Women aged 40 and over could be given free IVF treatment

Women aged 40 and over could be given free IVF treatment

Women aged 40 and over could be given IVF treatment on the NHS for the first time, following a review by the health rationing watchdog.

The National Institute for Health and Clinical Excellence (NICE) is considering scrapping its controversial age limit on treatment to make sure they comply with anti-discrimination laws.

Instead, infertile women could be granted or denied treatment based on tests which estimate how many eggs they have left. While this diminishes with age, the timing varies with each women.

It could also mean that younger women are denied treatment.

Last night fertility experts were divided over the idea, with some saying they would welcome getting rid of the "unfair mess" that exists today, while others warned that the new proposals would be unnecessarily complex and expensive.

The current guidance says all infertile women aged between 23 and 39 should be offered three cycles of treatment for free on the NHS, however few Primary Care Trusts (PCTs) meet this in full.

NICE is currently reviewing the guidelines to make sure that they comply with the Equality Act passed by the previous Government which promised to end many types of discrimination.

Documents seen by The Sunday Telegraph disclose that the rationing body is also considering how to ensure lesbians and single women have the same rights as heterosexual couples for treatment if they are thought to be infertile.

Rules which deny treatment to those whose partners have children are also likely to be axed, according to the minutes from a NICE committee debating the issues.

No decisions have been taken on any of the ideas which are intended to promote "equality of opportunity".

Clare Lewis-Jones, chief executive of the Infertility Network, a support group for those trying to have children, welcomed the idea of scrapping age limits.

"I think measuring ovarian reserve [the number of eggs a woman has] is a better way to make rationing decisions than age, but I would be concerned if any women interpreted this as meaning that age is not the key factor which determines their chances," she said.

"People read about women having children in their 40s, and often think their chances of babies late in life are better than they are – age is still the number one factor which determines fertility."

She said the review needed to take account of fundamental unfairness in the way different decisions were taken across the country.

Although NICE provides national guidelines, most PCTs do not follow them in full, with some setting more limited age restrictions, and most offering fewer than three cycles of IVF.

"The current situation is just a mess," Ms Lewis-Jones said.

Dr Allan Pacey, a fertility expert from Sheffield University said: "I think its logical to move away from age guidelines to those based on ovarian reserve. It is very unfair at the moment."

Glasgow Centre for Reproductive Medicine has the world's largest database of ovarian reserve, with records of more than 10,000 women.

Dr Marco Gaudoin, the centre's medical director said it was time for NICE to catch up with improvements in science and research demonstrating that the tests could provide a reliable predictor of fertility.

He said: "We have been pioneering ovarian assessment for years.

"We see 40-year-olds who are not allowed treatment on the NHS, and we find out often that in fact they have a pretty good ovarian reserve, and a good chance of successful treatment."

But Alison McTavish, secretary of the British Fertility Society cautioned against some of the changes.

"If you have to take decisions about rationing, age is a pretty good predictor of outcomes. Doing specialist tests on women to check their ovarian reserve, and investigations is a very expensive way of trying to make the system fair."

Minutes of NICE's committe drafting the scope of new guidance describe "strong support" for consideration to be given to the use of ovarian reserve tests, in place of simple age restrictions.

The minutes note: "Commissioners need clear agreed guidelines across England and Wales.

"Sometimes younger women with less chances of getting pregnant (based on ovarian test results, previous cycles, etc) get funded whereas older women with better chances don't."

Dr Gillian Lockwood, a fertility doctor and vice-chairman of the Royal College of Obstetricians and Gynaecologists, criticised what she described as "confused thinking" within the discussion paper.

She said: "It is not clear whether they are trying to design a mechanisms to protect themselves from the anti-discrimination lobby, or trying to set criteria which give women the best chance of a successful pregnancy".

"NICE seem to think that the best thing is to spend money on those with the best chance of a pregnancy; there is nothing fair about that at all."

NICE has just finished a consultation on the scope of the guidance, but it will not agree the new rules until 2012.

The documents do not propose extending the right to fertility treatment for most lesbian or single women seeking children, but suggest that those believed to suffer fertility problems should have the same access to IVF as heterosexual couples.

Read more about IVF and looking for a known sperm donor.

Posted: 27/06/2010 10:03:56


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