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Health service to fund IVF for the over-40s

Fertility treatment for all couples to be speeded up in NHS overhaul
One in seven heterosexual couples are thought to experience fertility problems and the numbers seeking help have risen.
Women over the age of 40 are to be allowed fertility treatment on the NHS for the first time and all couples who are struggling to conceive and qualify for IVF should get it sooner, according to national treatment guidelines published on Wednesday.
Women aged 40-42 who have not previously had fertility treatment on the NHS should be offered one round of IVF, the National Institute for Health and Clinical Excellence (Nice), whose guidance applies to the NHS in England and Wales, rules.
Previously the cut-off age has been 39. Those struggling to conceive have also been told the treatment should start earlier – after two years of trying to conceive naturally, rather than three.
Tim Child, consultant gynaecologist and director of the Oxford Fertility Unit, who was part of the guideline development group, said the decision to extend IVF past the age of 39 was not taken lightly.
"When a woman reaches her mid-30s her fertility begins to decline, even more so from her late 30s," he said. "However, many women do conceive naturally in the 40-42 year age group, but for those who can't, and who have been diagnosed with the medical condition of infertility, then improvement in IVF success rates over the last decade mean that we are now able to offer cost effective treatment with a single IVF cycle. This decision was taken after considerable discussion and close analysis of the available evidence."
But leading fertility doctors and patient groups warned that with the new guidance people would still be denied the treatment because of the reluctance of many primary care trusts (PCTs) to pay for it.
Clare Lewis-Jones, chief executive of Infertility Network UK, who was on the guidelines development group, said they would give new hope to infertility patients, but it would be "pointless if the recommendations are not put into practice".
One in seven heterosexual couples are thought to experience fertility problems and the numbers seeking help have risen. There is evidence that spending cuts in an NHS tasked with saving £20bn by 2015 have affected fertility services, which already had long waiting lists.
Nice reiterates that couples where the woman is under 40 should have three attempts on the NHS and even suggests the treatment should start earlier – after two years of trying to conceive naturally, rather than three.
But it proposes ending practices which scientific evidence now suggests are ineffective, which could reduce some costs. Women in hetereosexual relationships should be encouraged to keep trying for a baby through sexual intercourse for the two years before they qualify for IVF, rather than be given artificial insemination, Nice says. Studies show insemination does not achieve better results.
Same-sex couples will still be offered artificial insemination as well as people who have a religious objection to IVF.
Drugs to increase the number of eggs a woman produces should not be used in anyone whose infertility is unexplained, the guidance says. There have been many cases where women have become seriously ill as a result of over-stimulation of the ovaries.
Because of the risks to babies and the mother at twin and triplet births, Nice supports expert advice that wherever possible only one embryo created in the lab should be placed in the womb.
Under some circumstances, two embryos can be transferred in the 37- to 39-year-old age group and two in women aged 40-42. IVF should only be offered to women over the age of 50 where "there has been a discussion of the additional implications of IVF and pregnancy at this age".
Lewis-Jones said: "People are suffering every day because some PCTs have continually flouted the Nice guidelines."
Nice clearly understood the impact on people of infertility, which was a very distressing medical condition, she said.
"We know infertility can be treated effectively and thousands of people have become parents after fertility treatment. The current 'postcode lottery' approach to the treatment of infertility here has gone on for far too long and it is vital that the government supports the measures in the updated guidelines and communicates the need to implement them to those who commission fertility services in the NHS.
"We know the current system leaves many people unable to access NHS treatment and we need reassurance about the future of NHS fertility treatment as we move towards GP commissioning in 2013," she said.
The British Fertility Society, which represents clinicians, called for IVF to be made far more available on the NHS.
"It is now almost 10 years since Nice first published guidelines on fertility treatment and we are still in the untenable position that the majority of primary care trusts have not fully implemented these and patients in many areas of the country are unable to access treatment," said its spokesperson, Dr Sue Avery.
"Being denied appropriate fertility treatment can have a devastating consequence on patients' lives, effectively denying them the right to a family."