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Fertility, infertility and assisted conception

Updated Friday, 24th February 2012

Fertility problems can cause significant emotional distress. Sarah Earle discusses the options available to those looking for assistance

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A recreation of the IVF procedure Copyrighted  image Icon Copyright: Jupiterimages In most Western countries (and in some other parts of the world) many people spend much of their lives controlling or curtailing their fertility. This ranges from practices designed to prevent conception and avoid pregnancy altogether, to those that delay pregnancy or serve to limit the size, or spacing, of families. Indeed, there is an overwhelming focus on preventing unwanted pregnancies, and teenagers—in particular—are constantly bombarded by messages that promote contraception and safe sex. Whilst these messages are entirely necessary, they serve to create and reinforce the notion that fertility is endless and abundant.

In stark contrast, fertility is often finite (particularly for women) and many people experience either short or longer-term infertility. According to the Human Fertilisation and Embryology Authority (HFEA, 2010), one in seven couples will experience a period of infertility—or a ‘failure to conceive after frequent unprotected sexual intercourse for one to two years.’ (see NICE, 2004) In Britain, infertility affects 3.5 million people at any given time but, for the majority, this period of infertility will resolve without further intervention.

Of course, some people who experience infertility will not seek treatment and will remain ‘childless’, or ‘childfree’. Others will explore their options and may consider adoption, or fostering. It is also important to remember that there are other ways to become a parent. Modern families, created through different living arrangements, marriage, remarriage, divorce and separation, mean that ‘social parenting’ has become much more common and provides another route via which individuals come to parent children (for example, step-children) that are not biologically their own.

If and when individuals choose to seek fertility treatment there are numerous options available. This can include drug treatment (to trigger egg production), surgery (for example, to retrieve sperm or unblock fallopian tubes) or lifestyle changes (since behaviours such as smoking, drinking alcohol and being under or over-weight are known to affect fertility). A range of assisted reproduction technologies (ARTs) are also available including intra-cytoplasmic sperm injection, donor insemination and gamete intra-fallopian transfer. The most well-known of these ARTs is probably in-vitro fertilisation (IVF). The first IVF or ‘test-tube’ baby was born in 1978 and in the UK alone there are now over 12,000 IVF babies born each year. According to the HFEA (2010), although the prevalence of infertility has remained about the same, the number of IVF cycles performed and the number of patients being treated for infertility using this method continues to rise.

Treatment options are, of course, dependent upon whether male of female factor infertility is present, the age of the patient, and so on. But access to fertility treatments also depends on where you live. In the late 1990s mounting evidence revealed a ‘postcode lottery’ of extreme variation in the amount and type of fertility treatment offered by NHS trusts. Since then, The National Institute for Health & Clinical Excellence has published guidelines (NICE, 2004) which set out the best forms of treatment for people who have difficulties getting pregnant. The guidance recommends, for example, three free cycles of IVF treatment for couples experiencing fertility problems.

However, a recent report published by the All Party Parliamentary Group on Infertility (2011) reveals not only that the postcode lottery for fertility treatment still exists but that the situation is worsening! The report, which draws on data collected through Freedom of Information requests to Primary Care Trusts (PCTs), reveals that 73 per cent of PCTs are offering less than the three cycles of IVF treatment recommended by the NICE guidelines.

The report urges the NHS to regard fertility problems as a legitimate clinical need and ‘to uphold not only the letter of the NICE guidelines but also the spirit’, acknowledging the fact that fertility problems can—for many people—be a considerable source of emotional distress, leading to family breakdown and ill-health.

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