IVF

I posted the link on Sunday because I didn't have time for a more considered piece. The ensuing comments demonstrated that it is a subject guaranteed to create a debate.

As far as I am concerned, there are two separate strands to the debate. One relates to the public expectation that the NHS should not be rationed. The second relates to differing views on childbearing.

Before the NHS was set up, there was a belief that demand for its services would dwindle , whereas, not only has demand increased but so have the cost of treatments.

Most people have an expectation that their health needs will be met (eventually) by the NHS. This is certainly consistent with the founding principles. In practice this is not the case.

Perusal of any news source will find examples of patients denied the care they believe they need, often because of the 'postcode lottery'. Often, too, because of a clinical judgement that the patient will not benefit from the treatment. (To the patient, it's always worth giving it a go).

The demands on the NHS are numerous. An ageing population - "In 1951 there were 0.2 million (0.4 per cent of the population) people over 85 , while Census 2001 shows that this has grown more than fivefold to over 1.1 million (1.9 per cent of the population)." As the body wears out, there is more need for healthcare.

Many of us refer to the NHS with illnesses and injuries that are to some extent self-inflicted. Speak to anybody who has worked in Casualty about the proportion of admissions that are alcohol-related. Consider the cost to the NHS of Class A drugs. Add in hazardous hobbies such as DIY, football. Add RTAs. All of these cost the NHS money, and could be avoided, or, alternatively, could be covered by insurance.

Discussions about rationing of healthcare stall because of lack of agreement on how to ration it. It would be inequitable and inhumane to limit healthcare only to those who have a current or future economic benefit to society. Perhaps healthcare should be given only to cure, eliminating organ transplants and thus avoiding the need for costly aftercare, including drugs. More reasonably, there is an argument that treatment should only be limited to conditions that that will significantly shorten life.

The latter would rule out treatments for serious, life-limiting but not fatal conditions such as multiple sclerosis, or indeed, mental illness, which is slowly moving from Cinderella status.

It would rule out much reconstructive surgery - is it really necessary to reconstruct a breast after mastectomy. Or rebuild scar tissue following a car accident or fire?

Is infertility an illness. From a purely pathological - some might say Darwinian - viewpoint, failure to reproduce is a malfunction of the body, and, therefore, somebody with infertility is as entitled to treatment as anybody else with any pathological malfunction.

That is pre-supposing that the infertility exists in a vacuum. It rarely does. Much female infertility is caused by conditions such as Polycystic Ovaries, Endometriosis or Chlamydia. Taking PCS as an example. Not enough is known about it, but it is part of a cycle of obesity and diabetes. The last I heard the medics hadn't quite worked out what caused what. It is generally treated by Endocrinologists rather than by gynaecologists. Its superficial symptoms are hirsutism and spots. Other symptoms include absent, irregular or heavy periods, and, as I learnt some months after admission for suspected appendicitis/kidney infection, it can also cause excruciatingly unbearable abdominal pain.

I don't suppose many people, other than the craziest of Conservatives, would deny treatment for the above symptoms, despite the fact that they are rarely fatal. The philosophical question then has to be asked - how far is it permissible to go treating a condition? With non-reproductive conditions, it is generally 'as far as necessary (possible?) without harming the patient. Reconstructive surgery following a mastectomy will often also include a 'boob job' on the unaffected breast to ensure an even match. Why should the desire for even and pert boobs be regarded as clinically important and not the desire to reproduce?

When a couple decide to refer after, say, two years, of trying for a baby, the doctor will not immediately put them down for IVF. A sperm count is done on the man; the woman will have blood tests and scans etc to determine whether ovulation occurs. Drugs will be prescribed to boost ovulation, and failing that further, more invasive tests will be carried out. Stronger drugs will be prescribed. IVF is generally the last resort in fertility treatment, short of surrogacy.

There's often an assumption that repeated failure to conceive can cause depression and that this is due to societal pressure to have children. No doubt in some cases it is. Not everybody does become depressed. Some people take failure stoically, perhaps little differently from people who are frequently made redundant. Indeed, I have heard it said that people who are clinically depressed by infertility make poor candidates for treatment.

I find that people who are most critical of NHS resources being spent on fertility treatment are those who have had no problems conceiving (perhaps even slightly resent this fact) or have made a decision not to reproduce, or had a decision forced on them for non-medical reasons. It is galling to many infertile women to hear these criticisms, especially when abortions seem to be so easy to obtain on the NHS (they're not, actually). It is also galling to hear all about the right to choose not to have a child and yet be presented with the impression that a woman doesn't have the right to choose.

I see no contradiction in the feminist belief that a woman has the right to control her own life, including her own fertility, with the belief that a woman has the right to be treated for conditions that cause infertility. Of course, some people reproduce casually, when unable to support the child. Others do so out of a sense of obligation. I just find it difficult to believe that people who are casual about conception, or merely feel an obligation, will be prepared to put themselves through years of frustration and pain in order to reproduce.