Despite official guidance urging primary care trusts to provide one cycle of IVF for all women under 40, Health Correspondent Emma Brady found couples in the Midlands still face a postcode lottery.

One in six couples struggle to start a family and it appears the odds of getting NHSfunded fertility treatment across the Midlands are just as high.

When former Health Secretary John Reid called on PCTs to offer at least one funded cycle of IVF by April 1, 2005, it was hoped they would find it easier to get the help they needed.

Two years on from the deadline, a survey by The Birmingham Post of 15 Midland trusts reveals the NHS playing field is still uneven. All PCTs offered at least one cycle of treatment - ranging from IVF, donor insemination, intra-uterine insemination, or intracytoplasmic sperm injection - but the number offered per population varied from 30 to 335 a year.

Couples in Sandwell appear to have the odds stacked against them, particularly if fertility problems are diagnosed in their late 20s or early 30s, as couples face a wait of up to five years and only women aged under 35 are eligible.

To compound the issue it reduced the number of cycles per couple from three to two, with a total of 30 for the population effectively benefiting only 15 couples each year.

Dr John Middleton, director of public health for Sandwell PCT, said: "The PCT is in discussion with Midland Fertility Services to reduce waiting times by the end of the next financial year."

Other trusts reporting long waiting lists included Telford and Wrekin (four years), Wolverhampton (two years) and Walsall (one to two years).

Patients in Dudley did not have to wait for treatment last year, but following the merger of the borough's two PCTs, they must now wait up to a year.

Following the reorganisation of PCTs last year, a number of Midland trusts saw their catchment area and budget grow.

Prior to the change, Redditch and Bromsgrove PCT commissioned fertility services on behalf of three Worcestershire trusts with a budget of £85,000.

Those have merged to become Worcestershire PCT, and its budget rose 400 per cent to £423,000 - but the number of cycles offered per couple have not.

However, in order to meet NICE guidance, a number of social criteria have been extended or amended, with most now treating women aged between 23 and 39, although two trusts do not consider women older than 37.

Women previously served by Dudley Beacon and Castle PCT would only be considered if they were between 30 and 35-years-old, but the merged Dudley PCT has extended the bracket to 23-39 to meet NICE guidelines.

Fertility expert Dr Gillian Lockwood said the Government should seek to make its 18-week wait target apply to assisted conceptions and investigations.

Dr Lockwood, medical director of Midland Fertility Services in Aldridge, Walsall, where many of the region's NHS patients are treated, said: "It's not just the level of provision or the clinical criteria that vary enormously, but the social criteria that make this play-ing field very uneven.

"Sandwell appears to be one of the worst providers, as only women under 35 are considered for treatment, and if that first cycle fails they have to go back on a five-year waiting list for a second attempt.

"So to have a realistic chance of success in that PCT area you have to be under 30 to allow for one cycle.

"It's clear that the situation is not getting better. What I don't understand is if the NHS can ensure patients go from GP to treatment in 18 weeks, why can't the same principle be applied to fertility treatment?"