A friend once described having IVF to me as that familiar dream scenario: running towards something, getting nowhere, exhausted and straining to scream, but not being heard. It’s well documented that IVF is a physically and emotionally challenging process that millions of couples quietly face. Now, further cuts to the fertility services in the NHS mean women over 35 in many areas of England are facing even more hardship.
Since the beginning of the year, 13 different regions have restricted access to IVF to 30- to 35-year-olds only. What’s more, at least five areas now have a complete ban on funding IVF, and two-thirds of regions offer just one cycle. Financial cutbacks that aim to save trusts money, documented by latest research, have rendered IVF a “postcode lottery” of sorts.
The latest cuts are defying longstanding national NICE guidelines, which state women aged under 40 who have fertility problems should be offered up to three cycles of IVF. Women who are aged 40 to 42 should be offered one cycle, the guidelines add, if they meet particular criteria. But the Fertility Network UK showed that the scale of NHS cutbacks means that the number of clinical commissioning groups (CCGs) in England offering three full cycles of IVF has fallen by 46 per cent. Now, just 27 CCGs offer the recommended treatment. Areas that have drastically cut back include the Wirral, South Worcestershire, Redbridge and South Cheshire. Croydon became the first London borough to stop funding for IVF earlier this year, which saved the region £836,000 per year. More are reportedly considering the move.
Postcode lottery IVF is gambling with women’s reproductive health at time when they are emotionally and physically vulnerable
Some of the CCGs that have restricted their services say the age limit has been implemented to try and narrow the pool to those who are most likely to have successful treatment. Those outside of those brackets, presumably, will be forced to give up or go private – if they can afford the estimated £12,000 for two cycles at a private clinic. But it should be questioned at the very least, not solely because new protocols appear contrary to existing guidelines, which are being actively ignored in the name of financing, but because there’s an obvious inequality being implemented in their place. Speaking to The Guardian, Professor Simon Fishel, one of the pioneers of IVF in the UK, said that “if the country decides it will not fund IVF then fine, that is a decision that affects everyone… but what I cannot abide is the local variation for something like this, which doesn’t reflect local populations”.
It doesn’t reflect local populations, nor does it reflect or aid a female population struggling to juggle the myriad (often scaremongering) messages telling them how to be. Of course, fertility is finite. But a woman’s age and her fertility have dogged women’s progression in society for years – almost every week there’s a new study that accuses the vilified “career women” of “leaving it too late” to have children. Women are subjected to disproportionate pressure and responsibility regarding having children, the message being that our value declines with our fertility. Could restricting IVF to those aged 30 to 35 – a logistically difficult period for many to adhere to, with personal financial security so fraught – amplify the idea that women outside of that age bracket are deemed less valuable?
Perhaps. But perhaps stronger is the message that women are once again bearing the brunt of cuts, negotiating the risk – and the repercussions – of the financial crisis, and in a very uneven, unequal way. Guidelines are there for a reason and, so says a spokesperson for the health department, should be adhered to. Instead, postcode lottery IVF, regardless of any other wider issues surrounding it, is gambling with women’s reproductive health at time when they are emotionally and physically vulnerable. Exhausted, screaming, not being heard.