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.
Fertility Clinics NHS
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 above 18.5 and below 30
Neither partner to have undergone voluntary sterilisation, even if sterilisation reversal has been self-funded.
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 NHS fertility treatment are offered across Wales via each of its seven health boards. The criteria for treatment includes,
Women aged between 40 and 42 years (up to their 43rd birthday) who meet the access criteria are entitled to one cycle of IVF with or without ICSI provided the following 3 criteria are also fulfilled:
- 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.
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 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; 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. This however, is a guideline. Recent statistics have demonstrated shown 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 fertility 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,