Rationing and NHS fertility services: a commissioning perspective.

Of all NHS services, infertility appears to suffer the most from inequity or unfairness of provision across the UK. Infertility is a significant cause of population ill health and emotional morbidity which can be managed effectively and relatively cheaply. Although longing for a 'take home baby', most patients know that their planned treatment cannot guarantee success. They are aware of the scarcity of resources and of the need for their appropriate allocation. However, patients also expect to have their problem carefully assessed and appropriately treated by the best methods of assisted conception currently available and that this will be done fairly, given their particular clinical and demographic circumstances. Commissioners and clinicians have a duty to acknowledge infertility as a significant health need and to ensure that the treatment provided is both equitable and as effective as possible. This article outlines a local model of commissioning and provision of infertility services that may be of interest and value to those in the process of redesigning infertility services. A recently published Scottish Expert Report on infertility services in Scotland also offers a positive way forward in this arena.