In vitro fertilisation (IVF) is one way in which people with fertility issues can have a child. IVF is, technically, available on the NHS. It makes sense that in the country where this fertility treatment was pioneered, IVF on the NHS should be possible. In reality, NHS IVF is often described as a ‘postcode lottery’ and very difficult to access.
Here we look at the NHS IVF criteria and how, even when meeting this criteria, it doesn’t guarantee that you will be able to receive treatment.
What is IVF?
Let’s quickly explain what IVF is. This understanding is important in the context of IVF on the NHS because there are discrepancies in terms of what is called a ‘full round of IVF’.
The basic premise of IVF is that a woman’s egg is fertilised by a man’s sperm outside of the woman’s body, before being returned to the woman’s womb to develop. The egg and sperm may belong to the couple, or come from donors.
Most consider a complete cycle of IVF to involve:
- Suppressing your natural menstrual cycle.
- Stimulating your ovaries to produce more eggs.
- Checking and helping your eggs to mature.
- Collecting the eggs.
- Fertilising the eggs in a laboratory using sperm.
- Transferring 1-2 embryos into the uterus where hopefully conception will occur.
IVF is not guaranteed to be successful. The main factors affecting success are age and cause of infertility. Other factors affecting success rates include maternal weight, as well as alcohol, caffeine and smoking use during treatment. There is a 32% chance of success for women under age 35. This drops sharply with age and the chances of success for a woman aged 40-42 is 11%.
There are some risks involved with IVF treatment. These include side effects from the medication, multiple birth pregnancies which carry higher risks to mother and babies, ectopic pregnancies and ovarian hyperstimulation syndrome (OHSS).
Can you get IVF on the NHS?
The basic answer to the question of whether you can get IVF on the NHS is yes. However, this often isn’t the case in reality.
There are specific NHS IVF criteria.
NICE (the National Institute for Health and Care Excellence) has guidelines for what the NHS in England and Wales should provide in terms of IVF. The basic premise is that women under 43 years should be offered IVF if they have not got pregnant after two years of trying. NICE also recommends that women who have had 12 cycles of artificial insemination, at least six of which were intrauterine insemination (IUI), are also entitled to IVF on the NHS. Therefore, technically, the cut off age for IVF on the NHS is 43.
How many IVF rounds on the NHS you may be offered also varies. NICE recommends that women under age 40 should receive three full cycles of IVF on the NHS if they meet the other criteria. NICE recommends that women aged 40 to 42 should be offered one cycle if they meet the above criteria but also haven’t had IVF treatment previously and there’s no evidence of low ovarian reserve.
How to apply for IVF on the NHS
Unfortunately, while these are the NICE guidelines, it doesn’t mean that if you meet the NHS IVF criteria, you will get IVF or even be able to apply. This is because it is up to your local integrated care board (ICB) to set the rules locally. Their criteria is often much stricter than the NICE guidelines.
Your first step in how to apply for IVF on the NHS is to speak to your GP for a referral to a fertility clinic.
Here you will begin to learn about local ICB policies which affect whether you will be offered NHS IVF. In addition to the NICE criteria, they may also add their own NHS IVF criteria in your local area. Their additional criteria may include factors such as whether you already have children (including from previous relationships), a healthy weight, being a non-smoker and being within a specific age range that’s different to the NICE guidelines.
Your local ICB may also only offer one cycle, rather than the three recommended for women under 40. Additionally, they may have a different definition for what constitutes a ‘full round’ of IVF. 49% of clinical commissioning groups (CCGs) have their own definition of what a full round is.
Gradually, the numbers of local areas offering IVF have fallen. Between 2013 and 2017, the number of clinical commissioning groups (CCGs) offering IVF in line with NICE guidelines halved. This situation has worsened since then. The majority of places where you can get IVF under the NICE guidelines are in the north of England. The Progress Education Trust (PET) did research which showed that 89.9% of CCGs don’t offer the NICE recommended three cycles of IVF.
If you aren’t eligible for IVF in your local area then you may choose to get IVF privately. A single cycle of IVF done privately costs between £4,000-5,000. There may be extra costs on top of this.
It’s also worth noting that NHS waiting times for IVF have increased notably. Waiting times are around four months but sometimes more.
Will the IVF NHS postcode lottery improve?
In the Government’s Women’s Health Strategy, the IVF postcode lottery is considered. The Strategy promises to remove all non-clinical criteria used by local areas. This includes removing the criteria of either partner in a couple having a child from an existing relationship excluding eligibility.
Additionally, the Strategy says that lesbians and single women should get six free cycles of artificial insemination on the NHS, first before IVF, rather than having to prove their infertility by paying for this privately.
IVF support from bloss
At bloss, we recognise that fertility problems are distressing. This is made worse if you fall victim of the NHS IVF postcode lottery. Explore our library of articles about trying to conceive and learn more about how to navigate fertility difficulties and access the support you need at this time.
If you’re an employer, read our guide on how to support employees undergoing IVF treatment.
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