Mark Henderson, Science Editor

Thousands of infertile couples are being denied IVF that should be funded by the NHS because only 9 of 151 health trusts are offering the recommended level of therapy.

A total of 94 per cent of primary care trusts in England are still not providing the three free cycles of IVF that should be available under national guidelines issued in 2004, government figures have revealed.

The survey of IVF provision last year also showed that all but a few trusts have imposed tough criteria for free fertility treatment, rejecting patients who smoke or who already have children, including those from previous relationships.

Most of those that offered treatment paid for one cycle, and four trusts provided none at all.

The results – the first to incorporate figures from every trust in England – were published yesterday by the Department of Health. They show that a postcode lottery for IVF is flourishing despite guidance from the National Institute for Health and Clinical Excellence (NICE).

The NHS financial watchdog recommended in 2004 that three cycles should be available to infertile couples in which the woman is aged between 23 and 39. Women’s chances of conceiving are considerably better when more cycles are offered, to the extent that NICE identified three cycles as cost-effective. The advice is not binding, and the Government has provided no extra funds for it to be put into effect. The Department of Health has asked trusts to provide at least one cycle, and to move towards implementing it in full.

About one in six couples is affected by infertility. Almost 45,000 cycles of IVF are performed in the UK each year, but the level of NHS provision means that more than 30,000 of these are conducted privately, at an average cost of about £2,000 per cycle.

The new figures were published as doctors prepare to celebrate the 30th birthday of Louise Brown, the world’s first test tube baby, who was born in Oldham on July 25, 1978. Oldham is one of the nine trusts – all in the North West of England – that provide three cycles.

Susan Seenan, of the patient support charity Infertility Network UK, said: “Thirty years after the inception of IVF treatment, in the country that pioneered IVF, and four years after the NICE guideline, it is a complete disgrace that only nine PCTs are offering three free cycles.

“We are also disappointed that some PCTs are still offering no cycles at all, and that most are adding social criteria that make it difficult and unfair for patients to access the treatment they need.

“There is a real need for a standard set of eligibility criteria that operate nationwide.”

The survey was published on the Department of Health’s website in response to a parliamentary question from Sally Keeble, the Labour MP for Northampton North. It does not include data from Scotland, Wales or Northern Ireland.

It found that seven PCTs offer three cycles – Heywood, Middleton and Rochdale; Bury; East Lancashire; Stockport; Tameside & Glossop; Traf-ford; and Blackburn with Darwen. Central Lancashire offers two or three cycles, and Oldham “a maximum of three”. The four PCTs that have suspended free IVF treatment were North Lincolnshire, North Staffordshire, North Yorkshire and York, and Stoke on Trent, though the latter has since resumed provision.

About two-thirds of the trusts (100) offer one cycle, while 35 offer two, and three did not provide full information. More than half (86) specify that a couple must have no children, while another 46 impose other restrictions such as no children from the current relationship, or not more than one child. The survey found that 35 trusts specify no smoking, 30 say that patients must be in a stable relationship, and 33 impose age restrictions beyond those in the NICE guidelines.

A spokeswoman for the Department of Health said: “We recognise that there are local variations in the provision of IVF and that this does cause distress to many childless couples who feel that they are not getting the treatment they need.

“NICE published their guide recommendations that trusts provide up to three cycles of IVF in February 2004. But NICE and the Department of Health realised that this could not be immediately implanted and so trusts were encouraged to use this as a goal they move towards. The first step is for all PCTs to offer at least one cycle of IVF and the vast majority do so, with almost a third already offering more than one cycle.”

The three times weekly Workout of the Day has been up and running for almost a year now and it's time to reformat it slightly.  From now on the workouts will be posted as individual entries and then archived off-site.  They will have more guidance on completing the workout itself so as to produce better results.  Importantly there will be suggestions for beginners on scaling the workouts to their abilities.  For many readers out there who are unfamiliar with the exercise names and movements themselves, be patient.  We'll hopefully address this issue in the near future.  Of course the best way to experience the benefits of these challenging sessions is to sign up for the Allwell Centre Strength & Conditioning Programme.  See you there!

In a major change, the American Heart Association said that hands-only CPR - rapid, deep presses on the victim's chest until help arrives - works just as well as standard CPR for most adults.  Read more here...

“You only have to do two things. Call 911 and push hard and fast on the middle of the person’s chest,” said Dr. Michael Sayre, an emergency medicine professor at Ohio State University who headed the committee that made the recommendation.

Hands-only CPR calls for uninterrupted chest presses — 100 a minute — until paramedics take over or an automated external defibrillator is available to restore a normal heart rhythm.

This action should be taken only for adults who unexpectedly collapse, stop breathing and are unresponsive. The odds are that the person is having cardiac arrest — the heart suddenly stops — which can occur after a heart attack or be caused by other heart problems. In such a case, the victim still has ample air in the lungs and blood and compressions keep blood flowing to the brain, heart and other organs.

A child who collapses is more likely to primarily have breathing problems — and in that case, mouth-to-mouth breathing should be used. That also applies to adults who suffer lack of oxygen from a near-drowning, drug overdose, or carbon monoxide poisoning. In these cases, people need mouth-to-mouth to get air into their lungs and bloodstream.

But in either case, “Something is better than nothing,” Sayre said.  The CPR guidelines had been inching toward compression-only. The last update, in 2005, put more emphasis on chest pushes by alternating 30 presses with two quick breaths; those “unable or unwilling” to do the breaths could do presses alone.

Now the heart association has given equal standing to hands-only CPR. Those who have been trained in traditional cardiopulmonary resuscitation can still opt to use it.

For the full article click here...