For the one in seven couples who encounter fertility problems, yesterday’s announcement that the eligibility criteria is to be widened to provide for three cycles of IVF treatment on the NHS instead of two is a significant development.
The Scottish Government’s forward-looking approach means the system is now considerably more equitable. The decision adheres to the enshrining principles of the NHS which aim to provide care for all, free at the point of delivery and based not on the ability to pay, but clinical need.
Of course, there are those who argue that the treatment of life-threatening conditions should take priority. It is a reasonable point, but proper consideration must be given to the ruinous effects infertility can have, wrenching apart relationships that seemed unbreakable and consigning people to deep troughs of depression. Having a child is not the only way to enrich a life with meaning and purpose, but the yearning for parenthood is a force that cannot be underestimated.
The changes to the criteria, which also bring an end to the absurd ban on treatment for couples with a child at home, have resulted in some predictable headlines, with one pointing to a pending “VF baby boom”. Nothing could be further from the truth. The numbers involved remain modest. A mere 1,326 cycles were paid for by NHS boards across in Scotland in 2015-16, with a further 758 funded by the Scottish Government. The same report noted that Scotland is set to become the “IVF capital of the UK”. That may be the case, but it is worth emphasising that such a populace would be at home in a small village, not a city.
Those who have inhabited this unique place know only too well that yesterday’s decision is cause for encouragement, not celebration. Several close friends have sought to conceive through IVF in recent years. Some have been successful, others have not. In every case, the experience has given them cause to question what it means to hope.
It is an emotion that helps map out the future for couples who would otherwise see no light. Those who understand its limitations know to try and prepare as best they can for the worst, though hoping for the best grants them patience and fortitude. One friend told me how she was repeatedly told at the start of her treatment that there were no guarantees, a fact she was able to reconcile with a cautious optimism.
“I realised I had already mourned in a sense because I couldn’t conceive naturally,” she explained. “That acceptance was hard. I think it helped immensely when it came to starting IVF. It made it easier to believe things might turn out good because I knew I could process the pain and the loss if they didn’t.”
In her case, it took five cycles and six long years before she had her wish of becoming a mother granted. Along the way, she has been forced to sell her house and car in order to finance the treatment and she remains in considerable debt. The sacrifices are worth it. “I wouldn’t change a thing,” she reflects. “You become incredibly single-minded and everything else seems unimportant, or less important.”
For so many others who started out with a similar grounded view, the journey that sees an unwavering hope harden into a stubbornness can have devastating consequences if failure is its ultimate destination. What starts out as a source of reassurance mutates into a darker force, one that amplifies the pain and makes the continued absence of children keenly felt.
Another friend and his wife went through two unsuccessful cycles of treatment before deciding they could no longer face the despair that followed the longing. “We felt it was beginning to jeopardise the rest of our lives,” he said. “We wanted to have a baby desperately and we still do. But not at any price.”
When I texted him last night to ask what he thought about the changes to fertility treatment in Scotland, he replied: “It’s very good news but anyone who goes through one IVF cycle needs a huge amount of emotional support.
“You need that even more if you decide to do it all over again. It makes you obsessive.”
While much of that strength can be drawn from family and friends, the Scottish Government and NHS boards across the country must also make sure the support it has in place for those undergoing IVF treatment remains robust alongside the treatment itself. The SNP administration deserves great credit for helping improve the provision of care in this field, but as any politician will attest, raised standards means raised expectations.
Top-up funding has helped bring down waiting times significantly. In Grampian, the average waiting time was three years and eight months in December 2012; now, it stands at six to nine months. This is a commendable achievement, but it will require sustained investment in order to maintain, let alone improve such performance.
The government currently provides for 40 per cent of the nationwide costs for IVF. Such a high subsidy is unusual for a mainstream medical treatment, but if Scotland wants to make good on its progressive approach to fertility treatment, it must be in it for the long haul. It is a fine challenge to aspire to and if met, it will change lives for the better. Along the way, however, there will be those who find their dreams of starting a family go unrealised. The impact of the new eligibility criteria will be measured by birth rates, but the definition of its success should go beyond statistics to consider how we comfort those who discover hope is sometimes not enough.