9. Left holding no baby
Resolution submitted by the RCN Lothian Branch
That this meeting of RCN Congress calls on RCN Council to lobby for the implementation of the 2004 NICE guidelines on the availability of IVF
Report on this debate
Geoff Earl from the Lothian Branch proposed what turned into a highly emotional and impassioned debate.
Geoff started by saying that IVF is not a lifestyle choice – infertility is a medical condition that needs treatment. The NICE recommendations are always tough – as many people have found to their cost. Christine Gilmore Malone seconded that this is still a huge postcode lottery.
After the lunchtime adjournment, delegates heard some very emotional appeals from people who had been personally affected by IVF including mothers and a grandfather.
Impressing on the delegates that infertility is a medical problem that needs to be dealt with was a key theme. Colleen White said: “I’ve always been told, if at first you don’t succeed: try, try and try again. Sadly this isn’t an option for most people under going IVF treatment.”
Geoff concluded the debate by saying that the personal cost and the cost of helping these people if they don’t have access to IVF treatment, can’t be ignored and it is this cost that needs to be taken into consideration not just the monetary issue of IVF.
The resolution as passed:
| For | 318 | 89.58% |
|---|---|---|
| Against | 37 | 10.42% |
| Abstain | 0 |
| For | 77 | 77.8% |
|---|---|---|
| Against | 12 | 12.2% |
Background
In February 2004 the National Institute for Health and Clinical Excellence (NICE) published its Fertility: assessment and treatment for people with fertility problems (NICE, 2004). In order to reduce the ‘postcode lottery’, which was resulting in infertile patients receiving very different levels of service across the NHS, one NICE recommendation was three free cycles of in vitro fertilisation (IVF) for women under 40 years of age. It was estimated that three cycles could increase the chance of pregnancy to 50 per cent. Full implementation of this recommendation would have increased demand for IVF by an estimated 80 per cent, at considerable cost to the NHS. The then Health Secretary announced that there should be a move to offer at least one IVF cycle by 2005, and encouraged a move towards full implementation but with no mention of additional funding.
Today, many couples pay large sums of money to access IVF privately and increasingly travel overseas for treatment; neither of these options is feasible for people on low incomes. Unfortunately, the high cost of private IVF and the availability of just one NHS cycle of treatment encourage the implantation of more than one embryo. The result is heightened potential risk to both the mother and babies, resulting from multiple pregnancies.
While the NICE guidelines do not automatically apply to Scotland and Northern Ireland, clinicians are expected to make use of the most up-to-date and appropriate evidence and guidance available. Scotland has informed its NHS boards of NICE recommendations, (Scottish Executive, 2007) but has not formally published new guidance. In 2005, Wales introduced a new set of criteria related to age, BMI, previous children, smoking, and so forth. (Health Commission Wales Specialist Services, 2006). All Welsh health authorities now offer new patients that meet these criteria one cycle of IVF or intra-cytoplasmic sperm injection (ICSI). In 2006, Northern Ireland also revised its access criteria, and couples meeting these are offered one publicly-funded cycle.
The RCN Fertility Nurses Group has continued to raise concerns about the poor implementation of NICE guidance both with ministers and the Department of Health, recommending that better funding and ensuring ‘a funded cycle’ includes implantation of both fresh and subsequent frozen embryos would increase women’s chances of conceiving and ultimately reduce multiple pregnancies. The RCN is currently working with the Human Fertilisation and Embryology Authority on a strategy to reduce multiple births through IVF.
References and further reading
Ashcroft R E (2003) In vitro fertilisation for all?, British Medical Journal, 327 (7414), pp. 511-512. Available from: www.bmj.com/cgi/content/full/327/7414/511 (Accessed 4 February 2008) (Internet).
Health Commission Wales Specialist Services (2006) Commissioning policy: specialist fertility services, Cardiff: HCW. Available from: http://new.wales.gov.uk/docrepos/40382/dhss/40382121/Policy_plus_attachments.pdf?lang=en (Accessed 4 February 2008) (Internet).
National Institute for Health and Clinical Excellence (2004) Fertility: assessment and treatment for people with fertility problems, London: NICE (clinical guideline 11).
Available from: www.nice.org.uk/guidance/index.jsp?action=byID&r=true&o=10936
(Accessed 4 February 2008) (Internet).
Scottish Executive (2007) A report of the review of infertility services in Scotland, Edinburgh: SE. Available from: www.scotland.gov.uk/Resource/Doc/173213/0048365.pdf [see how to access PDF files](Accessed 4 February 2008) (Internet).