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Wiltshire health authority expanded its funding for in-vitro fertilisation last week. It went from not funding IVF at all to 'limited funding for women aged 35'.

That is 'aged exactly 35 years'. Not 35 and under, the rumoured cut-off point for new, national guidelines on treatment floated in the press last week.

'It is all we can afford,' says Dr Femi Oduneye, specialist registrar in public health medicine. 'Everybody will then get a chance at that age.'

The national debate about IVF funding was always likely to rekindle. Assisted-conception treatments must be some of the most often rationed in the NHS.

Yet the Department of Health confirmed last week that ministers are committed to ending 'postcode rationing' of IVF treatment 'as part of a general belief in tackling inequalities across the NHS'.

The DoH is carrying out its own survey of HAs' IVF funding policies, and has commissioned the Royal College of Obstetricians and Gynaecologists to produce a report setting out new guidelines, which is expected later this year.

It was speculation about this report that prompted fertility specialists and campaigners to voice alarm last week.

Phil Taylor, chair of Child, the national infertility support network, says success rates do not decline significantly until women are 38-40, so there is no clinical justification for such a low limit.

NHS Confederation chief executive Stephen Thornton agrees that a lower limit of 35 would be a rationing, rather than a clinical, decision. 'Most women do not start trying to conceive until their 30s, so if you had a limit of 35, you have to ask: would anybody ever qualify?'

In fact, the government probably faces an unenviable dilemma. 'If the government is going to work broadly within the current funds available to IVF, then it is going to have to set strict limits.

If it does that, advocates for infertile couples will say this is not being treated with the seriousness it deserves,' says Mr Thornton.

'Otherwise, it entertains a quite liberal set of guidelines, which raises the question of funding. IVF has not been a published priority. We need to know if it is going to become one.'

This is not a dilemma confined to IVF. The government's delayed national service frameworks on mental health and coronary care are likely to raise similar issues.

Mr Thornton argues that the only rational way forward is to look at treatments across the board, and then draw up a properly funded programme of work that is honest about financial constraints. 'Otherwise HAs will be in the very difficult position of the government, inadvertently stoking demand.'

Dr Oduneye also supports the idea of national guidance, but says: 'It will not help if we are asked to provide a service and no funds come with it.'

An added complication in the IVF debate is the nature of some of the criteria currently used to ration treatment.

In addition to its age limit, Wiltshire HA says assisted conception services will not be provided for people with children, including adopted children, from either partner. Male partners must be under 50 and women must have a body mass index of between 20 and 33.

In an age where government tax policy is scrutinised for its effect on marriage, deciding such issues nationally will not be easy.

Dr Ian Greatorex, chief executive of Salford and Trafford HA, is battling with such issues following a local trust's request to 'phase out closure' of a local infertility unit, and finds it fascinating. He believes moving to larger centres, with good national guidelines and ear-marked funding, is 'the way to go' - but suspects it will be difficult to get there.

Mr Thornton agrees that health secretary Frank Dobson could find himself making some 'quasi-moral' judgements, but says it is the price for ending postcode prescribing in favour of a national approach.