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Jill Kirby

Jill Kirby: NICE is wrong to say that older women and lesbian couples should get IVF on the NHS

As Europe waits to see if the euro is about to unravel, and as the UK government struggles to agree on any radical action to energise its own fragile economy, there is an air of unreality in the political news cycle. In a contest for the most out-of-touch proposal, the Prime Minister's offer to give every parent free government-backed advice on bringing up baby was surely last week's winner. Yesterday's recommendation from the National Institute for Clinical Excellence (NICE), to increase the availability of free fertility treatment on the NHS, looks like a strong contender for this week's list of foolish ways for spending money we don't have.

NICE has published new draft guidelines on the use and availability of fertility treatments, including in-vitro fertilisation (IVF), updating its 2004 guidelines to ensure compliance with equalities legislation. IVF is currently available on the NHS for women aged 23-39 (although provision varies widely between health trusts, as to conditions attached and the number of treatment cycles offered.). NICE is now recommending that IVF should also be free to older women, aged 40-42, and advises that women should be entitled to treatment after just two years of trying to conceive naturally, rather than waiting for three years as at present.

NICE also recommends that IVF should become available on the NHS to lesbian couples, who currently have to pay for private treatment if they want a child. Such couples will be offered first donor insemination and then full IVF, provided they have already unsuccessfully attempted insemination at a private clinic.

NICE admits that its new proposals have not been costed. IVF treatment currently costs the NHS between £1,300 and £3,000 per woman per cycle. In 2010, nearly 8,000 women aged 40-42 had IVF treatment privately; had their treatment been provided by the NHS it would have cost taxpayers up to £24million. Since only a small minority of women in the UK are living in a gay relationship, the cost to taxpayers of offering them IVF treatment will be less, probably in the region of another £2 or 3million a year.

But the entire history of the NHS leaves no doubt that where a new treatment or service, which was formerly unavailable, is provided free of charge, demand for the service quickly expands. With the blessing of NICE, IVF for older women and for those in same sex relationships is likely become both more acceptable and more widespread.

At a time of extreme financial uncertainty, with the NHS already burdened to breaking point, where will resources be found to offer these treatments? What possible justification can there be for expanding the remit of a procedure which many people (including some NHS trusts) already consider inessential? Is NICE in danger of eroding its own credibility by offering these guidelines, which will surely be met with exasperated incredulity by cash-strapped hospitals?

As if budget considerations were not enough to render these recommendations unrealistic, there are of course ethical issues at stake. I would contend that the new guidelines represent a watershed moment, at which artificial insemination and IVF cease to be about treating a medical condition and become instead the fulfilment of a lifestyle choice. In other words, the “right” to become a biological parent, thanks to the generosity of a taxpayer-funded service, regardless of age or sexual orientation.

Whilst a strong case can be made for NHS treatment of the causes of clinical infertility in women of childbearing age, arguably (although not necessarily) including access to IVF, can it really be accurate to describe failure to conceive after 40 as a clinical condition? Is it not rather a matter of timing? And is there not also a danger that women are encouraged to believe that postponing motherhood beyond 40 is a rational choice which carries little risk? Janet Fyles of the Royal College of Midwives defends the new guidelines in the Times, saying “What's the difference between a woman trying for a child at 39 and 42? There should not be a price placed on equal access for women.” By this logic, the age limit may be extended indefinitely, with women asserting their right to equal access IVF regardless of age. Yet the Royal College of Obstetricians and Gynaecologists has previously warned of the higher risk of complications (and costs) of childbearing for older mothers and has suggested that women should be encouraged to have children before they turn 35.

As to the decision by two gay women to produce a child to whom at least one of them is biologically connected, their condition cannot reasonably be described as a medical need – can it? There is still significant public and ethical concern about the desirability of raising a child without a father or father figure present, and confusion about the rights of the biological father to play a part in the child's upbringing, as well as the deception involved where a child's birth certificate names two female parents yet does not include the biological father. Should taxpayers be obliged to facilitate the creation of human life in these circumstances, in the name of equality? Even those who are happy to endorse this form of alternative family would be hard pressed to claim that clinical infertility is the condition being treated here.

Given the so-called “postcode lottery” in availability of IVF under current guidelines, and in view of the financial strains on NHS resources, it would surely make better sense for NICE to publish more restrictive guidelines, to focus treatment on women in prime childbearing years, especially those whose fertility has been affected by illness, accident or cancer treatments.

Instead, and contrary to all financial sense, NICE has damaged its own credibility by producing a politically-correct document which attempts to present age and sexual orientation as medical conditions requiring fertility treatment. The government should bin these draft guidelines and send NICE back to the drawing board.


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