We're still trailing behind when it comes to IVF

Anyone who has any personal experience of IVF will know that our funding situation in the UK is patchy at best, but the report released from ESHRE this week showing quite how badly we're trailing behind our European neighbours was still something of a shock. We came third from the bottom in a European table for funding fertility treatment, with only Russia and Ireland behind us. Belgium and Denmark both fund around three times as much treatment per million inhabitants as we do.  Even Slovenia funds twice as much.

I've just been on Radio Humberside discussing the situation, and the presenter seemed not to have considered that infertility might be a medical condition. It always strikes me as odd that if it's your fallopian tubes or your ovaries that don't work, a medical problem becomes  a "lifestyle choice".  Where do we draw the line with "lifestyle choices" and medical treatment? Infertility is not going to kill anyone, people often say. No, it probably isn't, but surely the NHS wasn't set up only to treat people who would drop dead if they weren't helped right away?  Even funding three full cycles of IVF for all those who needed it would be a tiny drop in NHS budgets - and cutting all IVF funding entirely wouldn't begin to solve our financial problems (indeed it could make them far worse, if more and more fertility patients started going overseas and coming back pregnant with triplets).

I think this debate is about something much more than infertility - although our attitudes to families and children in the UK probably provide an interesting tangential discussion. It seems to me that deciding that some medical conditions are unworthy of treatment is the tip of a very large iceberg which rests on our decisions about what the NHS is for. What other treatments might constitute "lifestyle choices"? Hip and knee replacements perhaps? Might people decide that they aren't entirely essential?  Perhaps being able to walk long distances without any pain is a "lifestyle choice" - you don't have to walk far, you can take painkillers.

Cutting IVF funding is easy - some people even think it's a good thing.  People with fertility problems are often so distressed that they haven't told their closest friends and family about what's happening to them.  They aren't going to be outside the local PCT waving banners and shouting.  Just because something is easy, that doesn't make it right - and being oblivious to the longer term consequences of short-term financial decisions seems to be all too common at the moment.

Surrey funding cuts

So Surrey is the latest to jump on the bandwagon - hping to make up a deficit of £125 million pounds by axing spending on tattoo removal, treatments for baldness and guess what... yes IVF. However they managed to end up with a deficit of £125 million pounds, one can safely say that it wasn't by spending money on fertility treatment, which is estimated to be less than half a percent of total NHS spending. And it's interesting that they have managed to cut £7 million from their spending on "management" (which is still going to cost around £10 million a year).

It's easy to cut IVF spending. No one gets terribly upset, apart from the people waiting for treatment who are often so devastated by their experience of not being able to conceive that they find it hard to talk to their friends about it, let alone to start waving placards outside their local PCT offices. The long-term impact for these couples is usually neglected in talk about "priorities". We know that more than 90% of couples with fertility problems suffer depression, and this can often lead to other health problems. In the future, the opportunity to try to have a child if you can't do it easily will only be available for those who have the cash to pay.

What's really worrying about all this is the precedent that is being set. Surrey have cheerfully announced that "If you don't need it, the NHS won't pay for it." Who decides what constitutes "need"? Do you really "need" a hip replacement? Or a cataract operation? Do children "need" free prescriptions? Do pregnant women "need" scans? If the NHS is only there to deal with life-threatening conditions, then we don't "need" an awful lot of what it does, but is that really a future that anyone wants?

IVF funding

When the government promised one full cycle of IVF on the NHS for all eligible couples by April 2005, it looked as if things might be about to change for all of those who were having difficulty conceiving. At last, the problem was being taken seriously. Perhaps the chances of getting at least some funded help would no longer depend on where you lived.

Two years on, that government promise remains unfulfilled. In some areas, there's no funding at all for patients who need IVF. In others, trusts have come up with stringent criteria to ensure that the majority of those who need treatment won't qualify. Is it really logical to refuse to fund treatment for women who are under 36, when we know that IVF is far more likely to be successful for younger women? And is it fair to refuse to fund anyone who has ever paid for treatment in the past? Or anyone whose partner may have adult children from a previous relationship?

The postcode lottery is more complicated than ever, and your chances of getting treatment depend on your age and your situation now, as well as where you live. Fortunately, there is an ongoing survey by the charity Infertility Network UK with the backing of the Department of Health to look at the way funding is working, or rather not working, which aims to help lay the foundations for better provision of treatment across the board. Maybe this is the first step towards keeping that government promise.