Plenary, 27 Jan 2005

Meeting date: Thursday, January 27, 2005

Official Report 735KB pdf

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Infertility Services

The final item of business today is a members' business debate on motion S2M-1852, in the name of Mary Scanlon, on infertility services in Scotland. The debate will be concluded without any question being put.

Motion debated,

I am grateful to secure the first debate on infertility in the Parliament and I thank those members who have stayed on for it. Coincidentally, there was an adjournment debate on infertility this week in Westminster Hall, led by the Labour MP Kevin Barron. He is chair of the all-party group on infertility, and its vice chairman is the Conservative MP Andrew Lansley. In that debate, Kevin Barron stated that 80 per cent of infertile couples in England have to pay for their treatment, the cost of which can run to tens of thousands of pounds. I do not have the figures for Scotland, but they are worth seeking.

It has been said that, in Scotland, we are more likely to discuss our debts and our bank balances than infertility. Infertile people naturally do not like to talk about their problem, not even to close family in many cases. Consequently, many will not even come forward for treatment. A recent article by Kate Foster in Scotland on Sunday states:

"This is the debt generation. It's not just about delaying childbirth to have a career, it's about being able to afford a home."

In The Scotsman, Gillian Bowditch says:

"Get the economy right and we'll get breeding".

The issue is complex, but I will concentrate on infertility treatment. Recent research in Aberdeen shows that the average sperm count has fallen by 29 per cent in the past 13 years. I have not read every word of the sexual health strategy that was launched today, but I would like sex education to be more about getting pregnant and not all about preventing girls from becoming pregnant. One couple in four in Scotland will need assistance to conceive at some point in their reproductive lives—that is equivalent to 32 MSPs. In a year, 5,062 couples present to their general practitioners and some 4,657 of those couples will be referred to hospital care. Members might not know this, but I understand that the commonest single cause of infertility is defects in male fertility, not in female fertility. That is followed by problems with ovulation, and disease of the fallopian tubes.

According to Infertility Network Scotland, births in Scotland could be increased by around 2,000 a year if all current attempts at in vitro fertilisation were successful, and more if present limits were removed. Infertility can have a profound effect on individuals, couples and relationships and is associated with high levels of depression and marital break-up. The Infertility Network describes the feelings that are expressed as fear, guilt, anger, shock, shame, isolation and inadequacy. That is not to mention the issues of femininity and machismo, which are too complex even to start to talk about.

Although we do not treat it as such, infertility is a public health problem as defined by the World Health Organisation. It is often described as a lifestyle, rather than a medical issue. It might not be life threatening, but it is life affecting.

Modern infertility treatments exist, and they offer an excellent chance of success. After three cycles of IVF or intracytoplasmic sperm injection—ICSI—treatment, a couple stands a 50 to 65 per cent chance of having a child. Well, almost: the cut-off age for the treatment currently stands at 38, when the success rate for treatment is about 25 per cent. However, it drops to less than 20 per cent after the age of 40.

In Grampian the waiting list is nearly five years—I see Margaret Ewing nodding. In the Lothians, it is two to three years, and it is about 12 months in Glasgow. Many couples end up paying the full cost of treatment themselves. Someone from Edinburgh e-mailed me last week to say that there was a seven-month waiting list for an initial test in Edinburgh. In order to get in before the deadline, she paid for it herself, through BUPA. Poorer couples clearly cannot afford to do that.

At a time when there are concerns about Scotland's falling population, as mentioned by the Registrar General for Scotland in his annual report, it makes sense to provide those who dearly wish to have a child, but who are experiencing difficulty, with every assistance, particularly given that the total number of births registered in Scotland in 2002 was the lowest figure ever recorded—and 2002 was the sixth consecutive year in which the total number of births reached a new low.

The raising of the upper age limit for IVF treatment to 40 has been mentioned. That is welcome, but unless it is accompanied by more prioritised resources, the waiting lists and waiting times will simply lengthen. As everyone knows, the earlier that treatment is available and the younger the age, the greater the success rate. I ask the minister why infertility treatment sits outside the waiting time directives and why it is acceptable for infertile couples to wait for up to five years for treatment, while waiting list targets for other treatments are six months.

In March 2003 a meeting was held, in the presence of the Executive, involving all the key players in infertility in Scotland. The meeting produced consensus and I hope that the minister will accept its recommendations in her winding-up speech.

The current criteria disallow infertility treatment for couples if there is a child from a previous relationship living in the home. That means that many women and men could be barred from treatment despite not having their own biological child. The options for such couples are to fund treatment themselves, or to return the child from the previous relationship to the former partner. What a choice.

Sperm donation legislation passed at Westminster comes into force in Scotland in April this year, from which time sperm donors will give on a willing-to-be-known basis. That means that information about the father will be kept, so that the child, at 18 years old, can trace his or her father. That will undoubtedly reduce sperm donation, which, in Scotland, is already critically low. We bring in a large percentage of sperm from England. In Glasgow, much of the sperm is imported from Denmark, but sperm from outwith this country will stop when the legislation commences in April. The removal of anonymity is a huge issue, and we need to plan now for how to recruit donors with the awareness that they are willing to be known. Scotland is now classed on an international scale as a very-low-fertility country. On that ground alone, we need to do more.

Women are choosing to start a family later. The average age for first-birth mothers is now 30. Unfortunately, two years of unsuccessful attempts to conceive and a five-year wait for treatment—which applies to many women—with a cut-off age of 38, means that women need to get serious about childbirth earlier than age 32, or they might be too late.

I will finish with a quote from Lord Winston, which was cited by the Infertility Network:

"The infertile deserve compassionate social, not demographic consideration of their problem."

I am grateful for the debate, and I look forward to the minister's response.

I thank Mary Scanlon for bringing this debate to the chamber. I am pleased that the Parliament is debating infertility, as there is no doubt that it desperately needs wider public discussion.

For most people who are affected by infertility, it is an extremely private issue that can cause mental and emotional anguish, and can lead to long-term problems such as depression and the breakdown of relationships. The nature of the condition and the complexity of the emotions involved mean that many of those who are affected avoid speaking openly about their experiences, even with the closest of family members. For women, feelings of sadness, jealousy, anger, grief and loneliness are all associated with the experience of infertility. Equally, men can suffer from emotional anxiety, stress, feelings of inadequacy and low self-esteem.

A sad result of the trend is that we rarely have open, honest or poignant discussions about infertility in the public domain. Those who are unaffected by infertility are therefore too often reliant on sensationalist reporting and public discussion, such as the recent outrage over the case of 66-year-old Romanian mother Adriana Iliescu, which can form their perception of the condition and its treatments.

In reality, of course, the sad truth for infertile couples is far more fundamental and heart-rending than such high-profile cases sometimes suggest. An estimated one in seven Scottish couples experience fertility problems. Waiting lists can be as long as four years. As Mary Scanlon pointed out, a cut-off age of 38 for IVF treatment for childless women, plus an average two-year wait before GP referral, means that the real cut-off age for discovering fertility problems is closer to 32.

In a country where political will is being applied to tackle a declining population, surely it is time that our society recognised that infertility is a legitimate health care need that requires nationwide commitment. We have to open up widespread discussion of infertility to ensure that there is greater understanding of all the issues involved.

As important as the need for a comprehensive and consistent nationwide approach to infertility is the need for a dedicated strategy to tackle the underlying causes of the condition. While current levels of involuntary childlessness can be attributed to different factors, such as women waiting longer to start families, previous illness and a fall in the average sperm count—as outlined by Mary Scanlon—the alarming rise in sexually-transmitted infections in Scotland in recent years could override all those contributing factors as the main cause of infertility in coming decades. It is therefore fitting that this debate should follow the Minister for Health and Community Care's statement on a sexual health strategy for Scotland.

As many as one in 10 young people in this country could have the sexually-transmitted infection chlamydia without knowing it. In some areas of Scotland, clinics have reported finding that as many as one in four young women are infected with the disease. The silent harm of chlamydia is of great concern. In a significant proportion of cases—particularly among women—it can be asymptomatic, and so can remain undetected, which puts women at risk of developing pelvic inflammatory disease and infertility. It is essential that we take action. Money that is spent now on better information services and testing the population, coupled with a national screening programme such as that in Sweden, could save us a great deal in future decades.

There are other causes that require attention. Once again I draw attention to endometriosis, which we debated four years ago. I wish to put some questions to the minister. In 2001, the estimated waiting time for the diagnosis of endometriosis was seven years, which highlights an urgent need for better understanding. Could the minister investigate whether the diagnostic situation has improved? Will she reconsider the possibility of having a public awareness campaign to encourage greater interest in and understanding of the condition among the public, the medical profession and the scientific community?

Once again, I thank Mary Scanlon for raising the subject of infertility. In the spirit of talking about it, I say that my husband and I have personal experience of infertility, having tried unsuccessfully for a number of years to start a family. We were extremely lucky to conceive without IVF—it was a miraculous occurrence—but I have not forgotten the emotional turmoil at the prospect of not being able to have a child. I hope that the forthcoming review of guidance on the provision of fertility services in the national health service will result in improved services and greater reassurance for couples that their decision to try to have children will be supported and resourced.

Like Elaine Smith, I congratulate Mary Scanlon on bringing this important subject to the chamber and on the cogent case that she has laid before us. Perhaps she could ask her colleague David Davidson why, of those who have remained for the debate, only one is male—apart from you, Presiding Officer. There might be a psychological explanation for that; I am not sure.

In the annals of the Parliament, we can see that the issues that are raised in members' business debates are important. I think that you will accept, Presiding Officer—although I do not have statistics—that the debates are often about issues pertaining to the delivery of the health service. I say that as a serial attender, or perhaps even offender.

I am proud that the Parliament has this important facility to bring to the attention of ministers and their officials issues that can often be lost in the broad sweep of general legislation. The debates ensure that we can bring before the Parliament not only constituents' issues, but issues that transfer across geographical boundaries in Scotland and elsewhere. Such subjects are part and parcel of what we should be talking about in the Scottish Parliament. I believe that members' business debates are part of making this a genuine people's Parliament and ensuring that minorities are not forgotten. I say to the minister that addressing any slippage in the provision of adequate services to infertile couples is part of ensuring that those who experience infertility and wish to undergo fertility treatment are not forgotten in the broad health policy agenda, which we accept is complex. In Scotland, according to the figures that I have, 2,500 couples a year undergo fertility treatment and can access three cycles of treatment via the NHS.

A committee of senior doctors has recommended that the age limit for receiving treatment be raised from 38 to 40. I hope that the Executive will accept that and provide the necessary resources to assist people, against the backdrop of demographic change in Scotland and the fresh talent initiative. We should enable people who are here to have children and if they have difficulties we should do everything that we can to assist them.

We all know that, increasingly, women are postponing the possibility of pregnancy until their mid-30s or thereabouts. It might come as quite a shock to many people who have been using various forms of contraception to discover that conception is not as easy as it seems. Raising the age limit for treatment is important given the demographic trend in Scotland.

Over the many years in which I have been an elected representative, I have discovered that it takes a great deal of courage for couples to talk about infertility. Elaine Smith has had personal experience of the issue and she is right that the people affected find it difficult to talk, even to close family members. However, they have to talk to their general practitioner, be referred to a consultant and come to our surgeries—I have dealt with several cases over the years. We are asking them to discuss one of the most personal, emotional and private aspects of their lives. They tell us how they feel about the barbed comments that are sometimes made. For the sake of parliamentary propriety I will not go into those comments. Some are meant in a jocular fashion, but the hurt and the emotional instability that people experience, which affect their close relationships, cannot be underestimated. Their angst is immeasurable. From my years of conducting surgeries—I do not want to say how many years—I know that it is unusual for an MP or MSP to be in tears during a surgery. I am used to constituents being tearful, but some of the cases that have been placed before me can reduce me to tears.

I want the minister to examine the distribution of cases. Mary Scanlon talked about the waiting lists, figures for which are available. When I checked today, I noted that the waiting time in Grampian—the list was established in 1995—is five years. From 1987 onwards, when people in Moray came to me with fertility problems, they were referred to Ninewells hospital in Dundee, which meant that they incurred a great deal of travelling expenses and so on. The waiting time in Lothian is three years and in Glasgow it is probably one year. I sincerely hope that the minister will address the disparity in waiting times. I know that the minister is not only a politically caring individual, but a personally caring individual.

I join others in congratulating Mary Scanlon on securing this debate. Over the years, she and I have disagreed on many health-related issues, but I genuinely admire her tenacity and consistency in championing a number of issues in the Parliament, infertility being one. Over the years, Mary Scanlon has raised this issue in forums that I have been involved in and has succeeded in raising awareness and changing minds and policy as a result.

I felt duty bound to speak tonight, not least because the motion mentions the report of the expert advisory group on infertility services in Scotland, which I launched in my former life as Minister for Health and Community Care. I remember spending some considerable time thinking about how that work could be taken forward. I readily admit that my recollections might have become fuzzy over time, but I recall being impressed by the work that was being done. While I agree that it is right that that work be re-examined—particularly with regard to implementation—it is important that any work that ministers take forward builds on the thorough work that has been done.

That work was done because successive ministers recognised that the degree of variation across the country was unacceptable. In infertility services, as in so many others, the challenge is how to remove the postcode lottery. That is what the Health Department and its ministers must focus on. The situation cannot be solved simply by issuing an edict from the centre or investing a pile of money; there are complex issues about service-level delivery in ensuring that there is a genuine equity of service across the country.

Communicating the work that is done by clinicians to people who are affected by infertility is also important. I remember studying the work and gaining an understanding of why some of the recommendations were being made. That involved spending a considerable amount of time discussing the subject with some of the best experts in the country. It is important that couples who have a limited amount of time with a clinician and who are already upset and emotional have the reasoning behind certain decisions and policies in the health service explained to them in a way that they can understand more readily than is often the case.

As others have done, I want to make a link with the earlier statement on the national sexual health strategy. Many have talked about the need to discuss such issues more openly. I am talking not about requiring people to be explicit about their personal experience, but about having a society that is able to discuss issues pertaining to sex and relationships, infertility and reproductive health in general. We have a long way to go before that happens, however. I well recall from my experiences of being pregnant and of trying to conceive—I will not go into more detail—that although I was well read and well educated and had accessed much information, I found that many matters were not part of the common currency of understanding in our society. We should not kid ourselves that as a society we have got to grips with the issues.

I agree strongly with Elaine Smith's points about the importance of recognising the link between sexually transmitted infection and infertility. I am disappointed that the sexual health strategy that was published today makes no commitment to a national chlamydia testing scheme. We need not wait for further evaluation of projects to progress that. We know from work that has been done that such testing works, diagnoses infection and can lead to people being treated. We should remember that chlamydia is the leading cause of tubal infertility in women. I hope that that is a clear issue on which the minister will respond.

Although much progress needs to be made, we should applaud not only the work that is being done in the health service to deliver services, but the research that is being conducted in Scotland. Right on our doorsteps, we have the centre for reproductive biology at the Edinburgh royal infirmary, which is undertaking leading-edge work on infertility and many other areas of reproductive health. Some time ago, the cross-party group on sexual health received from Dr Bob Millar of that centre an utterly illuminating presentation of which many members would be interested to hear more.

I congratulate Mary Scanlon again on securing the debate. I hope that it raises awareness and changes practice in the time to come.

I echo what other members have said. I thank Mary Scanlon for initiating an important debate. In my professional career as a doctor, I worked in community paediatrics, so I did not deal directly with infertility cases. However, I dealt with such cases indirectly, as I was for a time a medical adviser to the adoption panel in the Highlands.

The panel dealt with many couples who had undergone failed IVF treatment and the trauma of that. They were becoming older and had realised that adoption was the way that they might have a family. Sometimes, couples were still undergoing treatment during assessment as adoptive parents. They were put on hold while the IVF continued, so they experienced the trauma of worrying about whether the IVF would succeed and of thinking that they might be missing the chance of a placement of a child for adoption.

Mary Scanlon described infertility as a life-affecting issue, but I think that it is more than that; it can be a life-destroying issue. I would strongly take issue with anyone who said that treatment should not be available to everybody on the NHS, but I do not think that anybody would say that. It is up to us to make that provision available.

Mary Scanlon mentioned societal changes that might lead to an increase in infertility, such as the fact that women delay child rearing for reasons such as career issues. She also referred to the debt generation. I was talking casually to somebody up in the Highlands who said that his daughter, who is in her early 20s, has so much debt from her student days that she will be unable to consider having a family and taking a career break for years. He described that, perhaps in a rather extreme way, as a sort of genocide that was being perpetrated on that stratum of society—the people who have been students and who cannot consider becoming parents for many years until they pay off their debt.

Chlamydia, which has been mentioned, is another issue. I will not go into that, because other members have, but I echo the comment that we will not have good reproductive rates unless we have good sexual health, which is crucial in society.

Mary Scanlon mentioned the falling sperm count. I do not want to stray too far from the debate's purpose, but we must take that matter seriously. Evidence is increasing that at least one factor in the falling sperm count is toxic pollution in our environment. Many of the toxic chemicals that are found everywhere in our environment are known to be hormone disrupting.

At present, the REACH legislation—it concerns the registration, evaluation and something that I never remember of chemicals—is being gradually processed through all the European Parliament's committees. The chemicals industry is exerting great pressure for that legislation to be diluted, but we should resist that, as, indeed, the UK Government has so far. I have told the Scottish Executive—as have others, to ensure that our views are known at the UK level—that the regulations should be as stringent as possible and that we should try to phase out potentially hormone-disrupting chemicals for the good of future generations.

Someone touched on the slightly unfortunate publicity in the papers about a much older woman in another country who had been given infertility treatment. However, I do not think that that would happen here.

When I was looking up information for the debate, I rather extravagantly downloaded and printed off the Human Fertilisation and Embryology Authority's document "Tomorrow's children: A consultation on guidance to licensed fertility clinics on taking in account the welfare of children to be born of assisted conception treatment". Some of the advice that it contains is obvious and has been known for years, such as checking that neither parent has a record of child abuse. However, other issues are addressed—for example, the welfare of children who are born to certain family structures. The document states that the families' structure seems to have less effect than their standard of living and that poverty is much more important than how the family is structured. Particularly, children who are born by assisted conception to lesbian parents do well. That is worth saying, as the research is evidence based.

I very much welcome the debate. I believe that, in a civilised society such as we hope we have in Scotland, treatment for this distressing condition or group of conditions should be available to everybody, irrespective of where they live and what their income is.

As I listened to Mary Scanlon's speech, I was watching the reactions of members around the chamber. That is one of the reasons why I have chosen to speak in the debate, although I was going to stay and listen anyway. In case anybody thinks that I am the token male in the debate, I should say that I have done my bit for family raising. I had five children—with my wife, I might add—and I still have some responsibility there. I was interested to hear Mary Scanlon talk about the importation of sperm from Scandinavian countries. A recent DNA check found that Stonehaven, where I live, has the highest Scandinavian DNA profile in Scotland. There is nothing new in that; it is the motive that is different now.

Members have raised issues about age. I agree that the age at which people qualify for treatment should be raised, especially as nowadays people who have careers often marry or settle down much later in life. However, I have a slight reservation. I do not condemn my parents in any way, but my mother was 37 and my father was 42 when I arrived. That was fine: I had caring, loving parents. However, when it came to asking, "Are you going to come and play football, dad?" that was a wee bit beyond his level. We must bear the needs of the child in mind.

There is a lot of male angst because of the stigma that is attached to infertility. As is often the case in Scotland, we are not good at talking about mental health, infertility and similar issues. My late brother-in-law was desperate to have a family and could not believe it when he was told that the fact that he could not have children was his problem. That hurt him for years, to the point at which he might as well have become a father to my children—I would have liked that contribution financially—because he treated them as his own. When he died last year, the last thing that he said to a younger member of our family was that he very much regretted not having his own children, although he had enjoyed participating in my children's lives.

Taking all those personal experiences together, we ask what is causing the problem. I agree with Eleanor Scott—I made a note of this—that general health is important. There is, undoubtedly, evidence of environmental pollution in western society. I do not agree with everything that the European Union says or does and I think that we should scrutinise it in Parliament, but I believe that this country has to pay some attention to the effect of toxic materials on health in general, not just on the fertility aspect of it.

We have a diminishing population and family life is under stress. There are many pressures on family units and couples. When people can prove that they can bring up a child—and that has nothing to do with wealth; it is about people's ability as parents—that should give them some qualification for treatment. Parenting education should be given at school and that should include education in fertility and the things that can damage people's future ability to have a family.

Part of that is diet and lifestyle. People are binge drinking and there is dreadful misuse of alcohol, tobacco and drugs. The sexual health of the nation is poor and, as Susan Deacon said, we do not know how many infections there are. I would back her idea of a chlamydia testing scheme. For many people, the problem is a matter of lifestyle. They get into drink and drugs; they end up having sex and getting infections. That damages their lives.

Many contraceptive preparations damage women's fertility. They can limit a woman's physical capability to have children. Moreover, the sheer angst caused by fertility problems can cause mental health difficulties and those, again, can postpone children. There should be some form of counselling for people who have such difficulties. We need to get them into the system and speaking to people.

The community health partnerships have a public health role and I hope that the minister will respond on where she thinks fertility issues should fit in in that respect. On affordability, the health service in Scotland belongs to us and it is for us to decide how we spend the money. I am not being xenophobic when I say that I would not like people to come from other parts of the United Kingdom and Europe because we have something on the health service that they do not have. We have to consider the numbers carefully.

Few people are experts in the field, which is small and specialised—we cannot have a brain surgeon on every block. However, why can we not set up a peripatetic consultancy system that would operate out of Edinburgh, for example, and go to the regional centres? The problem is not a life-and-death one and nothing is going to happen overnight, so people can make appointments. If that happened, the experts could go out to where they belong—in the community.

I thank Mary Scanlon for giving us the opportunity to speak about infertility services and to review the guidance of the expert advisory group on infertility services in Scotland on criteria for access to NHS-funded assisted conception treatment. From talking to officials, I know that Mary Scanlon has a great passion for the issue and I have probably heard her speak about it in the past.

The Scottish Executive has long recognised that management of infertility represents a health need. Susan Deacon worked on the issue in her former life as a minister; we should acknowledge the importance of that. The Executive prides itself on putting families and children at the centre of our policies. We also acknowledge the heartache and pain that not being able to have a child or complete a family unit causes many couples.

As many members have said, infertility is much more than just a physical health need; successful and unsuccessful treatments can have long-lasting emotional impacts. For that reason, we are keen to ensure that access to NHS-funded assisted conception treatment is available fairly and equally throughout Scotland. Like many other MSPs, I have heard heart-rending stories at surgeries in my constituency.

NHS-funded infertility treatment has been available in Scotland for many years, although provision and access is variable around the country; I will touch on that more in a moment. In order to redress that, an expert advisory group on infertility services in Scotland—EAGISS—was convened to examine the services that are available and make recommendations for future management of assisted conception treatment. The group reported in 1999. The report covered a range of issues, including the evidence base for effective treatment and the service model for different levels of infertility treatment. One of the report's most important recommendations related to the criteria for access to treatments requiring Human Fertilisation and Embryology Authority licensing, such as IVF or ICSI. Following production of the EAGISS report, the Scottish Executive asked NHS boards to adopt the criteria.

The criteria covered clinical aspects, such as underlying health problems, previous treatments and age, and the number of treatment cycles that a couple should have. The criteria were based on the best clinical evidence of effectiveness that was available at the time. The criteria also stated that couples who already had a child living with them in their home should not be able to access NHS-funded treatment. That social criterion was reached by consensus. Again, Mary Scanlon referred to issues around that, which I will touch on later.

The EAGISS report was well received, I understand, by clinicians and service users because of its focus on ensuring equity of access across the country and its emphasis on basing the criteria on evidence of effectiveness. The chief medical officer asked NHS boards to implement all the recommendations and the service model that was set out in the report, but no timescale was specified.

To ensure that boards were working towards implementation, a review of access criteria was conducted in 2000, which found that NHS boards were working towards implementation of the criteria and that significant progress had been made. However, the review also found that there remained variability in the criteria that boards were using, particularly around the female upper age limit for treatment. Because of that continuing variability and the availability of more up-to-date information on the effectiveness of treatment, the Scottish programme for clinical effectiveness in reproductive health conducted a consensus conference in 2003, at which the very latest evidence was presented and each of the criteria was revisited. The conclusions of the conference were submitted to the chief medical officer for consideration.

Concurrent with those developments in Scotland, Westminster ministers asked the National Institute for Clinical Excellence to review fertility services in England and Wales. NICE published in 2004 recommendations for clinical management of fertility services in England and Wales, which included criteria for access to treatment.

We then asked NHS Quality Improvement Scotland to revisit the conclusions of the consensus conference, review NICE's recommendations and provide us with a coherent evidence base for provision of infertility treatment. I now have the results of that review by NHS QIS, which suggest—based on evidence of effectiveness of treatment—that there should be changes to the age limit of up to 40 years and to the number of cycles that are available to eligible couples, which is currently five cycles.

However, as I have already remarked, not all NHS boards have adopted the present EAGISS criteria. Many people have drawn attention to that. Therefore, prior to making any further changes, we need to ensure that we can deliver on the criteria and that we are not simply creating even longer waiting lists for treatment.

Mary Scanlon asked whether the Executive intends to introduce waiting-time targets. We do not routinely collect information on waiting times for fertility treatment because of sensitivities around patient confidentiality. The HFEA is responsible for maintaining all information on infertility services throughout the United Kingdom. Indeed, it releases information only to licensed centres in order to ensure that patient confidentiality is protected. However, we are very much aware of the kind of differences that exist. Margaret Ewing drew our attention to the longest waiting time—five years—which is in Grampian.

We need to think carefully about what is happening in terms of current implementation and its variability. We also need to think about whether we are going to change the criteria and whether we can deliver the criteria—that is critical. We are going to conduct a consultation in the coming months, in which we will take on board comments from service users, which is important, and clinicians. We will concurrently conduct an economic appraisal of the suggested changes to the status quo.

We need to be clear about the resource consequences of widening the access criteria before possible implementation of revised guidance. It is important that NHS services be provided equitably and fairly and that service users do not feel that they are subject to exclusion or inclusion on the basis of where they live. However, that does not mean that all infertility services can be available in every board area. David Davidson touched on that. Some areas of provision are highly specialised and can be delivered only by appropriately trained, resourced and licensed centres. That means that there will still be a need for couples to travel to a tertiary centre for specialist care such as IVF. However, we want to ensure that the pathway of referral on to those centres is clear and equitable, regardless of where the patient originally presents.

There has been much discussion about infertility. Elaine Smith, Susan Deacon and other members have talked about that. There is no doubt that we need to look in broader terms at issues to do with infertility. Indeed, the Scottish Executive is seeking to make a difference and to tackle issues such as smoking with legislation that it is introducing. It is also seeking to tackle over-consumption of alcohol and is taking steps to address obesity.

A lot with which I agree has been said about chlamydia and sexual health. Chlamydia is potentially damaging to fertility. Members may be aware that that is one of the areas that the national sexual health demonstration project, Healthy Respect, has been looking at, and it intends to demonstrate best practice in improving sexual health, including prevention and diagnosis of chlamydia. I recognise the importance of that. I respond to Susan Deacon by saying that we have to make it clear that tackling chlamydia is one of the central aims of our sexual health strategy. Although a national chlamydia testing scheme may not be feasible just now, I am certainly not ruling that out. I want to be absolutely sure that we are doing something effective about the appalling rates of chlamydia in Scotland. Let there be no doubt about that.

Through the consultation and appraisal that I described, we believe that we can develop a protocol for infertility services that not only provides equitable provision for patients but is deliverable within available resources. Through the consultation, we want to address issues such as the use of social criteria, the relative priority of infertility treatment—given the many demands on the NHS—and the balance between attempting to ensure that as many infertile couples as possible have at least a limited number of treatment cycles and ensuring that we maximise the effectiveness of treatment.

The minister speaks about resources being available. It is my understanding that, following the EAGISS report in 1999, health boards were expected to implement its recommendations but were not given additional resources. That is part of the reason for the increase in waiting times. Is the minister committed to taking resources from elsewhere in the NHS in order to earmark funding for infertility services in future?

I can tell Mary Scanlon that, as part of the consultation, what we need to establish is why services have developed so patchily across Scotland. Is it to do with resourcing or with clinical leadership in NHS board areas? We need to get to the bottom of that. Clearly, we need to establish protocols that will allow health boards to provide services that are equitable and available to people no matter where they live and no matter what their economic position is. We want to complete the review and publish our conclusions by end of summer 2005.

I also want to mention endometriosis, which was mentioned by Elaine Smith. I agree that endometriosis causes huge pain and suffering to women and I certainly take it seriously. I do not have at my fingertips up-to-date information on endometriosis, but I am more than happy to get an update for Elaine Smith and will forward it to her.

I conclude by thanking Mary Scanlon for the tenacity that she has brought to her work in this area. I would be delighted to meet her to discuss how we can take matters forward. I am more than happy to work in partnership with the other members in the chamber who have demonstrated an interest in the subject to see how we can improve infertility services throughout Scotland.

Meeting closed at 17:55.