Is Raising the Age for Ivf Treatment to 40 Cost Effective on the Nhs?

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The intention of this assignment is to highlight the fact that women are becoming mothers later in life and that doing so is adversely affecting their chances of conception. Since the introduction of IVF on the NHS the amount of people having treatment has increased over the years and so have the success rates, which have increased with developments in techniques and technology. As women are having children at an older age, it will be discussed whether it is necessary and cost effective for the NHS to provide fertility treatment to women up to the age of 42.

The age factors that affect the outcome of IVF will be investigated and comparisons made between the age groups, using data collected by the HFEA. One of the questions to be investigated is whether a woman’s age should be used as a factor for denying treatment, as some evidence suggests that using Ovarian Reserve testing is a much better indicator of the chances of success than age alone. This will then form the basis of the argument of whether or not raising the age limit on the NHS is cost effective in conjunction with the NICE draft Guideline Cost Effectiveness Studies.

This topic has been chosen as it is contentious, evocative and highly emotive. It is currently in discussions with the government and relevant authorities and organisations, and the draft guidelines set out by the National Institute for Clinical Excellence are in the process of being evaluated. This guideline will be summarised and a comparison made with the documents produced by the Primary Care Trust for Plymouth.

This essay will primarily focus on the age criteria for treatment and theories and professional opinions around this. The ethics of IVF and the physical process, although relevant, will not be discussed but a glossary of terms will be included.

According to the Office of National Statistics (ONS), the average age of women giving birth has steadily increased in all four UK countries over the last 25 years. In 2000, fertility rates were highest among women in their 20's. By 2010 this had increased to early 30's in England, Scotland and Northern Ireland. (ONS, 2011) These figures tie in with the HFEA Trends & Figures (HFEA, 2011) which state that the average age for women being treated in 2010 was 35.1 years, an increase of 1.5 years since 1991.

Age affects which IVF treatment is received, in that the proportion of women using donor eggs increases with age due to the natural decline in the woman’s egg quality. (Alviggi, et al., 2009) The research study “Biological versus chronological ovarian age: implications for assisted reproductive technology” conducted by Alviggi et al, 2009, found that despite advances in technology there are currently no assisted reproductive treatment strategies that can compensate for the natural decline in fertility with the increasing age of the female. Although chronological age is a very important predictor of ovarian response to follicle stimulating hormone (FSH), the rate of reproductive aging and ovarian sensitivity to gondotrophins varies considerably between individuals. It was found that environmental and genetic factors also have an effect, therefore biological and chronological ovarian age are not always equal, and that biological age is more important than chronological age in predicting a successful outcome. They further state that there are genetic markers and biomarkers (e.g. anti-Müllerian hormone (AMH) and antral follicle count (AFC)) emerging which can identify women with accelerated biological ovarian aging. With this knowledge, strategies for improving ovarian response can be used such as the use of leutenising Hormone (LH) and growth hormone (GH). The study showed that treating women with supplementary LH would optimise treatment outcomes with biologically older ovaries and that using GH could improve oocyte development, counteracting the age related decline in oocyte quality.

In a...
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