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IVF law is praised for its embrace of equality yet its practice reeks of injustice

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Postcode lottery

An intentionally provocative article in a recent issue of Grazia argued that in the face of ramped-up fears about teenage pregnancy, too many schoolgirls are so forcefully taught how not to get pregnant that they lack an education on fertility and childbirth. It reads:

“By failing to teach generations of girls how to get pregnant, we have left grown women unable to do so: unaware of the symptoms of infertility and blinded by the belief that IVF can solve every problem.”

Indeed the magic bullet afforded by IVF, in vitro fertilisation, is not as magic as you might think. IVF is one of the most invasive of all fertility treatments; it involves: suppressing the menstrual cycle; boosting egg supply; collecting eggs from the ovaries (with a needle); fertilising these eggs and transferring these into the womb. Side effects include, on the more moderate end of the scale, hot flushes and headaches, and, on the more serious, ectopic pregnancy and blood clots.

After all that, the chances of success are low: birth rates range from 2% to 33% depending on the woman’s age. The likes of Kim Kardashian have been open about their failed IVF attempts, the reality star claiming that the process left her “exhausted” and “over it”.

But for all the treatment’s clinical problems, the general consensus is that the law governing IVF has taken massive strides in recent years.

Legislation in the form of the Human Fertilisation and Embryology Act 2008, regulated by the Human Fertilisation and Embryology Authority, washed away many of the once discriminatory practices associated with the fertility treatment. This sweeping legislation (it has over 200 provisions) was described by the authority’s former chair Lisa Jardine as “radical [and] far-reaching”, it granting equal access rights to IVF for everyone regardless of marital status and sexual orientation.

While legal and ethical debates on the concept of third-person parenthood, sex selection, pregnancy post-menopause and more continue, concerns over equal access have been quelled by the 2008 act. Yet, as is so often the case with medical law statutes and others, the push for equality heralded by the act’s champions isn’t quite felt so acutely by those trying to make use of it. But it’s not potential users’ marital status or sexual orientation standing in their way, but where they live.

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This is because the provision of NHS-funded IVF cycles is organised by clinical commissioning groups (CCGs), i.e. by location. These CCGs came into being thanks to the Health and Social Care Act 2012, and there are currently 207 of them.

The National Institute for Health and Care Excellence (NICE) recommends that women who are less than 40-years-old and have been unable to get pregnant after two years of trying should be offered three full IVF treatments on the NHS. (Beyond that, those wanting access to IVF treatments are expected to pay privately, the NHS website stating that “costs vary, but one cycle of treatment may cost up to £5,000 or more”.)

IVF’s dismal success rates mean even three cycles won’t be enough for a high number of would-be parents. And yet, the non-binding nature of the guidelines means CCGs have free rein to set their IVF rules. You may expect just rare instances of guideline-straying but no: just 12% of CCGs actually follow them.

Campaign group Fertility Fairness has ranked all 207 CCGs as part of its ‘IVF League Table’, to provide an insight into how CCGs compare in their provision of fertility treatment. The likes of Bury and Oldham did well, their access score being two-and-a-half. By contrast, seven CCGs scored zero as they do not offer any NHS-funded cycles: Basildon and Brentwood, Cambridgeshire and Peterborough, Croydon, Herts Valleys, Mid Essex, North East Essex and South Norfolk.

This postcode lottery approach to IVF doesn’t just relate to the number of rounds on offer. To give you an example of the subtleties: in Liverpool IVF is available for women who have no living children (and who satisfy a number of other criteria), while in Haringey the recipient must have no living children from their current relationship and their partner must be childless. In Norwich, a woman must have been trying to conceive naturally for three years without success; in Erewash, one year will suffice.

The result of this patchy application of the law is that women with fertility issues in Hackney will be entitled to just half the number of rounds of IVF that her counterpart just down the road in Islington would be, or just one third of that on offer in Camden. The ‘one chance’ approach to IVF only adds to the “inevitable emotional roller coaster” that is fertility treatment, journalist Emily Phillips (again in Grazia) conceding that “the injustice is hard to bear”. NICE has called for an end to this practice, telling CCGs to “stop rationing fertility treatment”.

And yet, others argue that struggling women should be grateful for whatever ‘free’ rounds of IVF they manage to receive.

Journalist Sirena Bergman thinks that there’s a crucial distinction between “curing illness and curing dissatisfaction”. While the NHS continues not to fund eye tests, dental treatments, air ambulances, prescriptions and at-home care, she argues, they should not fund IVF. This feeling extends beyond opinion pieces. A recent poll of 600 medics found half of doctors think the NHS should stop funding IVF.

Journalist Fay Schopen, who candidly spoke about her fertility struggles in The Guardian, seems to err on this side of the debate when she says: “I don’t believe anyone has a right to have a child.” But, she continues:

“[A]s Professor Simon Fishel, who pioneered IVF in the UK, says: ‘You have to treat citizens equally and this is a deliberate inequality and obfuscation.’”

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15 Comments

Anonymous

Maybe have children in your twenties?

#firstworldproblems

Anonymous

Not if it’s a medical emergency. I needed egg freezing when I was suddenly diagnosed with cancer. I wasn’t planning on having kids in the near future, was unable to work and didn’t have the opportunity to build up any savings (I was NQ). Luckily my CCG paid, but that too is a postcode lottery.

Anonymous

Because everyone is fertile in their 20s?

Anonymous

I dunno, I’m a woman who plans to have children later so I guess I should be keen for access to IVF. But given the state of the NHS service at the moment, I don’t know if fertility treatments should be prioritised over other areas.

Corbyn. Sympathiser

There is no reason that any medical assistance should suffer, other than the decisions taken by the Conservative Party to starve our NHS to make it an appealing target for private capital. Local elections are not able to help with many NHS issues, sadly, but I hope that you and other readers will vote for the Labour Party in local elections in a few weeks time.

Anonymous

The NHS budget has increased under the Conservatives and whilst other departments were cut this continued to be protected. The NHS budget is now higher than it ever has been.

Corbyn. Sympathiser

The NHS budget has been cut in real terms and Jeremy “Hunt” **** is universally despised by NHS workers for his stewardship of the decline of the best health service on the face of the Earth.

Try again.

Anonymous

It’s Gandhi

Anonymous

It’s Gandy

Anonymous

CCGs vary in all sorts of ways eg access to hip replacements. The regional differences need to be put in context, it’s not just an IVF thing.
A more important issue of inequality is provision of egg and spermatogenesis freezing for those facing medical infertility eg through cancer treatment. Some CCG don’t fund that which really is a scandal.

Anonymous

Women in Liverpool are not offered free IVF if they have no living children of their own if their partner already has a child. Both prospective parents have to be childless to receive free IVF treatment in Liverpool and even then there are criteria you have to meet to be considered.

Personally I’m far more bothered about people having free plastic surgery on the NHS than loving couples who want to start a family but need assistance to do so. I know of someone who feigned suicidal thoughts and was given breast implants on the NHS!! Add to that the treatment of alcoholics and drug addicts who aren’t willing to help themselves and regularly clog up our GP surgeries and A&E departments… there are far bigger burdens on the NHS than fertility issues.

Anonymous

Same in most places. My husband has kids but I don’t so I know it isn’t an option for us but we are trying to find the money to do it privately.
It is somewhat ridiculous that one partner may not be able to have the opportunity to have their own child through that rule though.

Anonymous

Abortion – government get out of my body

IVF – government please get in my body

Anonymous

I have recently had successful IVF treatment through the NHS and we know how lucky we are. I think the inequalities are so unfair and because it is so expensive it means heartbreak for a lot of people that can not afford the ridiculous costs.

Having a child isn’t a given I understand that but there are many other reasons why women are accessing IVF treatment other than leaving it later so please don’t judge everyone individuals needs.

Anonymous

Sex education works because the same reasons not to have a baby in one’s teens apply for the majority of women in their 20s: lack of financial stability or stable employment with prospects for advancement, lack of affordable housing (renting or buying), lack of suitable partners (that is people who want to commit to raising a child together and/or are facing the same financial insecurities, etc). Not funding IVF punishes people for making good choices in the economic circumstances they find themselves.

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