Dr. Kirsty Horsey
Progress Educational Trust
06 March 2005
 [BioNews, London]
Proposed guidelines from the Welsh Assembly Government, put forward for consultation until 14 March, would rule out IVF treatment on the National Health Service (NHS) for couples if one partner already has a child. This would include adopted children and would apply even if the child does not live with the couple. The guidelines also propose to deny IVF to people who smoke, unless they agree to take part in a 'supported programme of smoking cessation'. If they agree, they can join an IVF waiting list, but must be non-smokers by the time of treatment.
The guidelines also include recommendations on age - a woman must be treated before her 40th birthday - and weight. In addition, they also say that a couple should not have had previous IVF treatment on the NHS or have had three privately-funded treatments. IVF will also not be offered to those previously sterilised. Same-sex female couples applying for IVF must show that they are both subfertile, and have been in the same relationship for at least two years.
The guidelines suggest the social criteria that can be applied by doctors in Wales when judging whether a couple ought to be given state-funded IVF treatment. These social criteria exist on top of clinical criteria issued by the National Institute of Clinical Excellence (NICE), in February 2004, which cover the provision of NHS-funded IVF in England and Wales. However, although funding was covered by NICE, it is left to individual health trusts to establish their own access criteria, so the availability of IVF services can still vary depending on where the couple live. At that time, Jane Hutt, the Welsh Assembly Minister for Health and Social Services, announced that from 1 April 2005 all couples aged 23-39 in Wales who met the clinical criteria established by NICE and any social criteria to be established by the Welsh Assembly Government, should be offered one cycle of IVF treatment on the NHS.
The provision of fertility services was referred to NICE in 2000, as services across the UK were 'inequitable' and 'patchy', leading many to claim that treatment was based on a 'postcode lottery'. The NICE guidelines, designed to set a national standard of service provision, stated that three cycles of IVF should be offered to all infertile couples meeting certain clinical criteria. But, despite NICE's recommendation, Health Secretary Sir John Reid announced that by April 2005, couples meeting the NICE criteria will only be offered one free cycle of IVF. In addition, he said, NHS-funded IVF will only be available at first to couples who don't already have children living with them. The Health Secretary said that 'full implementation' was a long-term goal, but he has not yet committed to a timetable for this.
The Welsh Assembly maintains that it is committed to equal access to treatment across Wales. In 2004 it announced that all couples who met clinical criteria set by NICE, as well as the Assembly Government's social criteria, could have one free cycle of IVF treatment from April 2005. It is those social criteria that are to be decided upon following the consultation.
In reaction to the Welsh Assembly's suggestions, Clare Brown, chair of the National Infertility Awareness Campaign (NIAC), said the guideline totally preventing IVF for people who already have children, perhaps from other relationships, was 'unfair'. She pointed out that 'in England, the Secretary of State for Health, Dr John Reid, stated that preference should be given to couples that do not have a child living with them, which is very different to barring them on the basis of having a child who may not, in fact, have anything to do with them on a day-to-day basis'. She continued: 'The level of entitlement in Wales is already different to that of England. While the Government is at least taking the first steps towards full implementation of the guideline, couples in Wales are faced with not knowing when they will be able to receive the three cycles that NICE has recommended'.
The charity Infertility Network UK (I N UK) says that it is 'concerned' that smoking will be used as a reason to deny treatment; saying that it believes this criteria is unique to Wales. The Welsh Assembly working group that compiled the consultation paper says that smoking can adversely affect IVF success rates, which is why only non-smokers should be accepted. 'Women who smoke are likely to have reduced fertility and passive smoking is likely to affect the chance of conceiving', they said, as well as pointing out that 'in men there is an association between smoking and reduced semen quality'. But Clare Brown, who is also chief executive of I N UK, said 'most of the access criteria are similar to those used in England and Scotland, but we have not seen this smoking criterion before'. She added: 'The NICE guidelines, which we support, say couples should be advised smoking could affect fertility', continuing 'we would be happy to encourage our members to give up smoking, because it is a good thing. But we would be concerned if it is being used as a criteria to ration treatment'.
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Reproduced from BioNews with permission, a web- and email-based source of news, information and comment on assisted reproduction and human genetics, published by Progress Educational Trust.
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