NHS funded fertility treatment in the UK has literally become a ‘Postcode Lottery’, with access entirely dependent on your home address. Patients in England have to rely on policy and funding decisions taken by local Clinical Commissioning Groups (CCGs) which has created a patchwork provision. In the devolved nations however, these decisions have been taken at a national level ensuring parity. We will consider provision and eligibility in each devloved nation before we attempt to unravel the more complicated situation across England.
IVF Treatment on NHS and Fertility Clinics
NHS treatment is commissioned through the Health and Social Care Board and currently provides for one fresh and one frozen embryo transfer.
To be eligible for NHS funded IVF, ICSI or FET treatments the following criteria needs to be met:
- Women need to be aged under 40; or
- Women need to be aged between 40 and 42 and have never previously had IVF treatment and there is no evidence of low ovarian reserve.
Unlike the other UK nations, couples who have children living with them (in any capacity) have equitable access to services and the upper Body Mass Index (BMI) score is also more generous at 35, rather than 30 in the other UK nations.
The document which oversees NHS provision in Northern Ireland, ‘Eligibility for HSC funded IVF and related treatments effective from 1st June 2019’ is available from, https://belfasttrust.hscni.net/wpfd_file/eligibility-for-hsc-funded-ivf-and-related-treatments-effective-from-1st-june-2019/
Health Boards in Scotland offer up to three cycles of IVF/ICSI for patients who satisfy certain eligibility crieteria which includes,
- Women aged under 40 for a fresh cycle of treatment
- Women aged under 41 for a frozen cycle of treatment
- Both partners must be non-smoking for at least 3 months before treatment and continue to be non-smoking during treatment
- The BMI of the female partner must be a minimum of 18.5 and a maximum of 30
- Neither partner must have undergone voluntary sterilisation
- Couples must have been co-habiting in a stable relationship for a minimum of 2 years
Scotland’s three cycle policy which started in 2017 resulted primarily from the 2016 National Infertility Group Report which recommended specific IVF criteria changes for all eligible couples. A copy of this report can be found here, https://www.gov.scot/publications/national-infertility-group-report/
Two full cycles of IVF on the NHS are offered across Wales via each of its seven health boards. If a couple wants to apply for IVF on NHS, they need to meet the following criteria:
Women aged between 40 and 42 years (up to their 43rd birthday) can access one cycle of IVF if;
- They have never previously had IVF
- There is no evidence of low ovarian reserve
- There has been a discussion of the additional implications of IVF and pregnancy at this age
- Men must be aged 55 years or younger in order to access IVF treatment on NHS.
Funded treatment is available for:
- Couples where one of the partners does not have any living children (biological or adopted).
- Single women or men who do not have any living children (biological or adopted).
The access criteria for IVF on NHS includes:
- The BMI of the female partner must be above 19 and below 30
- Where either of the couple/single woman/single man smokes the patient is not eligible
- For single patients, three or more IVF cycles by the patient will exclude any further funded treatment
- For couples, three or more IVF cycles by either partner will exclude any further funded treatment
A specialist services policy has been developed for the planning of Specialist Fertility Services for Welsh patients. It is available here,
NHS Funded provision in England is patchy to say the least. The NICE Clinical Fertility Guideline (https://www.nice.org.uk/guidance/cg156/resources/fertility-problems-assessment-and-treatment-35109634660549) recommended that:
- women aged up to and including 39 should have access to three full cycles of IVF treatment on the NHS;
- it also recommended that women aged between 40 and 42 who have never had IVF treatment and who do not have a low ovarian reserve should be able to access one full cycle of IVF with NHS funding.
This however, is a guideline. Recent statistics have demonstrated that the vast majority of CCGs fail to provide the recommended number of cycles and this figure is rising year on year.
Whilst the NICE Guideline does not go as far as imposing eligibility criterai upon individual CCGs it does point to a number of predictors which have an impact on IVF success. These predictors are used by many CCGs when they establish eligibility criteria and they incluide,
- Patients should be informed that the overall chance of a live birth following IVF treatment falls as the number of unsuccessful cycles increase
- Women should be informed that female BMI should ideally be in the range 19–30 before commencing assisted reproduction, and that a female BMI outside this range is likely to reduce the success of assisted reproduction procedures
- Patients should be informed that the consumption of more than 1 unit of alcohol per day reduces the effectiveness of assisted reproduction procedures, including IVF
- Patients should be informed that maternal and paternal smoking can adversely affect the success rates of assisted reproduction procedures, including IVF treatment
So, how does this patchwork of funded provision play out across the CCGs. The complicated picture can be seen in this Freedom of Information request made by the campaigning group Fertility Fairness in 2018, http://www.fertilityfairness.co.uk/wp-content/uploads/2018/10/England-FertilityFairness_FOI_2018.pdf
In summary some of the stark differences between CCG provision are outlined below,
In 2018 there were 193 different CCG’s (from 1 April 2020 this number has been reduced to 135 due to a number of mergers) responsible for NHS fertility funding. Despite the NICE Guideline regarding three cycle provision the different CCGs provided a range of funded treatments to patients in their particular area,
- 60% of CCGs offered 1 funded cycle to patients who satisfield eligibilibility criteria
- 23% of CCGs offered 2 funded cycles to patients who satisfield eligibilibility criteria
- 13% of CCGs offered 3 funded cycles to patients who satisfield eligibilibility criteria
- 4% of CCGs offered no funded cycles to patients who satisfield eligibilibility criteria
The criteria used for deciding eligibility for the funded cycles once again varied between CCGs. There was broad consensus when it came to what was considered an appropriate BMI range for women with all CCGs quoting the minimum 19, maximum 30 rule.
Although the CCGs imposed no eligible age range for male patients there were significant differences for women. Whilst the majority of bodies indicated an upper age limit of 40 there were some that would only offer treatment to women under 38 or 39.
One of the most arbitrary criteria used by CCGs was the time it considered appropriate for couples to try and conceive naturally before they were considered as having fertility problems. This length of time varied considerably between one and three years depending upon the CCG.
As you can see, access to funded NHS IVF treatment does really depend on where you live in the UK. There are wide geographic differences not only in the number of cycles available but also in the criteria used to decide who gets access to treatment.
For more information on funding in the UK you can visit,
NHS IVF Funding / FAQ
I live in Northern Ireland, what happens to any surplus embryos after treatment?
NHS funding covers the storage costs of embryos for two years. If you store them for any longer you will have to pay an annual fee. The exception is if you were storing them for oncology or certain other medical reasons.
I am in a same sex relationship in Scotland and we are already legal parents of a child at home. Can we get funded treatment?
Unfortunately not. Same sex couples will not be eligible if they already have a child in the home and both have consented to legal parenthood of that child.
I have a BMI of 32 – does that permanently exclude from funded treatment?
Not necessarily, although patients outside this range will not be added to the waiting list they should be referred back to their GP for management where required.
How do I get IVF on the NHS?
If you are having problems conceiving your first point of call is your GP. S/he will consider your medical history and possibly offer a physical examination in addition to suggesting any lifestyle changes that may aid your chances of getting pregnant. Then, depending on the area in which you live they may refer you to a fertility specialist after a qualifying period. The specialist will advise on treatment options, timing and whether IVF cycles are provided by the NHS in your area.
What is the waiting time for IVF on the NHS?
The National Institute for Health and Care Excellence (NICE) provides guidelines on access to NHS funded IVF treatment. It recommends that women under 40 should be offered three IVF cycles if they are not pregnant after having unprotected sex for two years. Women aged between 40 and 42 should be offered one cycle after the same time period. In reality the number of cycles offered by different NHS areas rarely match the NICE suggestions and waiting times for treatment varies considerably. For specific information about waiting times in your area contact your GP.
Can same sex couples undergo IVF on the NHS in UK?
Female same sex couples can not access IVF treatments on the NHS as easily as heterosexual couples. The NICE Guidelines suggest they can be considered for funded treatment after having six unsuccessful, self funded attempts using artificial insemination. NHS areas may also have their own specific policies and practices for female same se couples so once again you will need to check with your GP for guidance.
Currently, the NHS does not provide funding for treatments involving a surrogate which effectively excludes gay men from accessing funded treatment.
Is there an upper age limit for women to access funded IVF?
There are regional variations regarding the upper age limit for women. The majority of local Clinical Commissioning Groups state that 40 is the cut off point for treatment but there are areas which suggest the upper age limit is only 38.
What are NHS IVF success rates?
According to the latest data provided by the Human Fertilisation and Embryology Authority (HFEA) the average birth rate for each embryo transferred was 23%. For under 35’s this figure rose to 31% but decreased to 5% for women aged over 43 using their own eggs.
IVF on the NHS – pros and cons
If you are fortunate to live in an NHS area which offers the maximum three funded IVF cycles the pros would generally outweigh any cons. This is however not always the case and waiting times to access specialist advice and treatment are often onerous. Additionally if your treatment is dependent upon a donor this may add time to your wait and certain help like surrogacy is not offered. Same sex couples, women over 40 and those with a BMI higher than 30 will also find access NHS funded treatment a challenge, if not impossible.
We have been turned down for NHS treatment – can we appeal?
The simple answer is yes. We would suggest you write to confirm that you are aware of the NICE Guideline which clearly states that all fertility patients in the UK should receive three full cycles of fertility treatment funded by their CCG and the supplmentary Quality Standard published in 2014. The standard which was endorsed and supported by the NHS confirmed that infertility is recognised as a medical condition and consequently patients should be able to receive treatment as a core NHS service.