Rationing fertility services in the NHS: the patients' viewpoint

The aim of this article is to give the patients' viewpoint on the provision of infertility services by the NHS, to discuss how patients see this provision as a form of rationing and to consider the ethical aspects of this situation. Most patients seeking treatment to enable them to conceive are treatable and therefore the term subfertility should be used rather than infertility. Fertility services such as the NHS do not ration contraception and obstetric care, so why should subfertility services be different? Access to treatment is entirely dependent on where a patient lives and this situation is totally unethical. The area of reproductive medicine in which this inequality is most apparent is assisted reproductive treatments such as in vitro fertilization. The situation in the UK varies widely and this variation will soon become more marked as the Scottish Office Department of Health has announced a national service framework for commissioners of subfertility services that will ensure equity for patients. What about the rest of the UK? There are some areas in England and Wales that are quite well funded, but there are still many health authorities that refuse to fund assisted conception techniques, and in Northern Ireland there is no funding for these treatments. The emotional aspects of subfertility must not be forgotten: patients experience depression, tearfulness, anger, grief and, most worrying of all, some experience suicidal feelings. The changes to the system in Scotland were mainly due to patients and professionals campaigning together, as a partnership. Their success should be an example to the rest of the UK.