Stop smoking or the IVF treatment gets it

// 22 June 2008

The Observer newspaper today reports that childless women, and in some cases their partners, too, are being asked to stop smoking before they can be considered for fertility treatment.

A Department of Health survey released to Labour MP Sally Keeble shows that, despite official recommendations that all infertile couples should get three cycles of treatment free, clinics are increasingly making free IVF treatment conditional on not smoking.

Tobacco use is listed as a ‘non-clinical access criteria’ in the survey – in other words it’s not a medical requirement for treatment to work. Other lifestyle choices known to reduce fertility, such as drinking more than one or two units of alcohol a week, are not reasons for refusing treatment.

A spokeswoman for Infertility UK, which represents patients, said: "It’s another way of rationing treatment. PCTs are looking at different ways to cut down the amount of treatment they give people."

In the light of the recent news about such things as the ban on co-payments (topping-up one’s NHS treatment with private care) for palliative drugs by cancer patients, and the denial of access to medication and surgery for a transsexual woman in Nottinghamshire – one can only wonder why these cutbacks are suddenly considered necessary, apparently across the board. Is the NHS really so comprehensively underfunded – and if so, where are our taxes going?

(Cross-posted at bird of paradox)

Comments From You

Cara // Posted 22 June 2008 at 9:02 pm

“Other lifestyle choices known to reduce fertility, such as drinking more than one or two units of alcohol a week, are not reasons for refusing treatment.”

Don’t give them ideas – they’ll bring that in next! *rolls eyes*.

Hmmm. I think this is fair enough, though. I don’t smoke, I can’t stand smoking and I think parents who smoke when the woman is pregnant or around their kids are, to put it politely, negligent parents.

Also – the world is overpopulated – we have to get rid of the idea that it is some kind of divine right to have kids. It isn’t. If people want to adopt, they get heavily investigated by social services and I don’t know much about it, so correct me if I’m wrong, but smoking would not go in their favour. I don’t see why the NHS shouldn’t have criteria to decide whether to give IVF, similarly. In fact I’d be all in favour of people having to get a licence to reproduce “naturally” – and I’m quite serious. Too many kids are born into abusive backgrounds, and I’m not being classist here, I attended a private school for 2 years as a teenager and half my classmates were on drugs, having underage sex, etc. because although materially priveleged, their parents didn’t really give a %^&* about them and saw having a cute kiddie as a fashion accessory, but once they grew into a difficult adolescent…in fact as far as I know, many of my friends from that school still have major issues.

Also, the NHS *is* underfunded. Smoking may not directly reduce the chances of IVF working, but since smokers tend to have less healthy lifestyles and are less fit, surely it is less likely to work.

As someone with a medical condition that may reduce my fertility I am, however, not in favour of judging people who wish to become parents on their lifestyle choices, hence my opening snark as I am currently enjoying some wine :-) – with reference to the govt.’s current “drinking is BAD, girls!” judge-y “health” campaign. But then I’m not convinced that moderate drinking is bad for your health. I think we have to accept that parents or those who want to be parents have to make some changes to their lifestyle, including making sure they are healthy. But I don’t like the preachiness that women trying to conceive a child are vessels and must do nothing less than consume only pure organic rainwater blessed by monks and must not let their blood pressure rise one iota etc. There is a happy medium – but I just think smoking is a step too far. It’s not that hard to give up ffs.

Kat // Posted 22 June 2008 at 10:29 pm

Well…I believe everyone should have a shot at IVF and it shouldn’t be a lottery, but I also believe that people should do everything they can to conceive naturally before accessing it, and if that means both partners stop smoking, so be it. If the woman is obese or underweight, she should try to gain a healthy weight before accessing IVF as well. Weight and smoking are both factors that can cause difficulties in conceiving or leeping a pregnancy (smoking more in fathers actually) and so I don’t see why people shouldn’t be expected to try removing these obstacles before being declared infertile!

lucy // Posted 23 June 2008 at 7:36 am

“and if so, where are our taxes going?”

This is a comment i really resent. Because our healthcare has always been invoice-free the UK population have become *so* unaware of how expensive medical treatment is that we seem to think for our measly 30% base tax rate we deserve fertility treatment of all things? It’s crazy.

I absolutely agree with Cara, having a baby of your own IS NOT a basic human right and if the NHS were impregnating smokers rather than, say, extending availability of the HPV vaccine to adult women, i’d be pretty concerned.

Amity // Posted 23 June 2008 at 8:06 am

While I agree that smoking is dangerous to one’s health and that if you expect the NHS to foot the bill for your costly infertility treatments that you should be willing to make some concessions to your lifestyle and try to become more healthy, I also believe that if we’re going to say that women should ALWAYS have bodily autonomy, we can’t force them to do anything or tell them that in order to do X with their bodies they must do Y first. With smoking it makes sense but if the government can tell a woman that she must stop smoking if she wants a baby, what will be next? No drinking? Arrested if caught nibbling on unpasteurized brie? Poo inspected to ensure enough fibre in the diet and prosecuted if found to be lacking? It just seems that smoking has become the new social stigma and that we are more than ready to harshly judge and withhold rights from those participating in something we generally disapprove of.

I would also disagree that having a baby isn’t a basic right. It may not be a protected ‘human right’ but it is a biological one that many people desire. To scoff at their desire and fob them off with orders to “just adopt” (as if adoption is an easy route) seems disingenuous and insensitive. I don’t suggest that we let anyone and everyone get fertility treatments but I think a little more sensitivity to the difficulties many women face in their journey to parenthood wouldn’t go amiss. No one is perfect and we all accept that. Why the expectation that mothers should be?

Jennifer-Ruth // Posted 23 June 2008 at 9:15 am

I’m a smoker and think it is quite right for them to ask people to give them up before getting IVF.

We all know how awful smoking is for us (and fertitility and pregnancy), so it seems like a reasonable thing to ask…

Sarah // Posted 23 June 2008 at 9:42 am

I agree it’s easy for this sort of thing to turn into preaching at women for all their imperfections, but I don’t think it’s necessarily an unreasonable requirement in itself. IVF is an expensive procedure, not to mention unpleasant and risky to a woman’s health and not guaranteed to succeed anyway. With that in mind, it makes sense for the NHS at least to restrict it to those with a reasonable chance of success, or at least those who are not actively working against the chances of successful conception. So I guess it is ‘rationing’ treatment, but is that necessarily a bad thing for the NHS to do, especially for non-essential procedures such as fertility treatment? There are not limitless resources, after all, and it makes sense for them to be rationed wisely. I’m sure there are bad decisions about how to manage the available resources, and people unfairly treated, but I don’t think it’s reasonable to say that rationing is inherently wrong.

Shea // Posted 23 June 2008 at 9:51 am

“I would also disagree that having a baby isn’t a basic right. It may not be a protected ‘human right’ but it is a biological one that many people desire.”

But Amity therein lies the problem in your argument- where do rights arise from? A desire doesn’t automatically translate into a right to do or not do something. I have a biological desire to have sex, it doesn’t mean that I can force someone to indulge that desire or that I have a right to do so. Even less so if I am demanding hormonal and chemical correction in order to achieve it.

“To scoff at their desire and fob them off with orders to “just adopt” (as if adoption is an easy route) seems disingenuous and insensitive.”

I don’t scoff at their desire, but as the above posters point out, if it is a genuine one the individual has a duty to do everything reasonable to ensure the success of a treatment, as they do with any other surgery or treatment. I would feel the same about alcoholics and liver transplants or smokers and lung cancer.

I recognise adoption isn’t an easy route, but neither is IVF. Its invasive and fraught with failure. If the desire to have a child is strong enough then what is the issue in overcoming these adoption obstacles?

The trouble with is the NHS is it is a system based on the health needs sixty years ago. Expectations of what the NHS should do have sky rocketed, unrealistically. We don’t put in anything like the money needed to keep pace. For my part I don’t believe the NHS should be funding what amounts to lifestyle choices. Especially when I see patients who can’t afford the monthly injection to maintain their sight in cases of macular degeneration or the anti cancer drugs to prolong life.

Fertility is not a medical issue. It has become medicalised as a problem but it isn’t, being infertile is rarely damaging to health even distressing as it is. It isn’t something the NHS should be addressing.

It is time we took care of the health needs of the living without allocating healthcare resources on the basis of people’s desires.

BareNakedLady // Posted 23 June 2008 at 12:35 pm

Hmm.. I read this with a sense of ‘and that’s a bad thing because….?’

A woman should give up smoking during pregnancy anyway, for the health of the baby, so what difference does it make for her to give up earlier than that? The massive health benefits to herself and a potential increase in her fertility are not exactly bad side-effects. I don’t think it’s unreasonable to restrict the availability of IVF that way, either – as has already been pointed out, it is not a life-or-death procedure.

Cara said “It’s not that hard to give up ffs.” – I have to disagree, it can be very hard indeed. :) But if you want a baby badly enough for IVF, then you should be able to give up the cancer sticks.

Anna // Posted 23 June 2008 at 3:43 pm

“It’s not that hard to give up ffs.”

Spoken as one who has obviously never smoked.

They want to ban smoking for they that want IVF? Fine. They can ban any drinking too, and everything else that even minutely reduces your chance of conception.

Cara // Posted 23 June 2008 at 8:40 pm

:-) yes, can you tell I’ve never really smoked?! I did expect to get told off for the “it’s not that hard to give up” comment. So fair enough.

But yeah, you have to make an effort if you want a kid. When/ if I decide I want a baby, I would be prepared to eat more healthily, exercise, drink less, etc. and that would not be a walk in the park, as I love my wine and chocolate!

Thanks Shea and lucy. As I said, I might not be able to conceive myself, but I don’t think having a child is a right, because as Shea said – just because you want something, doesn’t mean you can have it.

Kat // Posted 24 June 2008 at 5:46 pm

No Amity – smoking SIGNIFICANTLY reduces the chance of conceiving in women and men. The point is that by stopping smoking or losing/gaining weight couples may remove the NEED for IVF, by being able to conceive naturally, which is better for all!

And Anna – I’m a smoker, been pregnant twice, gave up immediately both times. Not trying to be smug, it’s really NOT that hard. If I had had problems conceiving smoking would have been the first thing to go.

Jo // Posted 25 June 2008 at 3:16 am

Well, Cara,

All that “when/if” stuff about giving up habits when you decide to have a baby is all very well till you try it. Everyone fails on a few counts. The thing is that, as a smoker I’ve had four pregnancies. Out of which I’ve had two children. Naturally. But if I weren’t able the authorities would say ‘no’. And the injustice lies in that many fundamentally crap parents can and do have children. With heroin addictions and all. Does smoking matter that much? I know it affects the success stats. But how much? More than living rurally compared with urban life? More than obesity? Fat is, after all, a feminist issue. I think that smoking is the tip of the ice berg. We accept that injunction and many will follow. And ‘no’ it isn’t that easy to stop ffs.

Sarah // Posted 25 June 2008 at 8:53 am

I think IVF is also restricted for obese women, for similar reasons. I agree that if only the absolutely perfect were allowed to have babies, then no one would qualify, but that doesn’t mean there shouldn’t be reasonable restrictions. And you can’t necessarily say that just because ‘fundamentally crap’ people do become parents naturally, we should allow them to have IVF or indeed to adopt. It would be very difficult to restrict who can reproduce naturally, and would throw up all kinds of human rights implications, not least for women (I’m thinking of things like forced sterilisation or abortion) and I’m sure none of us want to go there. But there is no fundamental human right to access IVF or adoption services, and it seems reasonable to restrict these firstly to those who we have reason to think will be ‘good’ parents (by which I don’t mean being perfect in every way, just not actively putting their children at risk) and in the case of IVF, to those who have a reasonable chance of success. Presumably you can pay for the treatment privately if you don’t meet the NHS criteria for ‘reasonable chance of success’, but surely it would be better to take an honest look at your lifestyle and make the changes that you need to.

I have never smoked, but from what I have seen in family members and friends, I agree it is not easy to quit. Some people seem to manage it on the first attempt without too much difficulty, but others struggle for years unable to stop. We should remember it’s a real addiction. That doesn’t change the fact that it’s bad for children and reduces your chance of conception, not to mention increasing some of the health risks of pregnancy.

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