Fertility by Residence

INFERTILE COUPLES IN THE UNITED STATES often struggle to pay their medical bills because infertility treatments are rarely covered by insurance. But health care is free for all citizens in Great Britain - from the Queen to the vagabond - so it's safe to assume that infertility procedures under socialized medicine are free, too, right?

Wrong. It depends on your ZIP code.

Medical care is paid for by the national government, but 129 local health authorities decide which treatments are covered. Many authorities will cover surgery to repair a weekend cricket injury, but not in vitro fertilization (IVF).

Advocates for the infertile and many doctors assert that the system is unfair, including Doctor Peter Braude, a leading infertility specialist in London. "I could be living in my house and my health provider is prepared to pay for 100 in vitro fertilizations," Braude says. "While my neighbor across the road finds that the health care authority says, 'We're not going to pay because we don't believe in IVF.'"

A spokesman for Britain's main infertility support group, Issue, puts it more bluntly. "It is infertility treatment by post code, and we find that totally annoying and very discriminating," said Issue Chairman Tim Hedgley.

In the county of Essex, Katrina and Ian Cooke discovered that their local health authority kicked in next to nothing for their five rounds of IVF treatment. Ian is a 42-year-old diesel mechanic; Katrina is 35-year-old legal secretary. They married in 1992 and soon realized they couldn't get pregnant. Ian had a low sperm count and Katrina's fallopian tubes were blocked. Over five years they spent about $23,000 on treatments.

Freddie, Katrina and Ian Cooke in their backyard in Essex.

"We were lucky because my parents paid for almost 80 percent of the treatment," Katrina said, sitting on the couch in the couple's small living room, holding Ian's hand. The Cooke's could never have afforded the treatments themselves because Ian was laid off half-way through the process.

"We have lots of friends who have taken out loans and second mortgages and all sorts of things just to have a child, and it seems very wrong," Katrina said.

A study by Dr. Braude found that 80 percent of couples undergoing IVF in Great Britain pay for it out-of-pocket. The cost can range from roughly $8,000 per live birth to $63,000, depending on the couple's condition and their infertility clinic.

Infertility activists have a tough battle to change the National Health Service's approach to infertility coverage. The NHS is chronically on the edge of financial collapse, and a recent nation opinion survey found that British people list infertility treatments at the bottom of the priority list for national health coverage.