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Local areas in England are setting their own IVF access criteria

29 October 2018
Appeared in BioNews 973

Clinical Commissioning Groups (CCGs) in England are setting their own criteria – contrary to official guidelines – to ration access to NHS fertility services, according to campaign group Fertility Fairness

A new audit by the group found that most CCGs are not offering the full number of recommended IVF cycles, and are further limiting access by applying criteria that fall outside the National Institute for Health and Care Excellence (NICE) guidelines. These include restrictions by the age and BMI of the male partner, and if one of a couple has a child from a previous relationship. Some CCGs have instituted a cut-off age of 34 for women. 

Health Minister Matt Hancock told the Victoria Derbyshire programme that blanket bans which diverge from NICE guidelines are not acceptable. 'The point of having the national guidelines is so that that is the position people can expect right across the country,' he said.

NICE recommends three full cycles of IVF for women under 40 years old, and one full cycle for women aged 40-42. A full cycle of IVF treatment means one round of ovarian stimulation, followed by the transfer of any resultant fresh and frozen embryos.  

Fertility Fairness submitted Freedom of Information Requests to 195 CCGs. Of those, only 13 percent offer the three full cycles recommended by NICE, 23 percent offer two and 20 percent offer one cycle. Some 40 percent offer one partial cycle (transferring a limited number of embryos) and 3.6 percent fund no IVF at all. Around 15 percent of CCGs have reduced provision of IVF in the last two years and 10 percent are currently considering following suit.

Only 9 percent of CCGs allow couples where one partner has a child from a previous relationship to access IVF, and over a quarter now refuse treatment to couples where the male partner has a high BMI. These requirements do not relate to NICE's guidelines and are not supported by clinical evidence.

'It is shocking to see CCGs introducing their own "access to IVF" criteria, as well as reducing the number of IVF cycles they offer,' said Sarah Norcross, co-chair of Fertility Fairness, and Director of the Progress Educational Trust (the charity which produces BioNews).

'It is not the CCG's job to decide the criteria for accessing NHS fertility services. NICE has assessed the evidence in its guideline and developed access criteria for NHS patients.'

In other parts of the UK, IVF provision is standardised. Scotland offers three full cycles to women under 40, and Wales provides two. Both offer women ages 40-42 one full cycle. Northern Ireland offers one partial cycle to women under 40. All three allow couples where one partner has a child from a previous relationship to access services.

SOURCES & REFERENCES
Couples being denied IVF on NHS over man's age or weight
The Guardian |  29 October 2018
Male BMI and age ‘should not be used to ration access to IVF’
ITV News |  28 October 2018
The Victoria Derbyshire Programme
BBC 2 |  29 October 2018
Women over 34 are being refused IVF treatment
BBC News |  29 October 2018
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