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February 2008
It was reported in the Guardian Newspaper recently that thousands of couples are being denied NHS Fertility treatment despite a government pledge of a full IVF cycle for those eligible by April 2005.
A survey conducted by the Department of Health, revealed that half of England’s Health Authorities fail to provide the most basic treatment of a full IVF cycle, including freezing and replacement of embryos not transferred in the initial cycle.
Many women and their partners who fulfil strict criteria for a free IVF cycle are being denied it altogether, while others are receiving partial treatment which falls short of guidelines set up to standardise provision.
The Guidelines, issued in February 2004 by the National Institute for Clinical Excellence (NICE), recommend that eligible couples should be offered up to three cycles of IVF if the woman is between 23 and 39 years of age.
The government added a priority condition that couples with at least one child from the current or previous relationship should not have access to NHS treatment.
However these guidelines have been subject to variation depending on the priorities set by the local PCT.
There is therefore widespread inequality, due to PCTs treating it as a low priority and a life style choice.
This is worrying bearing in mind that in the UK, one in seven couples who are trying for a baby, experience delay in conceiving.
It should also be noted that most hospitals are also failing to comply with the Government target of eighteen months from referral for treatment to the start of that treatment.
There is also a call for cancer patients to be offered free fertility treatment on the NHS to enable them to store frozen sperm or eggs and have children in the future. It appears that sperm banking is widely available, but not always free of charge. Embryo storage is not always available and not always funded by the NHS. There is no provision for a woman to have ovarian tissue or eggs removed, frozen and stored on the NHS, although it is possible in the private sector, if she can afford to pay.
The National Institute for Clinical Excellence defines infertility as “the failure to conceive after two years of trying”. This effects 15 – 25 % of all couples.
There are two types of infertility: –
1. Primary Infertility - where the woman has never been able to get pregnant, which accounts for 70% of the total.
2. Secondary Infertility – where the woman has been pregnant before but has not been able to get pregnant again, which is the remaining 30% of the total.
Whilst the definition relates to two years of trying, most hospitals will investigate after one year of trying to conceive.
There are a number of causes, but the most common are:-
Tubal disease is a common cause of infertility. The tubes must be open in order to transport eggs from the ovaries to the uterus. Tubal blockage can occur because of infection (pelvic inflammatory disease), scarring from previous surgery, congenital defects, endometriosis, or other conditions. This prevents the egg reaching the uterus to be fertilised by the sperm
Endometriosis is a fairly common condition in which cells that usually line the womb are found elsewhere in the body. It affects approximately 2 million women in the UK, most of which are diagnosed between the ages of 25 and 40. Endometriosis can occur in several places in the body, most commonly including the fallopian tubes, the ovaries, the bladder, the bowel, the intestines, the vagina, and the rectum.
Ovulation disorders present in up to 30% of cases. Every month a normally ovulating female produces eggs that develop to maturity and are released according to precise timing governed by hormone relationships in the menstrual cycle. Some women suffer from lack of ovulation altogether and others irregular ovulation.
Sperm health problems account for approximately 75% of all male fertility problems.
Several conditions can affect a man’s fertility. Some men have a low sperm count, and some men have a condition where there is a total absence of sperm in the semen.
In some men a chromosomal abnormality can result in infertility.
This is often the first treatment for women who are not ovulating. The drugs trigger the ovaries to release eggs. This treatment can sometimes lead to conception after a few months without further intervention.
i) Intra uterine insemination (IUI)
This involves inserting sperm into the uterus at the time of ovulation using a very fine needle.
ii) In vitro insemination (IVF)
This is where the eggs and sperm are collected and fertilised in the laboratory before the resulting embryo is transferred to the uterus. The woman takes fertility drugs to stimulate the production of eggs. Once they are mature, they are collected by ultra sound guidance. A prepared sperm sample is then put with the eggs in a Petri dish and left for a few days to see if fertilisation takes place. A resulting healthy embryo is finally placed in the uterus
Approximately six thousand babies are born as a result of IVF each year. However, it should be noted that the procedure has an average success rate of only 15%. This rate is affected by the woman's age at the time of treatment. The National Institute for Health and Clinical Excellence (NICE) recommends that the optimal age range for IVF is between 23 and 39 years of age.
The typical cost of one IVF cycle at a private clinic is £2,500, and without NHS treatment, most couples can not afford the costs and give up on their dream of having a family.