Ship of Fools: IVF on the NHS

Thread: IVF on the NHS Board: Oblivion / Ship of Fools.

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Posted by Raptor Eye (# 16649) on :

The 'clinical excellence' people have called for availability of IVF on the NHS to be extended to older women, gay couples and people with some health problems, as shown here:

http://www.itv.com/news/story/2012-05-22/ivf-on-the-nhs-for-the-over-40s-suggests-national-institute-for-health-and-clinical- excellence/

I see the purpose of the NHS as to try to make people well and care for them when they are ill. I'm happy to extend this to provide care in pregnancy, but would draw the line there.

I have no issue with anyone going for IVF treatment, provided that they pay for it themselves and donors are made aware of the potential home for their gifts.

When we hear of sick people being refused drugs and treatment due to cost, it doesn't seem right to use NHS resources on people who are not ill. What do you think?

Please don't send this to dead horse territory by latching on to the 'gay' or 'ivf' issues, but keep your comments to the rights and wrongs of the use of scarce NHS resources.

Posted by the long ranger (# 17109) on :

Interesting - it looks like you are advocating a utilitarian system for allocating scarce resources in the NHS. So let me test how far you've thought this through:

1. There are patients who are so close to death that medication is a waste of resources - right or wrong?

2. All treatments need to be cost driven - right or wrong?

3. There is no reason for any medication to cost £100s per treatment -right or wrong?

Also, if it could be proved that treating infertile couples prevented illness and further drains on the NHS resources in the future, would that change your mind?

Posted by Erroneous Monk (# 10858) on :

quote:
Originally posted by Raptor Eye:
I have no issue with anyone going for IVF treatment, provided that they pay for it themselves ....

So you have no issue with the idea that for those who struggle to conceive naturally, for whatever reason, parenthood should be an option for the wealthy only?

Posted by Incipit (# 10554) on :

It sounds as though you haven't suffered the pain of infertility or subfertility. If you had, you would know the anxiety and depression - the mental pain - that it causes. If a medical treatment can alleviate that pain and address its cause (as it can), why would you not offer it to those in pain? Failure of imagination doesn't seem an adequate answer.

What about those suffering from depression, anxiety states, personality disorders? Are they ill, by your definition, or don't they deserve treatment either?

Posted by Beeswax Altar (# 11644) on :

quote:
Originally posted by Erroneous Monk:

quote:
Originally posted by Raptor Eye:
I have no issue with anyone going for IVF treatment, provided that they pay for it themselves ....
So you have no issue with the idea that for those who struggle to conceive naturally, for whatever reason, parenthood should be an option for the wealthy only?

I wouldn't have a problem with a theoretical NHS in the United States not covering IVF.

Posted by Niteowl2 (# 15841) on :

quote:
Originally posted by Beeswax Altar:
I wouldn't have a problem with a theoretical NHS in the United States not covering IVF.

Most private insurance companies don't cover IVF.

And like it or not cost does have to enter into any public health option. IVF expenses can run into tens of thousands of dollars. Those who need life saving and health maintaining drugs and procedures have a higher priority and unless taxpayers are willing to cough up extra money, those must always take priority.

Posted by Niminypiminy (# 15489) on :

I think it's a good thing NICE exists in order to make decisions about where the NHS should spend its money, and to base that on clinical and epidemiological research.

No doubt we all have prejudices about which conditions we think are more worthy of spending those scarce resources on.

No doubt NICE makes decisions that we don't agree with. But I am thankful that somebody is at least trying to make those judgements impartially, away from the fire and heat of opinion.

Posted by the giant cheeseburger (# 10942) on :

If IVF is to be publicly funded, what other lifestyle choices will follow with it? Should cosmetic procedures be funded to give people who feel deeply insecure thanks to some issue with their looks a fair go at life? How is this any different compared to choosing to want a child?

Posted by ken (# 2460) on :

The government probably thinks that the typical users of IVF services are well-educated middle-class married women in their 30s and 40s. Very much its target market for voters.

My inner humbug-detector is trying to tell me that if there was a medical service with similar costs and benefits that was mainly used by 60-something unemployed single men who live on council estates they would be less eager both to fund it and to tell people that they were doing it.

Posted by Ricardus (# 8757) on :

Does infertility not constitute an illness?

Posted by Niteowl2 (# 15841) on :

quote:
Originally posted by Ricardus:
Does infertility not constitute an illness?

The question usually asked is "is it medically necessary?" Private insurance companies here in the U.S. say no and Medicaid doesn't consider it medically necessary either.

Posted by Ricardus (# 8757) on :

quote:
Originally posted by Niteowl2:

quote:
Originally posted by Ricardus:
Does infertility not constitute an illness?
The question usually asked is "is it medically necessary?" Private insurance companies here in the U.S. say no and Medicaid doesn't consider it medically necessary either.

Necessary for what, though?

Posted by Raptor Eye (# 16649) on :

quote:
Originally posted by the long ranger:
Interesting - it looks like you are advocating a utilitarian system for allocating scarce resources in the NHS. So let me test how far you've thought this through:

1. There are patients who are so close to death that medication is a waste of resources - right or wrong?

2. All treatments need to be cost driven - right or wrong?

3. There is no reason for any medication to cost £100s per treatment -right or wrong?

Also, if it could be proved that treating infertile couples prevented illness and further drains on the NHS resources in the future, would that change your mind?

Your knee-jerk reaction is understandable, but I'm not advocating a system driven by costs, but one driven by care. I have sympathy with people who cannot conceive, and I would support a charity which helped those who couldn't afford to pay for it themselves. I don't see it as an illness needing NHS treatment.

There are many preventative measures which could be taken but are not, presumably due to lack of funds. Men are not currently screened for prostate cancer, for example.

Posted by Crœsos (# 238) on :

quote:
Originally posted by Ricardus:
Does infertility not constitute an illness?

Given that the cause of the vast majority of cases of infertility is old age, I'd have to go with 'no'.

Posted by the long ranger (# 17109) on :

@Raptor Eye - asking questions is not a knee-jerk reaction, it is trying to clarify an argument which is weak and poorly explained.

So the crux is that you've unilaterally decided that some treatments should be withheld by the NHS because the patients are not suffering from illness or disease.

Do you think the same about smoking? In-growing toenails?

How are you making these assessments?

Posted by the long ranger (# 17109) on :

As it happens, I think rationing of healthcare in England and Wales is inevitable. I just don't think it can be done by people pontificating about their pet healthcare expense.

This particular argument seems to have very little logic or medical rationale. God help us if this is the way decisions are made.

Posted by Enoch (# 14322) on :

Raptor Eye, I think I agree with you on this. Infertility is a tragic misfortune but it is not a death threatening illness, and does not disable people.

Ultimately, we do not have a right to have a child, any more than ultimately we have a right to live out our threescore and ten, or to insist that our children give us grandchildren.

Besides, in an overpopulated world, is it that essential that society extends itself to ensure that a few people who have difficulties making up their own 2.4, can do so?

Posted by The Great Gumby (# 10989) on :

quote:
Originally posted by Ricardus:

quote:
Originally posted by Niteowl2:

quote:
Originally posted by Ricardus:
Does infertility not constitute an illness?
The question usually asked is "is it medically necessary?" Private insurance companies here in the U.S. say no and Medicaid doesn't consider it medically necessary either.
Necessary for what, though?

And there's the rub. Unfortunately, we still haven't found the magic replenishing pot of leprechaun gold that would allow us to fund every treatment anyone wants, so someone has to have the job of saying "yes" or "no". The best measure we have for differentiating between different treatments is Quality-Adjusted Life Year (QALY), and combining this with the cost of treatment returns a utility cost for a treatment, which at least gives us a basis for making a decision. It's unpleasant to put a price on a life, but it's the best option we have.

But that doesn't help much in this case, because we're talking about creating life, not preserving it. It's possible that you could put a value on the emotional wellbeing of the parents, as is done for reconstructive surgery for example, but I suspect that would fall short of justifying this decision on those grounds alone. Ultimately, the question is whether you want to spend money so that people can have babies, which is a policy decision.

I think ken's half right about the motivation for this decision (although I'm extremely dubious of the implication that NICE is following a political directive), but I think he's wrong as well. I don't see this as a party political decision, but there may well be a policy aim to ensure that middle class types who put children off for their careers are helped to breed. There are all sorts of possible reasons for this aim, but in itself it isn't objectionable in any way.

Posted by Beeswax Altar (# 11644) on :

Having children isn't medically necessary and IVF doesn't cure the underlying cause of infertility. Infertility in gay couples isn't a result of illness. It's the result of human biology. Same thing can be said for single women, who for whatever reason, don't want the hassle of having children the natural way. The claim that childbirth is a way of treating mental illness is simply absurd. People get upset all the time about not getting something they want. Should the government start granting wishes in the interest of mental health?

Posted by Snags (# 15351) on :

It's the old, old chestnut of who gets to decide what's important, and as with most things, very often the average person on the street is too ignorant of the full story to be able to contribute much to the debate other than the blindingly obvious jerking of a knee.

For those who think along the "lifestyle choice" line, it raises all kinds of moral/ethical/value questions as to whether people should get treated for matters arising out of other "lifestyle choices". People who hurt themselves whilst pissed out of their heads. People who catch STDs from shagging around. Injuries sustained from choosing to do dangerous things etc.

And for those who think it's their inalienable right to be treated for whatever, whenever, they need to understand about finite resources.

Speaking as one half of a couple who went through a number of IVF cycles (self-funded, at a time when we were lucky enough to arrange our affairs so we could do so), personally I'm totally neutral on IVF being provided on the NHS. It wasn't an option for us, and if it was, I'm not sure we'd have taken it. However, I'm fully aware that it's not simply a case of wanting a baby in the same way a child wants sweets; it's a big, complicated, messy old thing, and takes different people different ways.

There are scarce resources, and it's not a just world. Anyone who thinks taking a decision to pursue (or not) IVF, or being in a position where it's your only option for having a biological family is just all a bit drama-queeny is deserving of language only fit for Hell, however. As is anyone who glibly suggests adoption as the natural, no-brainer alternative; it just indicates a profound lack of cluefulness.

And if this post seems confused, that's because it's a confusing issue. How do you weigh up the merits of treating someone on a persistently self-destructive course of behaviour vs. someone who's had an accident vs. someone who's essentially healthy but infertile vs. the old lady who's going to die soon anyway vs ...

Posted by Raptor Eye (# 16649) on :

quote:
Originally posted by Incipit:

What about those suffering from depression, anxiety states, personality disorders? Are they ill, by your definition, or don't they deserve treatment either?

Mental illness should of course be treated on the NHS. As it is, personal care for people with Alzheimer's is not provided by the NHS, and they're not always given the expensive drugs which help to delay the progress of what is a terminal illness.

Posted by Ricardus (# 8757) on :

I'm trying to work out the ethical implications of saying "Having children is only a lifestyle choice."

I'm not sure what they are, but I don't think they're very pleasant.

Posted by Raptor Eye (# 16649) on :

quote:
Originally posted by the giant cheeseburger:
If IVF is to be publicly funded, what other lifestyle choices will follow with it? Should cosmetic procedures be funded to give people who feel deeply insecure thanks to some issue with their looks a fair go at life? How is this any different compared to choosing to want a child?

I'm aware that it's difficult to know where to draw the line. Your comment highlights this. Cosmetic surgery for someone born with physical defects which affect their appearance may or may not be necessary for strictly 'medical' reasons, but I would want it to be provided under some circumstances.

This doesn't mean that I think that anyone who doesn't like the shape of something they were born with should be able to demand surgery on the NHS.

Posted by Pyx_e (# 57) on :

quote:
Originally posted by ken:
The government probably thinks that the typical users of IVF services are well-educated middle-class married women in their 30s and 40s. Very much its target market for voters.

My inner humbug-detector is trying to tell me that if there was a medical service with similar costs and benefits that was mainly used by 60-something unemployed single men who live on council estates they would be less eager both to fund it and to tell people that they were doing it.

Free cider?

Posted by OliviaG (# 9881) on :

quote:
Originally posted by Beeswax Altar:
... The claim that childbirth is a way of treating mental illness is simply absurd. People get upset all the time about not getting something they want. Should the government start granting wishes in the interest of mental health?

One of the common cognitive distortions in depression is "If only I had X, I would be happy." Treatment for mental illness is often about learning that you can live without something, or learning to want something within your reach instead. OliviaG

Posted by Niminypiminy (# 15489) on :

quote:
Originally posted by ken:
The government probably thinks that the typical users of IVF services are well-educated middle-class married women in their 30s and 40s. Very much its target market for voters.

My inner humbug-detector is trying to tell me that if there was a medical service with similar costs and benefits that was mainly used by 60-something unemployed single men who live on council estates they would be less eager both to fund it and to tell people that they were doing it.

Maybe I am naive, but I tend to think NICE is slightly more independent of government than that.

Demographic trends show that the age at which women give birth is rising, and it may well be that there is clinical evidence to show that IVF success rates for older women have improved enough to make it worth funding. The fertility rate among lesbians and single women is also rising. That's probably the pragmatic reason behind the decision.

NICE probably put out a press release for every significant decision they make, but the press don't pick them up. As this thread shows, IVF is a topic that interests people.

Obviously rationing has to happen -- that is one part of the rationale for NICE. There is, of course, a serious debate to be had about publicly funding services to people on the grounds of their own choices (for example, drinkers, smokers, drug-users).

One of the factors we might take into account is how much is actually spent on these things. I imagine that the cost to the NHS of IVF is marginal compared to the cost of dealing with the effects of alcohol.

Another is how partial and skewed decisions are when they are left to the plebiscite of opinion.

Posted by Beeswax Altar (# 11644) on :

You have far more faith in the impartiality and competence of bureaucrats than I do.

Posted by Snags (# 15351) on :

quote:
Originally posted by Raptor Eye:
I'm aware that it's difficult to know where to draw the line. Your comment highlights this.[/QB]

Give TGC's construction of "choosing to want a child" I'd have said the greater difficulty would be knowing which end of the pencil to draw the line with, rather than where to draw it. If it wasn't just shoddy phrasing, it betrays a rather fundamental lack of grasp on the entire problem domain.

Posted by Erroneous Monk (# 10858) on :

I think perhaps I'm asking a different question which is, if we cannot afford to make IVF available on the basis of need, should it, ethically, be available at all? Do we aspire to live in society where the wealthy are - through artifical means - capable of being more fertile than the poor?

Posted by Raptor Eye (# 16649) on :

quote:
Originally posted by the long ranger:

So the crux is that you've unilaterally decided that some treatments should be withheld by the NHS because the patients are not suffering from illness or disease.

Do you think the same about smoking? In-growing toenails?

How are you making these assessments?

I'm questioning the scope of the NHS and where its boundaries are. ISTM that if it was set up to provide medical care for people who were suffering from sickness or disease, and if it can no longer afford to do so as some people who are ill are not receiving the treatment they need, then it should not be offering services outside of that core purpose.

I don't agree with the suggestion made by some that 'self-inflicted' suffering should be excluded, eg the harmful effects of smoking or of in-growing toenails. I think it right for anyone involved in dangerous sports to provide additional insurance for themselves, but that is a decision they should make for themselves.

Posted by Beeswax Altar (# 11644) on :

quote:
Originally posted by Erroneous Monk:
I think perhaps I'm asking a different question which is, if we cannot afford to make IVF available on the basis of need, should it, ethically, be available at all? Do we aspire to live in society where the wealthy are - through artifical means - capable of being more fertile than the poor?

Yes, I aspire to live in a society where the rich have more children than the poor.

Posted by Snags (# 15351) on :

X-post with BA, for want of a more hellish appellation.

Ultimately it's about how you (one) weights your value judgements. If you examine almost any of the arguments too closely you'll come up against some fairly unpleasant conclusions, or a naive faith in infinite resource.

Personally I'm glad I don't have to make the decisions as to what's in and what's out, because it simply isn't clear cut in almost any area.

For the record, I wasn't suggesting that self-inflicted harm should be excluded, just raising the issue that you need to examine the criteria upon which you're basing your judgements.

If anything I tend towards the view that almost anything should be potentially available, but assessed on a real tough, case by case basis. That's totally unworkable, though, so you get blanket rules which will never quite hit everyones needs or expectations.

[ 22. May 2012, 22:12: Message edited by: Snags ]

Posted by orfeo (# 13878) on :

I think one of the things that should be looked at in the context of this kind of debate is adoption. Including the fact that the rate of adoption has slumped enormously over the years. Partly I would think this is because there is no longer the kind of stigma that led to children born outside of marriage or a stable relationship being offered for adoption.

But it's an important question, whether infertile couples who can be assisted by IVF are looking for a child or whether they are specifically looking for a child that is genetically theirs.

Posted by Snags (# 15351) on :

Orfeo,you're right, it is an important question. There's a big difference between a strong desire to parent - almost to the point of parenting anyone/anything - and a strong desire to have a child, your child. Whilst adoption can meet the former, it doesn't touch the latter. IME all infertile couples who seek IVF have the latter desire (duh!) but only some the former. And for those that have both, adoption doesn't "solve" the problem; they love their adopted kids to bits, but it doesn't make the wish for biological children magically vanish.

There's also the fact that adoption is a hell of a big thing to go into in the UK at least. I have the utmost respect for adoptive parents; we looked into it and ultimately decided it wasn't for us (not without a twinge of guilt, but that's a poor motive for trying to take on a child who will most likely have had a shit life experience already, and a bunch of issues of their own). It's also actually not that easy to adopt for the average person; not necessarily a bad thing in context, but also something that makes adoption not the obvious alternative that it might appear in"engineering solution" terms.

The whole thing is practically, emotionally and psychologically complex and messy. Which doesn't mean it's a no-brainer for NHS funding, but does often mean it's a soft target for glib thoughts (not accusing orfeo of that, BTW).

Apologies if any of this comes out funny; writing on the phone, which is less than ideal.

Edit to correct at least one bad auto-correct

[ 23. May 2012, 05:57: Message edited by: Snags ]

Posted by North East Quine (# 13049) on :

Originally posted by the giant cheeseburger:

quote:
Should cosmetic procedures be funded to give people who feel deeply insecure thanks to some issue with their looks a fair go at life?

I've had cosmetic surgery on the NHS. I went over the handlebars of my bike, and had the residual facial scarring removed three years later. It was simply a follow-up procedure; I had the original injury treated at A & E, a routine follow-up check up at which the scarring was noticed, a further annual check-up and then cosmetic surgery. I wasn't required to be "deeply insecure about my looks"; the cosmetic surgery (2 nights in hospital, general anaesthetic) was simply the end point of the treatment for the original injury.

Cosmetic surgery is such a complicated area, covering, as it does, such a variety of situations and conditions, that a blanket comment about it doesn't help any argument about IVF.

(NHS - [Overused]

Posted by Think² (# 1984) on :

This isn't a big change of policy, many pcts have been offering a set number of cycles for a while now. I think that as a society at the moment our birth rate is falling - and that will presumably be one reason why government wants to do this.

But also, it is worth remembering that government and its institutions exist to serve and provide for the people. And amomst the things that almost everyone watns, such as food, shelter and employmentthat form the bedrock of their contentment - are children. It does not seem odd for a government to provide socially acceptable ways to make this happen. One of these is having adoption services (which are almost certainly not cheaper than ivf) - another is if.

BA why is it important to you that the rich have more children than the poor? Do you feel the rich are particularly virtuous and worth emulating?

Posted by The Intrepid Mrs S (# 17002) on :

What would worry me about IVF in general is that surely it perpetuates fertility problems? Darwinism presumably mandates that the infertile can't breed; if they then produce offspring by artificial means, what are the effects on the fertility of the offspring? Is there any research on this?

Mrs. S, who knows she was lucky/blessed to get a pigeon pair without difficulty

Posted by Beeswax Altar (# 11644) on :

quote:
originally posted by Think²:
BA why is it important to you that the rich have more children than the poor? Do you feel the rich are particularly virtuous and worth emulating?

No, I feel the rich are better able to meet their children's basic needs. Raising a child costs money. Raising multiple children costs even more money. Hence, people with the most resources should have the most children.

Posted by Erroneous Monk (# 10858) on :

quote:
Originally posted by Beeswax Altar:

quote:
Originally posted by Erroneous Monk:
I think perhaps I'm asking a different question which is, if we cannot afford to make IVF available on the basis of need, should it, ethically, be available at all? Do we aspire to live in society where the wealthy are - through artifical means - capable of being more fertile than the poor?
Yes, I aspire to live in a society where the rich have more children than the poor.

I'm very glad you're not in charge.

Posted by BroJames (# 9636) on :

quote:
Originally posted by Beeswax Altar:

quote:
originally posted by Think²:
BA why is it important to you that the rich have more children than the poor? Do you feel the rich are particularly virtuous and worth emulating?

No, I feel the rich are better able to meet their children's basic needs. Raising a child costs money. Raising multiple children costs even more money. Hence, people with the most resources should have the most children.

It's hard to read this other than as implying that the most important needs of children are those which are satisfied by money.

Raising a child well depends on much more than money, and children can be well raised on slender financial resources, and badly raised by those for whom money is no object.

Perhaps what we should aim for is that those who are otherwise well qualified for raising children (and have the wish to do so) should not be handicapped by financial restrictions.

Posted by Think² (# 1984) on :

quote:
Originally posted by Beeswax Altar:

quote:
originally posted by Think²:
BA why is it important to you that the rich have more children than the poor? Do you feel the rich are particularly virtuous and worth emulating?

No, I feel the rich are better able to meet their children's basic needs. Raising a child costs money. Raising multiple children costs even more money. Hence, people with the most resources should have the most children.

Given society needs children, I would hope society would help with the costs. It is worth noting that the majority of your mass low paid workers - eg soldiers, porters, cleaners, binmen etc - are almost certainly not going to be the children of the rich cos social mobility doesn't tend to work like that.

Posted by Erroneous Monk (# 10858) on :

quote:
Originally posted by Beeswax Altar:

quote:
originally posted by Think²:
BA why is it important to you that the rich have more children than the poor? Do you feel the rich are particularly virtuous and worth emulating?

No, I feel the rich are better able to meet their children's basic needs. Raising a child costs money. Raising multiple children costs even more money. Hence, people with the most resources should have the most children.

Raising a child involves lots of other resources as well, physical, intellectual, emotional. Your view seems to be that of two sub-fertile couples, the ones who can afford the kind of stupendous amounts of money involved in purchasing IVF are the ones who will be best at meeting the child's needs. I don't think there's any evidence for that.

[ETA: cross-posted with BroJames and Think2]

[ 23. May 2012, 12:16: Message edited by: Erroneous Monk ]

Posted by North East Quine (# 13049) on :

Originally posted by orfeo:

quote:
I think one of the things that should be looked at in the context of this kind of debate is adoption. Including the fact that the rate of adoption has slumped enormously over the years. Partly I would think this is because there is no longer the kind of stigma that led to children born outside of marriage or a stable relationship being offered for adoption.

But it's an important question, whether infertile couples who can be assisted by IVF are looking for a child or whether they are specifically looking for a child that is genetically theirs.

Adoption can be very difficult, though. We looked into it briefly, but as the rules were (are?) that you can't start the adoption process within two years of a pregnancy loss (to make sure you're not acting irrationally through grief, which is fair enough) we couldn't pursue it further at that stage. By the time the two years were up, we'd had another pregnancy loss. If we'd wanted to pursue adoption, we'd have had to commit to using contraception, which is a big ask of a couple who want a child!! IVF wasn't an option for us, because I have no problem getting pregnant, just a problem carrying a pregnancy. However, the point is the same - IVF / adoption tend to be an either/or; you can't pursue both simultaneously.

Posted by orfeo (# 13878) on :

quote:
Originally posted by North East Quine:
Originally posted by orfeo:

quote:
I think one of the things that should be looked at in the context of this kind of debate is adoption. Including the fact that the rate of adoption has slumped enormously over the years. Partly I would think this is because there is no longer the kind of stigma that led to children born outside of marriage or a stable relationship being offered for adoption.

But it's an important question, whether infertile couples who can be assisted by IVF are looking for a child or whether they are specifically looking for a child that is genetically theirs.
Adoption can be very difficult, though. We looked into it briefly, but as the rules were (are?) that you can't start the adoption process within two years of a pregnancy loss (to make sure you're not acting irrationally through grief, which is fair enough) we couldn't pursue it further at that stage. By the time the two years were up, we'd had another pregnancy loss. If we'd wanted to pursue adoption, we'd have had to commit to using contraception, which is a big ask of a couple who want a child!! IVF wasn't an option for us, because I have no problem getting pregnant, just a problem carrying a pregnancy. However, the point is the same - IVF / adoption tend to be an either/or; you can't pursue both simultaneously.

Yikes. I wasn't aware of those rules around adoption and pregnancy loss.

All I know is exactly what you said - that adoption is these days very difficult. And frankly it looks like it's a road for heartache in many cases, rather than for creating a family.

I guess I raised it because it bothers me a bit that it's become such a difficult option. There's got to be a balance - we can't go back to the practices where babies were adopted without any real consent of the mothers, but it seems to me that we shouldn't be making it so darn hard that it's some kind of endurance test designed to make most prospective parents give up.

I've not had to face any of these issues personally. Even after I came out as gay, I always took the view that children weren't even a remote consideration unless and until I had a stable relationship to raise them in. About the nearest I've come is a close friend who was in the process of 'proving' a need for IVF by trying to get pregnant, expecting to fail because of a medical condition, and against all expectation succeeding. So they never got very far into the process.

Posted by Think² (# 1984) on :

Thing is, most child available for adoption have significant problems - so in some ways it is likely to be more challenging than having your own and they need prospective parents who can deal with that. But I agree the process is currently too fraught - though the government are reviewing it at the moment.

Posted by orfeo (# 13878) on :

quote:
Originally posted by Think²:
Thing is, most child available for adoption have significant problems - so in some ways it is likely to be more challenging than having your own and they need prospective parents who can deal with that.

Interesting. Can you expand re significant problems? I suppose this might tie into what I referred to earlier, that children aren't offered up for adoption purely for reasons of social stigma any more. So they're being put up for adoption in other, more difficult circumstances?

Posted by Raptor Eye (# 16649) on :

quote:
Originally posted by Beeswax Altar:
No, I feel the rich are better able to meet their children's basic needs. Raising a child costs money. Raising multiple children costs even more money. Hence, people with the most resources should have the most children.

If the fertility rate of the poor continues to be higher than that of the rich, whether naturally or by choice, it seems as if your wish would only be fulfilled by social engineering of some kind, which makes me shudder.

It is good for society as a whole to help the less well off to meet the basic needs of their children imv, as they too belong to that society. A line must be drawn there, too, between needs and wants.

Posted by Beeswax Altar (# 11644) on :

quote:
originally posted by BroJames:
It's hard to read this other than as implying that the most important needs of children are those which are satisfied by money.

Raising a child well depends on much more than money, and children can be well raised on slender financial resources, and badly raised by those for whom money is no object.

Perhaps what we should aim for is that those who are otherwise well qualified for raising children (and have the wish to do so) should not be handicapped by financial restrictions.

How would we ever decide who is well qualified to raise children? We can't. Children can be raised poorly by people with slender financial resources and well raised by people with money. Besides, the issue is the number of children not whether the nonrich should have children.

quote:
originally posted by Think²:
Given society needs children, I would hope society would help with the costs. It is worth noting that the majority of your mass low paid workers - eg soldiers, porters, cleaners, binmen etc - are almost certainly not going to be the children of the rich cos social mobility doesn't tend to work like that.

Society needs children. Ideally, those in society with more resources would have more of the children society needs. Social mobility would work that way if the rich had more children than the poor. Let's say my wife and I have two children and an affluent couple has five. Affluent couple can provide the same things for five children as we could for two.

quote:
originally posted by Erroneous Monk:
Raising a child involves lots of other resources as well, physical, intellectual, emotional. Your view seems to be that of two sub-fertile couples, the ones who can afford the kind of stupendous amounts of money involved in purchasing IVF are the ones who will be best at meeting the child's needs. I don't think there's any evidence for that.

No, I don't know if either couple have the emotional, physical, or intellectual resources to meet the child's needs. One wants to use taxes for IVF. The other wants to use their personal funds. I'm against using taxes to fund IVF regardless of wealth or any other factor. If forced to choose between everybody having access to IVF and nobody having access to it, I'd go with nobody.

Posted by North East Quine (# 13049) on :

Originally posted by orfeo:

quote:
Interesting. Can you expand re significant problems? I suppose this might tie into what I referred to earlier, that children aren't offered up for adoption purely for reasons of social stigma any more. So they're being put up for adoption in other, more difficult circumstances?

We were willing to adopt a child with significant physical problems, but were told that children like that don't come up for adoption, because physical problems show up on scans, and if the parent(s) don't think they can cope with a physically handicapped child they abort, rather than going to term and putting up for adoption.

Significant problems include fetal alcohol syndrome and attachment disorders.

We were asked (I think to see if we were serious about adoption) if we would, for example, adopt a child who had experienced sexual abuse; would we be prepared to give our biological children very explicit sex education so that they could cope with a potential adopted younger sibling behaving in a sexualised way towards them? This was something we were supposed to think through during the two year wait post-stillbirth.

As I say, we didn't take it any further, but we were given the strong impression that adoption would be an arduous process. (We were also told that we ticked the boxes for the sort of people they wanted as adoptive parents, largely because we had biological children, and therefore it was easier to assess what sort of parents we would be.)

Posted by Marvin the Martian (# 4360) on :

quote:
Originally posted by The Intrepid Mrs S:
What would worry me about IVF in general is that surely it perpetuates fertility problems?

My impression is that many of the people who want IVF are those who have waited until they are older and more financially secure before having children. Their infertility isn't because of defective genetics, it's because of age.

Posted by Niminypiminy (# 15489) on :

quote:
Originally posted by Marvin the Martian:

quote:
Originally posted by The Intrepid Mrs S:
What would worry me about IVF in general is that surely it perpetuates fertility problems?
My impression is that many of the people who want IVF are those who have waited until they are older and more financially secure before having children. Their infertility isn't because of defective genetics, it's because of age.

Are fertility problems generally genetic? Besides, natural selection works in large populations over long periods of time. Restricting fertility treatment (of which IVF is only one form) would have a negligible effect.

My guess would be that generally women undergoing private IVF treatment are older because older people are generally better off. One of the things about IVF on the NHS is that young infertile and not well off women can access it.

Both the women I know who have had IVF on the NHS were well under 30 at the time.

Posted by Snags (# 15351) on :

quote:
Originally posted by orfeo:

quote:
Originally posted by Think²:
Thing is, most child available for adoption have significant problems - so in some ways it is likely to be more challenging than having your own and they need prospective parents who can deal with that.
Interesting. Can you expand re significant problems? I suppose this might tie into what I referred to earlier, that children aren't offered up for adoption purely for reasons of social stigma any more. So they're being put up for adoption in other, more difficult circumstances?

Your supposition is largely correct, certainly around here. The children who are taken into care and therefore in need of adoptive parents are (generally, not exclusively) going to come from very, very dysfunctional backgrounds. They may have been born with an addiction, experienced various forms of abuse, potentially have major developmental/educational/emotional issues well above and beyond the normal range because of the nature of either the pregnancy or their early life.

You also need to factor in that the parent(s) will almost certainly have some kind of contact and visitation rights (which is often as it should be, but adds a hell of a lot of pressure).

And, of course, the adoption service generally prefer adoptive parents who already have their own biological children, so have experience and a stable family for the new child to come into. They also prefer you to be younger rather than older (although not too young) so that you're roughly age-appropriate at the school gate.

So if you're infertile, spend a good while trying naturally, then do try via assisted means, and then go for adoption, chances are you'll be too old anyway. Assuming they'll have you because you haven't got any kids of your own.

There's also a long and onerous vetting/assessment process, which is actually no bad thing in the circumstances. And of course, you'll go from no child to almost certainly having a school age or not far off child. Not overnight, they manage it, but even so, psychologically it's not as smooth as learning as you go with one you made yourself!

Posted by orfeo (# 13878) on :

Hmm. That all seems very much as if adoption is now more or less part of the same stream as foster care, only on a permanent rather than temporary basis.

Sorry, I seem to have steered the thread off its original topic somewhat. I suppose it just leapt to my mind as another means of creating a family that's out there in theory.

[ 23. May 2012, 14:45: Message edited by: orfeo ]

Posted by Masha (# 10098) on :

Adoption can be an amazing experience though.

I know the negative aspects but I wanted to focus on positive in this post. I have friends who have adopted and have wonderful, happy families.

I do agree that it's not to be taken on lightly though - the children placed for adoption are often forcibly removed from abusive/neglectful birth parents, after the birth parents have been given many chances to 'get it right'. Some children have significant issues as a result of this, which is understandable.

But such a worthwhile thing if you're up for it.

Masha, hopeful adoptive single mum of the future...

Posted by Think² (# 1984) on :

quote:
Originally posted by Marvin the Martian:

quote:
Originally posted by The Intrepid Mrs S:
What would worry me about IVF in general is that surely it perpetuates fertility problems?
My impression is that many of the people who want IVF are those who have waited until they are older and more financially secure before having children. Their infertility isn't because of defective genetics, it's because of age.

That of course is part of the problem with BA's proposition - people tend to get richer when they are older.

Posted by Beeswax Altar (# 11644) on :

It would be a problem if people had all their children at the same time through multiple births.

Posted by jrrt01 (# 11264) on :

Fertility does decrease with age (mainly female age). However, it decreases only slightly until sometime after 40, whereupon it decreases much more rapidly. Hence I suspect NICE chose 42 based on sound scientific evidence.

The NHS treats all sorts of medical conditions that are not life-threatening. Infertility is a medical condition that thankfully we can now treat in some cases. I see no reason why it shouldn't be available on the NHS.

People presenting for IVF tend to be older because normally they have spent a considerable amount of time trying to get pregnant without any help, then with some intervention. It is usually several years before any couple get to actual IVF.

Additionally, each health authority used to (probably still does) set its own rules. Some required you to be older than a certain age before you were eligible.

This won't be important for middle class couples, who will in many cases continue to go private owing to the far greater convenience of private treatment. It might be highly significant for those who cannot afford any other options and who cannot conceive for medical reasons without intervention.

Posted by jrrt01 (# 11264) on :

Beeswax Altar wrote:

quote:
It would be a problem if people had all their children at the same time through multiple births.

NICE recommend that embryos are transferred singly. Using this protocol IVF has no more or less chance of multiple births than natural conception. This is to avoid the greater health risks to the mother and children from multiple births (particularly triplets and above). I assume this is the problem you meant.

Posted by ken (# 2460) on :

quote:
Originally posted by Raptor Eye:
If the fertility rate of the poor continues to be higher than that of the rich...

Its not at all clear that it is - the data is confusing and hard to interpret.

quote:
Originally posted by Marvin the Martian:
Their infertility isn't because of defective genetics, it's because of age.

And, not quite off-topic, by the time you get to my age, if you hear a young person saying that they definitely will never ever want to have children, or (almost worse) that they do want children but will put it off till they are ready, you cringe inwardly, and keep your mouth shut, because telling the truth does no good because they will have heard it all before and not taken it in and just think you are being an old git.

Posted by OliviaG (# 9881) on :

quote:
Originally posted by jrrt01:
Beeswax Altar wrote:

quote:
It would be a problem if people had all their children at the same time through multiple births.
NICE recommend that embryos are transferred singly. Using this protocol IVF has no more or less chance of multiple births than natural conception. This is to avoid the greater health risks to the mother and children from multiple births (particularly triplets and above). I assume this is the problem you meant.

This was the main argument when IVF was added to Quebec's health plan. People paying privately for IVF are more likely to choose to implant multiple embryos for the best chance in one go (AIUI, Octomom had 12 embryos implanted). If IVF is funded, then people can be more conservative, knowing they can have another try. The cost of an additional cycle of IVF is waaaaay less than the lifetime cost of caring for babies with complications arising from a multiple birth.

Posted by Snags (# 15351) on :

It's academic in the UK. The regulations mean you can't legitimately put back more than two at a time anyway, without some remarkably extenuating circumstances. Caused a major stink when one of the chaps on Harley Street (expensive doctors work here, for the wider world) was found to be ignoring this to boost his stats.

It also avoids some of the Dead Horse aspects, as room for "selective reduction" etc. is removed.

Posted by Think² (# 1984) on :

Is it not the case that they make more than two ?zygotes?* And then implant two and ditch the rest though ?

(*can't remember the correct term for the relative stage of development)

Posted by Snags (# 15351) on :

I'm a few years out of date, but the normal route is fertilise as many eggs as possible, put the 'best' pair back and freeze the remainder. You can then come back for a 'frozen cycle' rather than 'fresh', which is much cheaper (less drugs, no harvesting etc.). Rinse and repeat until freezer empty.

Not all of the little geezers will survive freeze/defrost, but debating the ethics of that puts us in the Other Place and is way off topic for here.

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