All couples who have unsuccessfully tried for a baby for two years should have a right to three complete cycles of fertility treatment on the NHS, according to draft guidelines published today, potentially ending heartbreak for many - but at huge financial cost.
The national institute for clinical excellence (Nice), which has put the guidelines out for consultation, has not been asked to consider the cost of IVF for all who need it and estimates vary wildly, but there is no doubt the bill could be large. About 45,000 couples a year seek treatment and 27,000 couples a year receive it, mostly in the private sector because some health authorities will not pay and others operate strict rationing and have long waiting lists.
IVF - test-tube fertility treatment which involves stimulating a woman's ovaries to produce eggs and then mixing them with her partner's sperm - costs £3,000 a cycle in a private clinic, but the cost within the NHS could be as low as around £1,700. Not all couples will need IVF - some may just be prescribed drugs to aid ovulation. But even if only 20,000 more couples had three cycles each of IVF, it would cost the NHS at least an extra £100m.
The government has, however, recognised the injustice to the desperate couples who cannot afford to pay in some parts of the country. Alan Milburn, the former health secretary, said in November 2000 that the current state of infertility services was "a very real cause for concern".
Announcing his intention of asking Nice to formulate guidance, he said a Department of Health survey "shows huge and unacceptable variations in access, funding and provision of infertility services between different parts of the country. Different treatments also have very different success rates.
"The lottery of care in infertility services is glaring, obvious and it is unfair. It is causing undue hardship and distress to many couples. It is high time it was brought to an end."
Nice recommends that couples should be treated promptly and appropriately, so money is not wasted. Women should be eligible if they are aged 23 to 39 but younger women can be treated if the cause of their infertility is known.
Couples should be told that 84% would conceive in a year after regular intercourse, and 92% within two years. They should be told that smoking and obesity could reduce their fertility, but that tea and coffee would not, and that it is uncertain what effect tight underpants have on men's sperm production.
Once tests have established that a couple appear not to be able to conceive, they will be eligible for three attempts - or cycles - of IVF involving ovarian stimulation with drugs to increase the number of eggs produced. If there are eggs left over from an unsuccessful attempt, they should be frozen.
The clinic should attempt to fertilise and replace those eggs in the womb before undertaking a second complete IVF cycle, so effectively the couple could get up to three attempts with fresh eggs and three with frozen. No more than two embryos should be replaced at a time to try to avoid multiple pregnancies.
Child, a national support organisation for infertile couples, welcomed the draft guidelines. "The emotional impact of infertility on a cou ple's life is devastating, and finding themselves unable to access the treatment they need on the NHS, causes further distress at an already painful time in their lives," said spokeswoman Sheena Young.
Speculation about the potential cost of treatment for all on the NHS had caused much concern, she said. "We do of course appreciate that providing a fully funded NHS programme for the treatment of infertility, will cost a significant amount of money. There are, however, areas where savings can be made, such as stopping repeat investigations, inappropriate treatment and reducing the cost of multiple births."
Infertility in most cases had a medical cause, she pointed out, and needed treatment.
