When I heard the NHS would be offering one free cycle of IVF for women over 40, according to revised Nice guidelines published today, my initial reaction was delight. I'm a 41-year-old woman who'd like the chance to try for children and I know many women my age – of varying economic means – in the same boat. So this was both a ray of hope and an acknowledgement of the predicament many women of my generation are in. But then I read the small print.
Nice raised its recommended cut-off age for IVF to 42 from 39, but only for women who've been trying to conceive naturally for two years. Being single and three weeks short of my 42nd birthday, that rules me out. It also rules out many women around my age who, because of a mix of individual circumstances and expectations from society and parents about career success, are facing the prospect of a life without biological children, but not by preference. Nice accepts the extended age range will benefit "a very select group of women", and that the final say on eligibility lies with local health authorities – the much talked about "postcode lottery". But the announcement got me thinking about the bigger picture and the message that this week's headlines could send out.
While the changes take some of the elitism out of infertility treatment – giving couples who don't have thousands of pounds to spare access to IVF – they don't address the broader question: how to encourage and enable women and men to try for families before it's too late? Age is only one factor in the infertility mix, but it's an important one that many childless women believe has been overlooked – or at least not stressed enough – in the past few decades.
While gender equality has changed the face of society, our reproductive systems are much the same as they were generations ago. Women and men are most fertile in their early 20s, while female fertility drastically declines after 35. Despite that, my generation grew up thinking and hearing we had plenty of time and that we could have it all. We studied, travelled and built our careers well into our 30s, often failing to find a suitable partner before it was too late.
Today, one in five women reach their mid-40s without giving birth, nearly double the proportion seen in the previous generation – some by choice, but many by circumstance. And while IVF has helped millions to conceive, it would be misguided to view it as a safety net: the odds of conceiving via IVF aged 40-42 are around 20%, half what they are for those aged 18-34.
This announcement must not lead to complacency around fertility and add to the large number of women – and men – who are grieving involuntary childlessness. There needs to be a focused effort on finding ways to help those who want to be biological parents to do so before they have to resort to painful technologies like IVF. This can be done by asking the following questions: how can we better educate younger generations about fertility while also encouraging them to fulfil their potential? How can we shift workplace culture and attitudes so women – and men – aren't penalised if they take a break to have children early in their careers, rather than waiting until it might be too late? And how can we ensure working parents have access to affordable childcare and flexible working conditions so the combination of a career and a healthy family life becomes an attainable goal for all, and not just the wealthy.
