To what extent should the NHS fund IVF treatment?
Disclaimer: I don’t really have a super firm opinion on this issue, and think that this should be assessed on a case by case basis, although I know that this is not always possible. Below are some of my thoughts on both stands!
Some (quite a lot of) background info about the NHS and IVF
The NHS, which is the national health service in the UK, seeks to provide healthcare for all in the UK based on their need for medical care rather than their ability to pay for it, and is funded by taxes. Today we discuss if the NHS should fund IVF treatment, the arguments for and against it, and the impacts it can have on people.
What is IVF?
IVF, which stands for In vitro fertilization, is one of the several techniques available to help people with fertility problems to have a baby.
What happens during IVF?
The IVF process involves 6 main stages
Suppressing the menstrual cycle with medication
Boosting egg supply with medication to encourage the ovaries to produce more eggs than usual
An ultrasound scan to check the development of eggs
Inserting a needle into the ovaries, via the vagina, to collect the eggs.
Eggs are then mixed with sperm for a few days for fertilisation
Transfer of embryos into the womb
These stages take place in a laboratory, after which the embryo is returned to the woman’s womb to develop into a foetus. This process can be carried out using the individual’s eggs and their partner’s sperm, or eggs and sperm from donors.
The current NHS guidelines towards who can have IVF
From the NHS website “IVF is only offered on the NHS if certain criteria are met. If you don't meet these criteria, you may need to pay for private treatment.”
The provision of IVF treatment varies across the country, and largely depends on the individual NHS clinical commissioning groups (CCGs) policies. Although the NHS is working towards having the same standard of care throughout the country, the provision of IVF treatment is not standardised across yet. The National Institute for Health and Care Excellence (NICE) have fertility guidelines and make recommendations about the accessibility to IVF treatment from the NHS to various groups of people. However, oftentimes local CCGs have stricter criteria.
Provisions and Criteria
· Woman Under 40 can be offered 3 cycles of IVF treatment if they’ve been trying to get pregnant through regular unprotected sex for 2 years and they’ve not been able to get pregnant after 12 cycles of artificial insemination
· Woman aged 40-42 can be offered 1 cycle of IVF treatment if they meet the criteria above, show no evidence of low ovarian reserve and have been informed of additional implications of IVF and pregnancy at their age
· Woman aged 42 and above are not offered IVF treatment
Other criteria by specific CCGs
· Having no other children from current and previous relationships
· Being at a healthy weight
· No substance abuse or smoking
Why the NHS should fund IVF
Until you yourself are in the situation, nobody can ever understand the heartache that someone may feel when they are unable to have a baby. With each IVF cycle that the NHS funds, they give someone another chance to have their own child.
One cycle of IVF can cost more than £5000 and there are often many additional costs for medicines, consultations and tests. In addition to this, one would normally have to go through multiple cycles of IVF before having a positive result and the costs continue to pile up endlessly.
No one argues that patients with multiple miscarriages should be denied further treatment. Isn’t the funding of repeated cycles of IVF based off of the same principle? It is merely giving someone the ability to make a choice they would have otherwise had if it were not for a medical condition. In this case, the ability to have a child despite their infertility. Furthermore, just because the need for IVF is due to a lifestyle choice of one wanting to have their own children, this does not mean it should not be funded. By this argument, many illnesses that the NHS treats, associated with obesity, sports, drinking, drugs and work related illnesses should not be treated as well.
Although it is true that the NHS has limited funds that need to be used wisely, who is to say that IVF treatment is less important than others? It really all depends on an individual’s situation and circumstance. Taking away the funding of IVF treatment could mean depriving people of the means to have their own child, which could change their life. After all, nobody says “We don’t treat Leukaemia because there’s a limited pot of money.” Perhaps, instead of taking the opportunity to have a child away from people, which really in the grand scheme of things will not cost the NHS much as compared to their other expenses, the root of their problems should be addressed instead.
IVF treatment, gives people the opportunity to bring life into the world, and will change their own lives forever. Is there really so much difference between granting people this and any other life-saving treatment the NHS offers?
Why the NHS should selectively fund IVF
Selectively funding IVF could enable the NHS to maximise the use of their limited funds, allowing them to fund IVF treatment for those who will have the highest chances of success.
The success rate of IVF depends on many factors, which is why the NHS has various criteria for funding the IVF for their patients. One very important factor in determining the success rate of the pregnancy is age.
IVF is known to result in more successful pregnancies among younger women, and is not recommended for women over 42 because the chances of a successful pregnancy are too low. There are also several associated dangers with pregnancy at an older age, with higher rates of miscarriages and births of babies with disorders.
The graph below shows the IVF success rates against a females age
In addition to age, maintaining a healthy weight, avoiding alcohol, smoking and caffeine during treatment can improve one’s chances of having a baby with IVF.
The reasons above are why the NHS selectively funds IVF, as it may be a waste of their limited funds to provide IVF treatment to those who have low chances of successful pregnancies.
Why the NHS Should not fund IVF
The NHS has to carefully allocate their already limited funds, and besides this, IVF can sometimes do more harm than good.
IVF does not always result in pregnancy and can be very physically and emotionally demanding. Sometimes, the health risks involved are also more than the possible positive outcomes. For example, IVF medications can result in hot flushes and headaches, multiple births that are dangerous for the mother and children, an ectopic pregnancy and ovarian hyperstimulation syndrome.
Furthermore, the NHS has very limited funds and money is desperately needed in many other sectors and could be better used for the treatment of illnesses in those who are already living.
Moreover, in the 21st century, where the cost of living continues to rise, we unfortunately also need to consider if those who are temporarily unable to afford IVF should really be considering a child at the present moment, and how the standard of living this child would be affected in the future. In the UK, there are also many children waiting to be adopted or fostered, thus making more children may not be a top priority.
With Covid-19 being as serious as it is in the UK, many NHS staff are working extremely long hours, medical supplies are running low and beds in hospitals are precious. Many other surgeries and appointments have already been delayed, and it is uncertain when life in hospitals can return to normal. In this case, should the NHS really continue to fund optional treatments such as IVF?
In an ideal world, where the NHS was overflowing with funds and staff, the NHS would be able to fund IVF as many times as it took for a successful pregnancy for whoever wanted it. Unfortunately, this is far from the truth and the NHS has long lists of treatments they need to fund and doctors to take care of.
The NHS could also consider assess the funding of IVF on a case by case basis, and not just allocate it based on a number of criteria. Everyone’s life and situation are different, and is much more than just statistics and facts.
Do let me know about your thoughts on this issue! I would love to discuss it.
General reading from