PREGNANT PAUSE BEFORE IVF BABY BOOM
Fears NHS will struggle to cope when rules change
The NHS will struggle to fulfil promises to couples seeking IVF treatment after a big change to the rules, doctors have warned.
From next month, couples with a child from a previous relationship who are struggling to conceive together will be allowed to seek NHS IVF treatment.
The change, along with a decision to guarantee three cycles to every eligible couple instead of the previous two, is designed to end a postcode lottery for patients.
But IVF specialists warn that the NHS will need to dramatically increase capacity if they are to maintain their commitment to assessing all patients within a year. And there are growing fears some patients will deliberately delay seeking treatment until the three- cycle rule comes into play next year, which could hamper their chances of success.
Marco Gaudoin, fertility expert at the Glasgow Centre for Reproductive Medicine, said: “I applaud the Scottish Government for their decision to change el igibi li t y criteria.
“But if you speak to the clinics, they say t he y don’t h av e the capacity and they don’t have the money.
“To go from two to three cycles, they need 50 per cent more money or waiting times are going to go up.
“We see patients who say there is no way they are being treated within 12 months.
“And as waiting times go up, patients will seek other options. But unlike other things in medicine, fertility is so age-dependent.
Gaudoin was backed by Dr Samra Khan, fertility consultant at the Nuffield in Glasgow, who also believes the changes will make it difficult for the NHS to meet their targets.
She said: “There may be an increase in patients by a third, that’s a significant increase and that will impact on waiting times and services will have to be expanded more to meet those targets of one year.”
The latest changes follow a raf t of recommendations by the National Infertility Group, who published their report in March.
Last night, the Scottish Government said that demand from couples where one partner has no biological child could increase by up to 15 per cent.
And they said there could be a further increase in demand of 10 per cent because patients are guaranteed three cycles.
Last year, there were 2015 treatment cycles carried out in Scotland on the NHS – but that does not translate to 2015 couples having treatment, as some will have had two cycles over the course of the year.
The GCRM perform around 900 cycles a year while Nuffield do around 200.
Some patients also opt to fund their own treatment through the NHS if they do not meet eligibility criteria.
Pregnancy rates on IVF can be as low as 25 per cent for some age groups and generally not much higher than 40 per cent.
According to IVF regulator the Human Fertilisaton and Embryology Authority, overall success rates continue to rise and the IVF birth rate has increased to 26.5 per cent nationally.
The latest Scottish Government figures showed that, under the previous rules, all patients were seen within the agreed 12-month waiting time.
But Khan said this does not mean patients actually started treatment after a year. And she warned that some couples could delay approaching the NHS so that they qualify for three cycles of treatment – which she says
could lead to disappointing results for couples, whose chances of success reduce with age.
Khan said: “Next month we will have the inclusion of those with a child at home and from April 2017, couples will be guaranteed three cycles.
“But the NHS may see a lull before a flood in numbers. It is not advisable from a clinical point of view. Increasing age is the most important factor.
“But the public might perceive it differently and delay even their first consultation by potentially 18 months if they wait from now until next April.”
The latest announcements form part of a commitment by the Scottish Government to introduce equality across fertility services, regardless of where patients live.
First Minister Nicola Sturgeon promised to end the inconsistency during her time as health minister.
The average cost of IVF per cycle now sits at £ 4147 in the NHS.
Private providers operate in a lucrative
market, charging between £3400 and £ 4300 per treatment. But the big money doesn’t guarantee succeess for the patients – or the providers.
Last year, the IVF unit at Spire Murrayfield closed their doors after five years.
They said at the time: “While we’re delighted that more patients are able to access NHS treatments, this does mean that the clinic has seen a reduction in patients since opening.
“As NHS-funded patient places continue to increase and waiting times come down, it is inevitable that the clinic’s numbers will continue to decline and so we have reached the difficult conclusion to close.”
Though Gaudoin and Khan believe the NHS will struggle to meet their commitments under the new rules, the Government insist they will not look to reverse the trend that led to Spire’s closure by turning to private providers for help.
And they say funding for additional cycles and increased capacity will be met – despite warnings that more than £ 400million is being axed from budgets in Scotland.
A Scottish Government spokesman said: “Introduction will be managed carefully so that health boards have the capacity to cope with the increase in patients – this will not involve the use of private operators.”
One health board, NHS Lothian, are confident of meeting demand after seeing their waiting list plummet in recent years.
The board’s consultant in public health medicine, Dr Graham MacKenzie, said: “We are starting from a very strong position because our service has good outcomes and our waiting times are well within the national target.
“We will monitor the level of demand to support the offer of a third cycle of IVF for eligible couples so that we ensure that capacity is in place to meet the changes in the national criteria.”
Charity Fertility Network Scotland have welcomed the Government’s plans.
Scottish branch co- ordinator Gwenda Burns said: “I think the Government are being sensible by implementing one criteria next month and leaving it six months before another one comes in.
“That will allow them to revisit the expected increase in cases in the new year.
“Our concern will always be that patients are treated as soon as possible to give them the best chance of success.”
Patients say there is no way they are being treated in the next 12 months