IVF is an important procedure that provides infertile couples with the potential to conceive a child and is now the most common and successful treatment for couples with unexplained fertility issues. Since the birth of Louise Brown, the world’s first ‘test-tube baby’, in July 1978, an estimated
five million babies have been born world-wide as a result of IVF. Specifically, in the UK, 201,811 IVF babies were born between 1991and 2010. Moreover, rates of infertility in the UK are rising with currently 1 in 7 couples struggling to conceive naturally, and so consequently the importance and demand for IVF is projected to increase.
Unfortunately, even though the requirement for IVF treatments in the UK is clear, the NHS is increasingly cutting back on IVF provision, potentially making the UK the first country in Europe to have completely removed public funding for IVF treatment. There is no doubt that the NHS is under extreme amounts of pressure due to factors such as an ageing population, rising cost of medical technologies and now the added pressure of Covid-19. However, cutting back on fertility treatment is in direct conflict with the National Institute for Health and Care Excellence (NICE) guidelines. In 2013 NICE, which aims to improve the NHS for patients, published updated clinical fertility guidelines and made several recommendations for provisions of IVF. This updated 2013 report recommends that women aged 39 and under should have access to three full cycles of IVF treatment on the NHS. A full cycle of IVF has been defined as placing 1 or 2 fresh embryos back into the womb and any remaining quality embryos are frozen so they can be used later as part of the same cycle. These guidelines from a regulatory body illustrate the pressure the NHS is under to consider funding fertility treatment for all and setting aside a budget to meet the projected increase in demand for IVF.
In 2016, only 41% of IVF cycles were paid for by the NHS. This is clear evidence that IVF is far from being free for all those that want it. This is mainly due to the fact that providing free rounds of IVF is costly to the NHS, with each cycle costing upwards of £5000, overall costing the NHS roughly £77 million per year and making up around 0.05% of the NHS annual budget. Despite this cost, IVF is not the most expensive elective treatment offered by the NHS. For example, knee replacements, which are also elective procedures, cost the NHS an estimated £585 million in 2015, with each operation costing £6,500. This raises the question whether this money is a more valuable spend to the individual with a knee issue compared to a couple suffering the negative psychological implications of infertility.
Not only is IVF only partially funded by the NHS, but access to free IVF treatment is also based on an individual’s postcode. The access criteria and number of cycles available on NHS funding is determined by the local Clinical Commissioning Groups. The CCGs appoint most of the hospital services in their local area and decide what specific services are needed for their diverse local population. However, inequality is built into this system. Not all CCGs offer NHS funded IVF treatment. The number of free cycles is contingent on living in the right catchment area and is often referred to as a ‘postcode lottery’. Many CCGs argue that they are faced with large financial pressures and must make difficult decisions as to what treatments they prioritise. IVF is often a low priority due to the fact that infertility is not a life-threatening condition. In fact, only 13% of CCGs offer the recommended 3 cycles. Inequality seems to be further compounded by treatment policies as CCGs are finding alternative ways to reduce provisions by tightening access criteria. For example, the NICE guidelines state that IVF services should be offered to couples if at least one partner has no living child. However, 91% of CCGs restrict free IVF to couples where both partners have no children. Ultimately, many couples will not qualify for NHS funded IVF treatment and will then have to decide whether they pay for private treatment or if they find alternative routes to having children. This current regional disparity emphasises how it is salary and postcode that determine who has IVF, not medical need.
Although infertility is not a life-threatening disease, the treatment of infertility by using IVF makes way for new life, allowing couples, who would have otherwise been unable to conceive naturally, the chance to have a child. However, the financial and physical pressures faced by the NHS make it clear that the NHS is unlikely to have the resources or the money to fully fund every round of IVF in the UK. Nevertheless, the current system creates an inequality where only those who live in the right area or have enough money can have the chance to be parents. With the number of people demanding IVF on the increase as rates of infertility rise in the UK, this ‘postcode lottery’ approach needs to change.
There are also cost advantages to be gained in greater standardisation of funding. The NHS needs to standardise treatments across the UK to provide an equal and comprehensive access to fertility treatment by ensuring that every local CCG offers the NICE recommended three full cycles of IVF for free. Advances in fertility treatment have also resulted in IVF becoming more cost effective, simple and successful, which should allow for provisions to be more easily implemented by the CCGs. Ultimately, although evidence suggests that the NHS will be unlikely to fully fund IVF treatments in the UK, fair and equal access to fertility treatment provided by the National Health Service across the country needs to be made mandatory.
Fenella, Head Girl
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