The number of people seeking IVF treatment for infertility is increasing.
Treatment is already rationed: several health boards in Scotland have reduced the number of IVF treatment cycles they offer from three to two. But the waiting lists continue to grow and the NHS budget is shrinking.
Fife Health Board has now taken the controversial step of requiring both partners to be non-smokers and women not to be significantly overweight before they can have IVF. This is to improve both their chances of a successful pregnancy and better outcomes for mother and baby. Despite the board committing an additional £100,000 to fertility treatment, however, it has been severely criticised by the Infertility Network, which supports couples unable to conceive, for limiting the service.
The decision reflects the increasing dilemma facing clinicians and decision-makers in the NHS. So many more treatments and technologies are now available that the budget cannot keep up. When additional savings are required, restrictions are inevitable.
As a medical condition that blights lives but is not life-threatening, fertility treatment has suffered from low priority. But as many women do not discover they cannot conceive until into their 30s and male fertility has been gradually declining, demand is growing.
It is now well established that smoking contributes to both male and female infertility. Couples undergoing treatment will therefore have a better chance of success if neither of them smoke, and they take other measures to optimise their health, such as limiting alcohol and not being overweight.
Fife is not alone in refusing IVF to smokers; Forth Valley also requires both partners to be non-smokers and both are right to do so. It may seem harsh to deny treatment to couples whose self-esteem has already been dented by infertility but they have a real incentive to stop smoking and should be given help to do so. If a service has to be rationed, it makes sense to treat patients with the best chance of success.
The refusal to treat smokers must raise questions for other branches of medicine as more people suffer from diseases due to smoking, excessive alcohol consumption, drug taking or overeating and the cost to the NHS rockets. It is reasonable to require a patient to lose weight or stop smoking before an operation if it will improve the outcome but at what point should we draw the line?
If there is a criticism of Fife's decision to impose new criteria it is in the timing of the announcement. The Scottish Government's National Infertility Group is currently reviewing all criteria for access to IVF. There have been far too many anomalies in fertility treatment across the country, including how many cycles patients are entitled to and how long they have to wait as well as varying restrictions on age, smoking and weight. The group is about to publish its report.
It would be sensible – and fair – for health boards to await the outcome so that access to treatment is on an equal basis throughout the country.
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