NHS funded fertility treatment--a national service in name only?

The variable nature of NHS provision of fertility services has again been highlighted by the response of commissioners to the recent guidance from the National Institute of Clinical Excellence. This paper describes an evidence-based model for policy aimed at minimising inequity across one Strategic Health Authority. The paper highlights the difficulties resulting from the current Department of Health guidance on targeting those in greatest need. A different way of describing this group is proposed, namely, defining childlessness in terms of parental status alone. This is clear to both patient and clinician at the outset, not subject to variable interpretation and because it is quantifiable for any given population, facilitates the commissioning of a level of service provision that reflects expressed need. A clinical audit suggests that the annual incidence of fertility problems prompting attendance at secondary care clinics is similar to levels observed nearly 20 years ago, at around 98 per 10,000 of the fertile population (proxy denominator, women aged 25 - 39). Our model further indicates that, for the more complex treatments, if both partners were required to be childless and treatments were to be delivered within 12 - 18 months of listing, commissioners would need to fund treatment for around 15 - 20 patients per 10,000 of the fertile population. If only one partner was required to be childless this figure would rise by 15 - 20%. We argue that despite the clinical guidelines, fertility treatments will remain a 'postcode lottery' unless central government addresses the priority to be given to fertility treatment on a national basis.