Fertility rights

GAIL Cox will never forget the moment she first held her twin baby girls Maisie and Isobel in her arms. She says it was an 'overwhelming' experience. It is for most mothers. What made it especially so for Gail and her husband Robbie was the fact that they had had so much difficulty conceiving.

After four years of trying, they had finally resorted to in vitro fertilisation (IVF). They were lucky. Gail became pregnant at the first try - but even so, throughout the nine months until her twin girls were born, she was hardly able to believe what was happening.

She says her feelings on first holding her two daughters were "the same as anybody else who has just had children for the first time - but maybe even extra strong, because we had had to wait so long. It was shock, it was joy it was just overwhelming. I couldn't believe it."

Gail and Robbie, from Holgate in York, were lucky in another way, too. Because they lived in York and met the region's eligibility criteria, they qualified for up to two cycles of IVF treatment free on the NHS.

Gail's friend who lives in Bristol was not so lucky. The health authorities there were not willing to fund IVF treatment. "So they weren't able to have it on the NHS," says Gail.

In desperation, her friend went private. The couple paid for three cycles of treatment - a huge financial burden for an ordinary couple to bear at about £3,000 a time. In the end, they still were not able to conceive.

It has left Gail feeling acutely aware of the postcode lottery that is the NHS - at least when it comes to something such as assisted conception. "We were so grateful that we could have it on the NHS," she says.

With his announcement that from April next year, primary care trusts across the country will be expected to fund at least one cycle of IVF treatment on the NHS for eligible couples, Health Secretary Dr John Reid took a step towards ending that postcode lottery.

It is a step that Helen Gration welcomes. Helen, wife of Look North presenter Harry Gration, turned to IVF to have children because Harry, who had three children from a previous marriage, had had a vasectomy before they met.

It meant that without IVF, Helen and Harry would not have been able to have children together. She, like Gail, required only one cycle to become pregnant - and the birth of twin boys Harvey and Harrison changed her life forever, says Helen.

"I would never have had the experience of being a mother," she says. "And it's an experience I would not swap for the world. There is nothing that can measure up to it. It has completely altered my perspective on life."

Helen and Harry had to pay for their IVF treatment because Harry already had children. But it doesn't make Helen any less convinced that the postcode lottery is wrong - and that IVF should be available on the NHS regardless of where you live, provided you meet the criteria. She "can't imagine how she would have felt" had she been unable to afford IVF and had lived in an area where she was denied simply because of where she lived, she says.

Just what Dr Reid's announcement will mean for desperate childless couples in York and North Yorkshire who are thinking of turning to IVF as a last resort, however, is not absolutely clear.

The National Institute for Clinical Excellence (NICE) which drew up the new guidelines on which the Health Secretary's announcement was based recommended three cycles of treatment should be offered free on the NHS to couples who qualified.

So far, however, Dr Reid has promised only "at least one". Offering three free cycles would lead to an 80 per cent surge in demand and was not achievable overnight, he said.

In York and North Yorkshire, this complicates matters because, until now, couples who were eligible have received two cycles of treatment free.

It is not impossible, concedes Sarah Barklam, a senior manager with the Selby and York Primary Care Trust, that the effect of Dr Reid's announcement could actually be to reduce the number of free treatments available to couples in the region.

It is very unlikely, however, that that will affect couples who have already been promised two cycles of treatment, she says. "My view is that it would be very difficult for us to apply the policy retrospectively," she told the Evening Press.

Another problem, however, is that the eligibility criteria set out by NICE are different from those that have, up until now, been applied in York and North Yorkshire.

Under the new national guidelines, the treatment should be available for couples in which the woman is aged between 23 and 39, provided they meet other criteria.

In our region, IVF treatment on the NHS has until now been limited to couples in which the woman was aged 35 or less when she was referred to hospital for treatment. This could mean that couples who were not previously eligible do now become so, Ms Barklam conceded.

The trouble is that there are many other eligibility criteria apart from age - such as how long a couple have been together, and whether either of them has children from a previous relationship - that also determine whether couples can be treated on the NHS.

The criteria used in different parts of the country vary, so there is still a need for much clearer guidance on what the new rules should be to ensure that access to IVF treatment on the NHS is the same for everyone no matter where they live, Ms Barklam said.

The Selby and York Primary Care Trust, along with three other trusts in the region, will be examining the new guidelines very closely over the next few weeks to see exactly what the implications are for patients in this area, Ms Barklam said.

Even without such worries over practicalities, there also remains a question mark over funding. Nationally, the estimated cost of providing three free cycles of treatment is £85 million.

York consultant gynaecologist Adrian Evans welcomes the principle of providing IVF on the NHS but questions where the cash is going to come from.

"It's all well and good to talk about what is good," he says. "But the government doesn't always feel the need to fund these things."

With so much uncertainty, it means there could be worry ahead yet for couples in York and North Yorkshire who are desperate to take the IVF route to parenthood, but can't afford to pay for it themselves.

Your at-a-glance guide to infertility

WHAT IS IVF?

In vitro fertilisation involves a woman being artificially stimulated to produce a number of eggs by the use of hormone treatment.

The eggs are then 'harvested' by the insertion of a needle into the ovary and then mixed in the lab with the partner's sperm.

The resulting fertilised embryos are placed back into the womb.

Donor sperm and eggs can also be used where appropriate.

The chances of a successful pregnancy increase with the number of embryos returned to the womb, but this also raises the risk of a multiple birth.

According to the National Collaborating Centre for Women and Children's Health, which developed the new guidelines for NICE, multiple births carry increased health risks for both mother and babies.

So the guidelines include a number of recommendations designed to reduce multiple pregnancies.

These include suggesting that no more than two embryos should be transferred in any one cycle of treatment.

FACTFILE

As many as one in seven of couples in the UK experience some form of problem with conception. Not all will need to resort to IVF treatment, however.

There are other less invasive procedures such as intra-uterine insemination (IUI).

Under the new guidelines, IVF is recommended for couples where the woman is aged between 23 and 39 years at the time of treatment and where there is an identified cause for their fertility problems (such as absence of sperm or blockage of both fallopian tubes) or where the couple have been trying without success to have a child for three years.

At present about 32,000 couples have IVF treatment in England and Wales each year, with only around 20 per cent of those having the treatment on the NHS - a level of access that is well below that in many other European countries.

When the NICE guidance is fully implemented, the number of people having IVF will almost double.

Patients from the York and North Yorkshire region are generally sent to the Leeds General Infirmary for IVF treatment.

At the moment there are thought to be between about 120 to 150 couples from the region on the waiting list for IVF treatment.

The waiting time can be anything from 18-24 months.

The pregnancy success rate for couples who have had one cycle of IVF treatment is 25 per cent.

That doubles to 50 per cent among couples who have had three cycles of treatment.

Updated: 09:45 Thursday, February 26, 2004