Treatment for infertility should not be offered on the NHS. Do you agree with this statement? (20 marks)
Common mistakes
● Details of infertility treatment
● Complications of infertility treatment
● Rationale for treating infertile couples
● Centres for treatment
● The law on infertility treatment
A good answer will include some or all of these points
● Infertility is a disease
● Treatment is both necessary and important
● World Health Organization’s (WHO) definition of disease (not only the absence of
infirmity)
● Cost implications deter ready availability of this treatment on the NHS
● Other mundane conditions being treated – stripping varicose veins, plastic surgery, sexchange operations, etc.
● Rationing in other disciplines
● Problem of making it available to all on the NHS
● Abuse
● Diverting scarce resources from other important areas to infertility
● Ideal – combining funding?
● Conclusion – may be a place for investigating and treating, but not for all cases, and not
every unit should offer advanced assisted reproduction techniques – to ensure compliance with the law and improved success.
Sample answer
Infertility affects about 15 per cent of couples in the UK. There are many causes of this condition, most of which can be corrected at the primary and secondary levels.
However, in some cases, more extensive and advanced investigations and treatment are required.
The controversy about treating couples with infertility is often focused on these advanced therapeutic
modalities. Infertility is a disease and deserves to be treated like any other disease.
The WHO
defines a disease as not merely the absence of an infirmity but complete psychological, physical and mental wellbeing.
Couples with infertility, although they may not have a physical disability, have a psychologically disabling condition which deserves the same treatment offered
to others with depression, anxiety and physical disorders.
The arguments for or against treating patients with infertility concentrate on the absence of
physical disability and, therefore, failure to conform with the definition of disease.
More importantly, because of the rapidly advancing technology in this field, cost implications for
various health authorities are quite enormous. Another point often advanced against offering
treatment is the low success rates, especially that following the advanced infertility treatments.
Are these really justified?
Not all cases of infertility require advanced treatment methods. For those cases where the
cause can easily be identified and adequate treatment offered, the results are very good. In fact,
the treatment is often considered by most as being cost effective.
However, for the advanced therapies, the success of the regimens varies, but is usually in the region of approximately 15–25 per cent ‘baby take-home’ rate.
The suggestion that all infertility treatment should not
be offered on the NHS is therefore not valid for the cases that can be managed at the primary
and secondary levels. For the cases requiring advanced treatment, the cost argument needs to
be supported.
Within the NHS, rationing is an important process and allows prioritisation of treatment
because of inadequate resources. However, there are many minor medical conditions that are
treated, despite the need for rationing, e.g. stripping varicose veins, cosmetic plastic surgery
and sex-change operations.
It could be argued that most of these treatments are not essential
and are unnecessary. However, the reasoning behind treating these conditions is the severe
psychological consequences that failure to treat may have on patients.
Infertility is known to consume the whole life of couples, affecting their work, relationships with colleagues and families, and has been known to cause marital disharmony and psychiatric illness.
Therefore, treating couples with infertility indirectly treats these associated problems.
The NHS aims to treat all, irrespective of the problem. Infertility is a disease and therefore
deserves to be treated within the NHS.
But is it life-threatening compared to other conditions,
such as cancer and cardiac diseases? This argument is unsubstantiated as many other illnesses
being treated in the NHS are not life-threatening.
If the arguments against offering tertiary
treatment for infertility are that limited resources for important health conditions will be
diverted to the treatment of this condition, a similar argument could be advanced for the
treatment of other non-debilitating conditions.
Therefore, the argument about treatment must be similar to that for other conditions. In an
ideal world where resources are limitless, this would not arise.
It is important to acknowledge
that rationing is an integral part of the NHS and will remain so for a long time to come.
Where resources are limited, there may be a place to limit the treatment of couples with infertility to
that offered at primary and secondary levels.
However, tertiary treatment must be made available but in a few designated centres where expertise and wide experience exists in order to improve the success rates. Regulating practice is important to prevent abuse.
The principles of rationing require that all cases are assessed on merit and treatment offered when it is considered to be necessary. Couples with infertility being refused treatment on the NHS are being
treated unfairly and that undermines the fundamental principles of the NHS.
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