NHS
National consultation on NHS-funded infertility treatment
By Scottish Executive
Sep 10, 2005, 23:11

A national consultation on NHS-funded infertility treatment aimed at improving equality of access across Scotland was launched today.

The consultation, which runs until December 8, will examine:

* Clinical criteria - e.g should the (38 year-old) age limit for women to receive infertility treatment be increased?
* Social criteria - e.g should priority for treatment be given to couples who have no other children living in the home?
* Other issues - e.g what impact would widening the access criteria have to NHS waiting times for treatment?

Deputy Health Minister Lewis Macdonald said:

"Infertility affects roughly 75,000 couples in Scotland. Demand for NHS-funded assisted conception has increased and we need to ensure there is equal access for all regardless of where people live in Scotland.

"We have national criteria for accessing infertility treatment provided by the NHS, and Boards are expected to follow this guidance. However I am aware there is still some variation among Boards regarding the provision of infertility treatment, and that not all Boards are following this guidance as they should.

"I also know there are differences in criteria and waiting times for the most specialist treatments within the four specialist centres in Scotland. This is why we are launching a national consultation today, with the aim of securing equity of access to high quality infertility services across Scotland.

"We want to seek views on what changes are necessary to improve access to assisted conception treatment. This consultation is mainly aimed at NHS Boards and service providers so we can examine the issues that are preventing the implementation of consistent access criteria. We also hope to find out why there are discrepancies in waiting times across different areas in Scotland.

"I am also keen to hear from people who use infertility services and other interested groups. We are asking questions to gauge people's views on issues that may affect access to infertility treatment for women in Scotland like age or whether their partner has a child who lives in their home.

"We are consulting widely in the hope that we can secure an equal service for all in Scotland."

Infertility is defined as a 'failure to conceive after regular unprotected intercourse for one or two years".

There has been no real increase in prevalence of infertility, but evidence shows that more couples are seeking fertility assistance.

The Expert Group on Infertility Services in Scotland (EAGISS) set out recommendations for national criteria for NHS-funded infertility treatment in 1999. It was hoped the publication of the report would provide equity of access to service and treatment. In 2000, the Chief Medical Officer asked Boards to adopt this framework.

EAGISS criteria states a woman should be less than 38 at the time of treatment. It also states that eligible women should be entitled to a maximum of three assisted conception cycles.

Following one cycle of treatment, a couple should be able to undergo successive cycles within a timeframe of their own choosing.

However more recently, guidelines produced by NICE in 2004 state the age limit for women to receive infertility treatment should be 40 and that cycles of treatment should be increased to five. Clinicians, NHS Boards and service users will be consulted to find out what criteria should apply in Scotland.

Access to infertility treatment is not currently covered by the waiting times guarantee as it is measured separately from national waiting times standards. Following this consultation on access criteria for NHS-funded infertility services, the need to apply a target waiting time for tertiary infertility treatment will be considered.

A woman's age is the single most important variable that affects the success of conception. Women aged 35 to 39 have a 50percent less chance of conceiving spontaneously than women aged 19 to 26 years. Approximately 30 per cent of infertility is unexplained and the rest can be contributed to ovulatory failures, low sperm count or quality, tubal damage or conditions such as endometriosis. Lifestyle factors such as diet, smoking and substance misuse also influence a couple's chance of successful conception.

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