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Why Do Some Women Get Three Chances At IVF And Others Get One?

Grazia’s Emily Phillips – author of new infertility comedy TRYING – is about to embark on her one allotted round of NHS- funded IVF. To mark National Fertility Awareness Week, she asks, when will the IVF postcode lottery end?

As my husband Charlie and I finally face up to the reality of IVF after three years of not getting pregnant, I’m reluctant to say that this is our only chance. But it feels like it might be. Because as Charlie and I join hopeful couples at Homerton University Hospital’s mandatory information evening, we are told that, as residents of Enfield – unlike other East London areas that feed into their clinic – we are only eligible for one NHS-funded round of IVF (in vitro fertilisation).

Everyone else there, like my friend and colleague at Grazia Anna (right), receives three. As our round approaches, I’m trying to hold on to hope. But mostly I feel fear: about being open about

doing it, about the thrice daily injections and pessaries that burn, and about the inevitable emotional roller coaster. But my main fear is that it won’t work and then we’ll face even more setbacks than those years of desperately wanting a baby, as we attempt to self-fund additional rounds.

In National Fertility Awareness Week (30 October- 5 November), I’m joining the voices rallying on social media to start talking about the scandal of women being unevenly apportioned the ability to become a mother on the NHS. The NICE (National Institute for Health and Care Excellence) guidelines state that women aged under 40 who have been trying to get pregnant for two years should be offered three cycles of IVF on the NHS and that women in the same situation aged 40 to 42 should be offered one cycle of treatment*.

So why, like many women in their thirties (I’m 34) up and down the country, am I being told I’m only eligible for one? Because where we live doesn’t allow more. Individual clinical commissioning groups (CCGs) control their spending on IVF and ours has decided one cycle is enough. The injustice is hard to bear. It’s taken 18 months to even get to this point on the

NHS waiting list from first talking with the GP. By that point, we’d already been unsuccessfully trying to conceive naturally for 18 months. What followed was a never-ending list of doctors’ appointments, blood tests, tube dyes, egg counts and sperm samples. My empty womb has been investigated with meticulous zeal but the conclusion for us is the infernally unhelpful

diagnosis of ‘unexplained infertility’. They told us that IVF should be useful in our case, but throughout the process of being referred, no one could tell me how many rounds I’d be eligible for. Instead, I had to wait for Homerton’s information evening, where an impersonal slideshow told us that we were the unlucky third of the audience who’d receive only one round, while the people around us, who lived in neighbouring areas and would receive treatment at the same clinic, would have three chances. How comforting it must be to know you have those back-up options when stress has such a negative impact on whether or not IVF succeeds. But for me, all of the pressure is on this one shot.

In 2014, 48,165 patients had IVF in the UK. Breaking down the success rates per age bracket, my chances are between 29 and 32%**, which means odds are we’ll require three rounds before it will work. And with private IVF costing upwards of £6,000, self-funding an additional two rounds would be a massive undertaking. For us, with little savings and maxed-out credit cards, it’s not impossible, but will mean we can’t move house next year as we’d hoped (if you move to an area that gives you three rounds, you have to have lived at your address for two years to qualify, so that wouldn’t help us). The thing with family planning (indeed any planning ) when you’re facing infertility is you have zero control over your future. But I know we’re some of the lucky ones. For many people, gathering the cash together is impossible. And yet, in the UK, according to the Fertility Network, 60% have to pay for their own IVF treatment, taking on the financial burden as well as the emotional and physical roller coaster. Increasingly, fertility is becoming the preserve of the wealthy.

And yes, I hear the complaints from people who don’t require it – either by virtue of good fertility, or by choice of staying childless – that perhaps IVF isn’t a medical necessity. That it’s not a right, but a luxury to be given the chance to have a child. I see that the NHS, squeezed as it is, has so much good work to be doing, rather than funding an ‘optional’ lifestyle choice that creates another pregnant woman who needs maternity healthcare and a child to consume precious resources.

But what these people perhaps don’t see is that to many – and I’m not sure whether to count myself in that number with my ‘unexplained infertility’ – this is a medical necessity. Wanting to be a parent may not be an illness, but the ability to become one is often hampered by very real medical concerns.

Stacey Borland, from Spalding, is 27, and has endometriosis. Misdiagnosis for over a decade meant that her Fallopian tubes were so damaged that she had to have them removed three months ago. Now IVF is her only option for conception. Her healthcare authority, Peterborough, is one of the UK’s first to cut funding completely for IVF. This means she’ll have no option but to pay for private treatment. ‘After my operation, I had a mini breakdown. It’s almost like, after the blow of having the illness, it’s a second devastation not being able to have that chance to try, even though it’s not our fault. That’s why people get so frustrated, because you’re drained from this illness that’s causing the infertility and then it’s like you’re getting it from both barrels.’ Although Peterborough is her local hospital, Stacey lives in nearby Lincolnshire, so is waiting to find out if they will allow her one round because of her home address, not her hospital location.

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Emma Brewer, from West Hampshire, is 36. She was being referred for fertility treatment aged 33 when she got pregnant naturally. Tragically, her baby girl was stillborn. After trying again for another 21 months, she was referred for IVF again as she turned 35. Her local clinical commissioning group’s policy was only to treat women under 35 and they also ruled that, because she had carried one full-term pregnancy, she could not have NHS-funded IVF. She appealed, won, and had one round, which sadly failed. ‘People don’t realise how much of a postcode lottery it is,’ says Emma. ‘Since I’ve lost my daughter I’ve got to know other women who’ve gone through fertility issues after losing children andbeen given two cycles if they’re under 40.’

Following the medical hurdles, the process of undergoing IVF is littered with emotional obstacles that often feel insurmountable. I know that with every prick of the needle pumping you full of hormones, the rising resentment and hopelessness are difficult to manage. When treatments fail – as two rounds of self- funded IUI (intrauterine insemination) already have for us – you are at your lowest ebb, feeling as if the whole world is able to do something you can’t.

But with the risk of sadness and loss often comes the potential for joy. For my friend and colleague Anna Dewhurst, 37, this meant giving birth to Lou after four years of trying, a demanding round of IVF and a difficult birth. Because of her postcode, she was granted

the maximum attempts. ‘I was relieved I had three rounds,’ she says. ‘If I’d had to pay after only one round, it would have placed so much stress on the process. Having that back-up meant I was more relaxed and, thankfully, it worked first time. But once you’ve had a baby, you aren’t allowed more IVF on the NHS to conceive siblings, even if you struggle again.’

On 10 November it’s the 40th anniversary of the conception of IVF’s first success, Louise Joy Brown. Like Anna’s beautiful baby boy, I’m taking this as a lucky omen that maybe I’ll become a mother at last.

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