraffe that was the figure that shocked me most too, but I wanted to post the whole section, as not to be accused of being selective and to also point out what NICEs recommendations about counselling were, as judging by a few comments on this thread, people's experience seems to differ on that as much as the age limit varies from place to place.

[maamalady]

It is interesting how varied the care is, RedToothBrush. The postcode lottery gets me three cycles, but we've not been offered any mental health services, or advised to seek them out (or where to look for them). We have been told that stress is a contributory factor to infertility, but that hardly helps much...

[higgle]

I support the changes, and don't think that overall they would cost the NHS large amounts in comparison to treatment of some lifestyle choices illnesses that there is never any argument about. I know I couldn't go through the anguish of fertility treatment myself though, I'm not emotionally strong enough. When it looked as if DS1 might be an only child I investigate adoption from abroad as an option instead - though I now know that can bring lots of anguish in the procedures too.

[SteIIaBeIIa]

Basically - if you read my post carefully you will see that I didn't say needing IVF was about a sense of entitlement I said that lots of women feel that having a child is a sense of entitlement.

Having a child is not an entitlement for anyone.

I am not entitled, you are not entitled. Anyone who hopes for a child and has a child is lucky.

I am lucky.

[JethroTull]

There's been lots of intelligent responses on this thread as well as the 'not so intelligent'.

From my perspective of both recent involvement with both NHS & the private sector, I'd would have just liked the NHS to have been more honest. We were 'under investigation' for almost 2.5 years with appointments months & months appart. Had the NHS said at appointment 2 - you will undoubtedly need IVF however at the moment this PCT has no funding & isn't likely to have funding for another 18 months' we would have made the decision to go private then (We were extremely lucky to have this option I know). But they didn't say this, they strung us along, giving us hope.

I'd also like the NHS to acknowledge that low AMH is a factor in infertility. It wasn't mentioned to me even though it is clear on my results. When these results were passed to our private consultant it was the first thing she picked up on.

No, it's not anyones right to have a child but in a country where we have a NHS it is surely a 'right' to have infertility investigated. Where do you draw the line - do obese people no longer deserve the right for medication for obesity caused diabetes? Smokers for lung cancer? Drinkers for alcohol related disease?