Thousands of couples aged under 40 may face a long wait for IVF treatment they have been promised on the NHS in England and Wales from next month, a fertility expert warned yesterday.
Simon Fishel, managing director of the CARE Fertility Group of private clinics, suggested that changes promised to end the present patchy provision could destabilise it.
About three-quarters of the current provision for a total of 25,000 couples is paid for privately, but 70% of this is expected in the long term to shift to NHS-funded provision.
There will also be a huge expansion in demand from women who could not previously have afforded it: 8,000 IVF babies are conceived each year, but this could rise to 13,000 eventually.
John Reid, the health secretary, has for the moment promised only one "free" cycle of treatment, but has made clear that the eventual plan is for the NHS to offer all three cycles thought to offer the best chance of pregnancy. This plan, based on guidance from the National Institute for Clinical Excellence, could add £85m to the NHS bill for fertility treatment in England and Wales.
Demand for IVF may rise by 80% in England alone. In some parts of the country NHS provision has hardly existed. Private clinics will still perform most procedures, under contracts with local NHS primary care trusts. They are nervous that costs will be driven down far below the £3,000-£3,500 a cycle which Mr Fishel suggests is common. Private clinicians fear that trusts will operate on tariffs of £2,700.
In the short term, clinics might choose to sign "loss leader" contracts, but Mr Fishel argued that bureaucratic and other costs may soon force the private sector into treating private patients only. Some smaller clinics may go to the wall.
The NHS would be faced with huge costs to build its own clinics. Meanwhile, there would be "overburdened NHS facilities, long waiting lists and a small number of high-quality, expensive private centres", Mr Fishel suggested at a conference in London organised by the Human Fertilisation and Embryology Authority.
Surveys by fertility drug companies and other interested groups suggested that two-thirds of trusts would not be able to fully implement guidance requiring three cycles, he said. Just under half had finalised plans to do so, while 15% did notintend to fully implement it.
Initially, the government has made it clear that priority should be given to couples with no adopted or foster children. Mr Fishel suggested that trusts would add other social criteria when determining funding, including whether couples had previously paid for IVF, how long they had lived in an area, and how long they had been together.
Alan Trounson, professor of stem cell sciences in Monash, Australia, outlining future fertility developments to the conference, said research in animals could eventually lead to women delaying the menopause, meaning they could have children well into their 50s.
Drugs could be developed in the next decade that could control the release of eggs.
