A public consultation, taking place as part of the Scottish Executive review of NHS-funded fertility treatment in Scotland, closed this week. The consultation set out to examine clinical criteria for treatment, such as age limits; social criteria such as whether couples have no other children in the home; and other issues such as potential impact on waiting lists that may result from widening access to treatment. Despite guidelines for national criteria for Scottish NHS-funded infertility treatment laid out by the Expert Group on Infertility Services in Scotland (EAGISS) in 1999, service provision amongst NHS Boards has remained inconsistent.

This week an advisory group comprised of the heads of Scotland's IVF units, leading clinicians and patient representatives submitted a report to a cross-party parliamentary group recommending a ban on NHS-funded IVF for clinically obese women. Currently, individual health boards are able to select patients for treatment according to their own policies, with Glasgow Royal Infirmary the only one of Scotland's four publicly-funded fertility clinics to already ban IVF for obese women. Fertility centres in Aberdeen and Dundee do provide treatment to obese patients, but they are required to join a weight loss programme. If ministers were to accept their recommendations it would be the first time Scotland has implemented a blanket government policy limiting health care according to patient weight.

Although the view was not unanimously held, the recommendation will suggest that women with a body mass index (BMI) of 36 and over will automatically be denied treatment. A BMI measuring over 30 marks clinical obesity, with 40 and over indicating morbid obesity. Chairman of the advisory group Dr Mark Hamilton, a consultant obstetrician at Aberdeen Royal Infirmary and an inspector for the Human Fertilisation and Embryology Authority, was reported as saying that IVF is less likely to be successful in obese women and that 'there are also safety issues for the baby and mother. Politicians are a bit nervous about using weight as a barrier to accessing treatment but we have to be pragmatic and sensible about it, acknowledge that it is an issue in society and take on board that treatment might be hazardous'.

Hamilton added: 'There needs to be a consistent approach to the funding of fertility services throughout Scotland and not only the age of the woman, the number of cycles that couples should receive but also health-based criteria like weight and smoking and so on. We are not trying to use weight as a barrier to treatment - saying that we don't like the overweight - it is a case of safe and appropriate treatment'.

Reproduced from BioNews with permission, a web- and email-based source of news, information and comment on assisted reproduction and human genetics, published by Progress Educational Trust.