Issues of quality in providing services for subfertile couples.

The effectiveness of subfertility treatments has recently been reviewed in Effective Health Care.' Many health authorities are coming under increasing pressure to purchase treatments for subfertile couples, though because treatments are perceived to be ineffective2 few districts currently purchase comprehensive services. The review in Effective Health Care found that many treatments that include assisted conception (such as in vitro fertilization-embryo transfer (IVF-ET)) are effective, given appropriate indications for their use (table).' The decision whether to purchase these services or how much to purchase is not just a technical question and will need to be located within the contexts of general fertility services within a district and of competing claims on resources. However, since purchasing in this area will probably increase, this paper examines some of the key questions which will need to be addressed to ensure high quality service provision.