I agree with Abha Maheshwari. I was part of the national infertility group. There are probably a number of factors. Like her, I am not aware of any reluctance to provide extra cycles, but the whole thing needs to be seen in a wider context. The national infertility group took more than two years to reach its conclusions and the report that was produced looked at the criteria to achieve equity of access for assisted conception treatment and equity in waiting times. That has now been achieved, which is something that we are very proud of.
It is fair to say that any number of additional cycles that are provided to a couple will increase their chances of a pregnancy. Ultimately, we all want to give couples the best chance of achieving a pregnancy. That is why we do what we do. The factors that come into play are similar to those that were current when the national infertility group was first convened. Although it is desirable to provide as many cycles as possible, that has to be seen in the context of what is possible in the wider health service.
At the time of the national infertility group, the evidence pointed to the fact that three cycles were the optimum number. That may still be the case. However, we also need to understand that the clinical service has moved on since 2010, which is when that evidence was available. That picks up some points that Mr Keir mentioned.
Things have changed in terms of the eligibility criteria. Part of the reason for optimising body mass index and stopping smoking and alcohol consumption was to improve success rates, and we have definitely seen that happen. Units now also provide extended embryo culture. We have the facility to keep embryos in culture for up to five days, which means that we can get more information about the embryos before we replace them in the woman. When we get more information, we are better able to identify embryos with the best implantation potential. That has also increased success rates.
That is one side; the other side is that, because we are getting better at culturing and creating embryos, we will have more issues around freezing. We will be able to freeze more embryos, because techniques of freezing have improved. The more frozen transfers a patient has, the more resource that will take.
There is not an easy answer. Everybody would like patients to receive their best chance, but that needs to be seen in a wider context of service improvements and the demands on a service in providing that changed service.