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See all MNHQ comments on this thread

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

583 replies

JaneGMumsnet · 20/02/2013 10:26

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

OP posts:
RedToothBrush · 20/02/2013 19:00

Clearly you think the NHS is a bottomless pit of money, Northey

Its not, but then equally, rationing can't be done on price tags and short term financing either.

Long term cost effectiveness is far preferable than short term yearly budgets. Which means that decisions being made on short term yearly budgets could easily be costing us all a lot, lot more over a 5year period or even a twenty year period.

This is one of the other massive issues of the NHS - short termism and passing the costs off to other departments and not tracing this...

Whats the saying about buying good shoes, built to last?

Northey · 20/02/2013 19:01

What about the example of partial deafness, sheila, or the desire breast reconstruction after mastectomy? Neither of those is life-threatening. Do you think they should be untreated too?

FrankellyMyDearIDontGiveADamn · 20/02/2013 19:02

But is infertility not a disease that needs treating? I have Polycystic Ovaries meaning, like it sounds, my ovaries are covered in cysts which inhibit normal hormone production. Why is one disease more deserving than another? Not all diseases are life-threatening: eczema is not, so shall we give up treating that?

Obviously there have to be lines drawn in the sand and im not advocating unlimited IVF for anyone who wants it, but fertility treatments do seem to take an awful lot of bashing whenever NHS funding is discussed.

Northey · 20/02/2013 19:08

Alzheimer's isn't life-threatening. IBS isn't life-threatening. Hell; a broken leg isn't life-threatening. All those things are addressed with measures that are paid for from the health budget.

Sheila · 20/02/2013 19:16

childlessness is not a disease - the causes of it might be, but you can treat these without providing IVF.

Matildaduck · 20/02/2013 19:24

Sadly it's all about success rates with IVf.

I think it would be good if you could pay towards your ivf if your chances are slim. To be told no is horrific. To be told well its not that likely but if you want to you can pay x% towards we'll let you have three goes.

Then it wouldn't be so expensive.

Northey · 20/02/2013 19:27

The cause of my childlessness is having only one Fallopian tube, which is scarred shut. It would be rather more expensive to treat that than it would be to give me ivf.

maamalady · 20/02/2013 19:28

How do you propose diagnosing and treating all these myriad problems, Sheila? IVF is the go-to answer because it's cheaper than finding out the real problem, and may well be the only answer anyway.

What do you propose the NHS do with me and DH - we are "unexplained", but at the age of thirty and three years TTC with nary a sniff of a pregnancy, we are quite clearly infertile. How many tests can be done? The doctors don't know what's wrong, but they have a half-decent chance of solving the unknown problem with IVF, so why can't we try it?

Allthingspretty · 20/02/2013 19:35

I dont know what it feels like to want a child so much that you would go through ivf.

I personally dont agree with the chamges to the guidelines.

PolkadotCircus · 20/02/2013 19:39

Well if you did you would agree.

beginnings · 20/02/2013 19:41

I have one DD who was the result of my fourth IVF cycle. The first was on the NHS. We were offered two by our PCT but the clinic wanted to follow the same protocol for the second go even though they told me it wouldn't work. We went privately. For those who say you can only do one or two cycles a year, that's not true, I did four in eight months.

Evilgiraffe I'm not sure that trying IVF instead of doing much testing is always the right way forward. In my opinion, the issue with these guidelines is that they're not putting the money where it would be most sensibly spent. The NHS, in my experience, is way behind the private sector in terms of testing and research but (rightly) will only follow clinically tested protocols. For instance, the NHS do not yet test for levels of anti mullerian hormone in women. The private clinics do it as a matter of course and it's a very strong indicator for levels of ovarian reserve which is an important factor in deciding what protocol to follow in many cases. In addition, the NHS doesn't do the level of immunology testing that the private sector does. If I had had the two sets of tests I detail here, at a cost privately of £550, it is perfectly possible that my first round of IVF would have worked. That would have saved the NHS potentially, and me definitely, a vast amount of money. The NHS protocols still seem to follow the premise that IVF is designed to help people with blocked tubes who otherwise are fertile. That isn't the case for a lot of people seeking fertility treatment.

I was just 32 when I started trying to conceive and 35 when DD was born so I started late, but not that late.

Phineyj · 20/02/2013 19:43

In my opinion this change to the guidelines is pretty much pointless (although reasonable clinically -- success rates at older ages have increased quite a bit). It's already nearly impossible to access NHS IVF in most areas and the wait to see a specialist is about a year in our area and then a year in between appointments. I doubt it's very different elsewhere.

We paid for two rounds of IVF privately, the second successful. We were treated abroad as our consultant was honest with us and explained the treatment we needed would mean waiting at least 2 more years in the UK but would be available immediately in other countries. Although I was several years under the age cut-off when we realised there was a problem, it seemed very likely that once we'd got through the NHS delaying tactics that I'd be too old, and that was without the issue of additional waiting time for our specific treatment. It seemed insane to travel thousands of miles for a couple of outpatient procedures, but it was basically our only option other than giving up (we applied for adoption by the way...were told we couldn't be considered as we hadn't given up hope of birth children..it is a Catch 42).

However, stopping IVF on the NHS altogether would essentially be saying that only well off people with the misfortune to be infertile can do anything about it -- which would be very unfair. It would also be a great shame on the country which invented IVF.

I also think people should bear in mind that IVF is the only NHS treatment which has the potential to create future taxpayers!

What I think would be more helpful, rather than increasing the age cut off when in reality the numbers accessing NHS treatment will remain vanishing small, would be a requirement for every PCT area to have a clinic in primary care that would give neutral, evidence-based advice on fertility to those who need it, going through all the options and their costs (including pointing couples towards counselling, and adoption where appropriate). I lost count of the GPs we saw, and hardly any were helpful or even seemed to know anything about infertility, which is astonishing when you think how many patients must present with it.

I agree with the poster above that GPs & specialists should be honest about how unlikely it is IVF treatment would be provided in any timely way. However, the NHS could bulk purchase IVF services and then pass the cost onto patients, or means test? At the moment there seem to be clinics making excessive profits out of vulnerable people, a lack of quality control and it is very difficult for the layperson to know how much to spend, what treatment is best or what the true chance of success is. And that's before you even get into the fact that you can travel abroad for these treatments, at which point HFEA basically wash their hands of you.

Of course no-one has a right to have a child but surely at the very least we have the right, in a country with an NHS, to be able access impartial, honest advice and not to be denied access to a proven treatment where we meet the clinical criteria, simply because of where we happen to live.

timidviper · 20/02/2013 19:54

I work in healthcare and know how difficult the juggling is with healthcare budgets. In a perfect world I would think this is a great idea but sadly this world is not perfect, we have a finite pot of money and, weighing in the likelihood of poor success rates and increased risks of complications which could incur even more costs, I would probably prefer that money go to other areas with a higher measurable success rate.

maamalady · 20/02/2013 19:56

beginnings - I was thinking from a purely financial point of view. IVF is the go-to because it has a reaonable chance of success, and is cheaper than testing for a whole host of different potential issues.

Phineyj - yes, it would be incredibly helpful to be able to see someone for advice. My GP is neither knowledgeable not interested in fertility problems, but thankfully is co-operative with referral requests. We are prepared for our IVF appointment next month to give us a long wait before treatment can start - in which case we'll go private despite meeting NHS criteria and living in a PCT that offers us three cycles. We may be young, but we're already three years in and don't want any more needless delays.

CaliBee · 20/02/2013 20:01

I think its a shame that the government have seemingly only extended the IVF service...correct me if I'm wrong. IVF may not be the best way forward for all 40 plus women. An extension to all fertility services would have been more useful I feel.

MrsDeVere · 20/02/2013 20:07

This reply has been deleted

Message withdrawn at poster's request.

beginnings · 20/02/2013 20:08

evilgiraffe I'm thinking from a financial point of view too. The tests I had (a number of which I had on the NHS by the way, the private clinic just told me what to ask for and I was lucky enough that my surgery were prepared to do them, although there was an approval process for one of them) all added up to a LOT less than an IVF cycle.

Conversely, when I pitched up at Guy's for my first NHS cycle (which was cancelled as I didn't respond well to the stimulating drugs), the only test they did was for FSH and then went straight for IVF. I think that's mad.

maamalady · 20/02/2013 20:14

Fair enough - although if the results had suggested you'd needed IVF anyway...? I don't know, I'm not an economist.

Hear, hear, MrsDeV.

beginnings · 20/02/2013 20:25

Well, that's a whole other story. I'm currently pregnant with number 2 with no fertility treatment but am taking the drugs that I was prescribed during early pregnancy the last time which may well be why this one is sticking and my first two pregnancies didn't. So, did I need IVF? Would other better courses of investigation have helped? I don't know.....

MrsDeV, I completely agree with you up until your last sentence and would have been heartbroken had I never had children. The two and half years I spent trying to conceive were the hardest of my life and much shorter than most other peoples waiting times.

But, the NHS does have to think about how to apply resources and, in my experience, IVF is too quick an option. GPs are horribly uninformed about infertility treatment - and don't get me started on their ability to deal with the process of getting treatment - let's improve that, and testing, and then maybe people will get quicker, better help. IVF is no fun. I wouldn't wish it on my worst enemy.

zzzzz · 20/02/2013 20:27

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Message withdrawn at poster's request.

beginnings · 20/02/2013 20:33

side note - best of luck evilgiraffe I hope your appointment goes well and you have success soon.

johnnybear71 · 20/02/2013 20:35

Ok so I'm ready to be slammed and please this is just my opinion and I don't wish to offend or belittle anyone's feelings....I feel for those women who can not conceive and as a father i understand that urge to want to be a parent....however surely its time for us as species to stop "playing god" (I'm atheist). We have over 7 Billion people on the planet who are finding it hard to find food and this is only going to get worse....Now please I do understand that having you own child is very important but surely if it is not meant to be then its not meant to be....There are so many children in care needing a forever home and I know its not the same but men (and women) have always been there as step parents so why not just take the step...I couldn't imagine being without my kids and like i said I really do with my heart feel for childless couples but I also feel for those mother and fatherless children in the care system stuck there for years waiting for a mummy and daddy to look after them....I hope I haven't upset to many people and hope the following links are helpful to anyone wishing to adopt...xxx
www.adopting.org/adoptions/older-parent-adoption-adopting-after-40.html
www.barnardos.org.uk

williaminajetfighter · 20/02/2013 20:38

I'm very in favor of the changes even though, as others have said, they are just guidelines that don't need to be followed.

While I appreciate that budgets in the NHS are tight and not infinite, I've seen the waste of NHS health promotion programs and money spent on projects that don't always work. Or the duplication in health promotion like the 10 different posters at my doctors office, produced by 10 different organizations all promoting breastfeeding. Why so much duplication of effort? Don't even get me started on PFI schemes. By comparison I think an investment in IVF services seems reasonable.

It also seems that infertility is a growing problem and it would be wrong for the NHS to ignore it. Also offering IVF up to 42 seems a fairly reasonable request for couples when the fact is that many couples aren't in a position to TTC until they are in stable jobs and can afford homes, which stats show is often late 30s.

Another point --- so much care is spent on the elderly and not all treatments work or are effective. Can you imagine if the elderly over a certain age were denied treatment because it was less likely to work, due to their age or condition? eg. can you imagine if they created a policy that 'after 85 your chances of survival are slimmer and your body has deteriorated to such an extent that we won't treat you for XX and XX'. It may be that this is decided on a one-off basis by realistic health professionals in discussion with family, but a blanket policy??!! People would be up in arms because 'some 85 year olds are very healthy' and others, of course, are not... and issues about equity and fairness would abound. How different is a policy re: IVF?

MrsDeVere · 20/02/2013 20:41

This reply has been deleted

Message withdrawn at poster's request.

maamalady · 20/02/2013 20:41

Is it playing god? Or is it addressing a medical problem? Would you deny treatment of another type of organ failure? At what point do you decide that it's not meant to be? Many people would say that failed IVF is where they draw the line. As MrsDeVere said, adoption is not the same as giving birth, and is a separate issue.

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