The cover feature 'The cost of living' highlighted the lack of equal access to assisted conception treatments.

But only a small proportion of couples seeking advice will need advanced assisted conception. Commissioners should divide fertility treatment into primary, secondary and tertiary care. Many couples who consult their GP in primary care will become pregnant, either by being patient or by following basic advice.

The enormous variation in primary care management should be tackled by developing protocols and close liaison with a secondary level hospital fertility clinic.

At my secondary clinic, many patients will become pregnant with relatively straightforward, inexpensive treatments, and I act as a broker for those who need to move on to a tertiary assisted conception clinic.

Equity of access is a problem mainly at tertiary level, where assisted conception centres offer donor insemination, intracytoplasmic sperm injection and in-vitro fertilisation.

Clearly, the NHS must prioritise tertiary treatment, but it is important to realise most couples can be helped by improvements in primary and secondary level management.

Consultant obstetrician and gynaecologist (reproductive medicine)