Helping couples to conceive

Written by Peter Black and published in Western Mail on Sun 28th Jun 2009

Infertility is a complex and emotional subject. For couples who experience it, it can touch every aspect of their lives and cause a great deal of unhappiness and distress. For many couples, In Vitro Fertilisation and Embryo Transfer, more commonly known as IVF, is the last resort and can be a traumatising experience in itself, with no guarantee of success and a high rate of failure, even after three cycles.

But politically it is also a challenging issue. IVF is an expensive treatment and we know that the NHS has a finite budget. IVF cannot be offered to every couple indefinitely and it's an unfortunate reality that conditions such as a maximum age and number of cycles have to be imposed to ensure that the opportunity for children is extended to as many couples as possible.

At the moment, Health Commission Wales will only fund one cycle of IVF. This means each couple in Wales hoping to conceive through IVF has only one opportunity to try, and if unsuccessful would have to look at funding treatment themselves. This is far beyond the means of most people, costing between £4,000 and £8,000 per cycle, depending on the type of treatment taken.

The previous Minster for Health took the view that 'one cycle of IVF was the fairest way of providing a minimum level of service on an equitable basis across Wales.' which is an argument that I appreciate. However, with the conception rate of one cycle of IVF being only around 28%, is this policy really one that is appropriate?

Guidelines from the National Institute for Clinical Excellence (NICE) state that three cycles is the optimum number, with conception rates increasing at each stage. During the second cycle the conception rate is higher, at 48% and in the third 63%, meaning the majority of couples will conceive. While the budgetary constraints are obvious, can the Minister really believe a policy that only results in success 28% of the time is the right one?

I have had an assurance from the Minister that she will review the current policy when she comes to set the budget next year. It is though, possible to make savings in the current IVF budget that can be used to fund further cycles.

One option that is available is to cut the number of multiple births that are occurring. While a single birth costs the NHS £3,000 (including health costs for the first year of life), the cost of twins is an estimated £9,000 and triplets £32,000.

The Human Fertilisation Embryology Authority has a policy designed to more than halve the rate of IVF multiple births from the 2006 level of 23% to 10% over the next three years. I have written to Edwina Hart AM, the Minister for Health asking her to investigate the impact of such a policy in Wales, hopefully freeing up more money to help people who are unsuccessful after their first cycle.

What is clear is that the government has to take some action to increase the number of cycles available in Wales. The majority of Primary Care Trusts in England fund at least two and many fund three, leaving Wales lagging behind. The situation in Scotland is that all Health Boards offer at least two cycles.

While I appreciate it isn't an easy or cheap task, the government should strive to increase the number of cycles available with the aim of meeting the NICE guidance of providing three. I do not expect this to happen overnight, but I would hope that the Minister can accept that the situation in Wales needs to change and start working towards that goal.