Postcode And Pay Packet – Not Medical Need – Key Factors In Access To IVF In The UK

From Huffington Post

Susan Seenan, chief executive of leading patient charity Fertility Network UK and co-chair of campaign group Fertility Fairness

If you need fertility treatment to have a baby, your post code and your pay packet – and not your medical need – are the key factors in whether you will be able to try IVF.

New data from campaign group Fertility Fairness released at the start of National Fertility Awareness Week shows the number of clinical commissioning groups (CCGs) in England offering the recommended 3 IVF cycles to eligible women under 40 has halved in the last 5 years: just 12 per cent now follow national guidance, down from 24 per cent in 2013.

In contrast, the number of CCGs which have removed NHS IVF has almost doubled in the last year. There are now 7 areas which do not provide NHS IVF: Mid-Essex, North East Essex, South Norfolk, Basildon and Brentwood, Croydon, Herts Valleys and Cambridgeshire and Peterborough – and more areas are considering following suit.

fertility fairness

A striking north-south divide exists in terms of NHS IVF provision. Scotland is by far the best place to live – all clinically eligible women under 40 can access the ‘IVF Gold Standard’: 3 full IVF cycles and access to treatment if one of a couple has a child from a previous relationship.

Just 4 areas in England offer this IVF Gold Standard and all are in Greater Manchester: Bury, Heywood, Middleton and Rochdale, Tameside and Glossop, and Oldham – the birth place of IVF 40 years ago. Everywhere else in England it is a postcode lottery as to what level of care you will receive – the majority of areas offer 1 partial IVF cycle and refuse access to treatment if one of a couple has a child from a previous relationship. For information on the level of care each English CCG provides and how they rank, click here.

In Wales or Northern Ireland there is parity of care, but neither offers the IVF Gold Standard: in Wales, clinically eligible women under 40 are offered 2 full IVF cycles and access to treatment if one of a couple has a child from a previous relationship; in Northern Ireland clinically eligible women under 40 are offered 1 partial IVF cycle and access to treatment if one of a couple has a child from a previous relationship.

This National Fertility Awareness Week we are commemorating 40 years of IVF, 40 years of a life-changing technology pioneered in England. However, that achievement means nothing if only those who can afford private IVF benefit. The Government should be ashamed that, after 40 years of IVF, it is your postcode and your pay packet, and not your medical need, which are the key determinants of whether you will be able to try IVF.

fertility fairness

In England, as well as cutting the number of IVF cycles offered, CCGs are finding alternative ways to reduce provision. National Institute for Heath and Clinical Excellence (NICE) guidelines recommend that eligible couples should have access to 3 full IVF cycles, where a full cycle of IVF treatment is defined as one round of ovarian stimulation followed by the transfer of all resultant fresh or frozen embryos. However, approaching half of all CCGs (49 per cent) use their own definition of what constitutes a full IVF cycle – and only transfer a finite number of embryos, rather than all resultant embryos.

Some CCGs stipulate entirely arbitrary age criteria for access to NHS IVF, in contravention of NICE’s guidelines stating that eligible women under 40 should be offered 3 full IVF cycles and eligible women aged 40-42 should be offered 1 full IVF cycle. Approaching half of all CCGs (48 per cent) do not offer NHS IVF to women aged 40-42; 10 per cent of CCGs refuse access to NHS IVF if women are over 35. And a few are currently consulting on proposals to only offer NHS fertility services to women aged between 30-35.

Sarah Norcross, co-chair of Fertility Fairness said: ‘The scale of disinvestment in NHS fertility services is at its worst since NICE introduced national fertility guidelines in 2004. Fertility Fairness is calling for full implementation of the NICE guidelines, standardisation of eligibility criteria across England and the development of a national tariff in England for tertiary fertility services – eliminating regional cost variants and removing a key barrier to CCGs’ compliance with national guidelines.’