If you are from the UK, you may have encountered roadblocks while trying to get IVF treatment from the NHS. A lot of people have gone to the NHS with high hopes of getting funded for fertility treatments but when they actually got around to starting the treatment they realized that reality is much different, in that, there's so many restrictions and qualifying criteria you have to meet to get funded. To add to an already stressful fertility journey, the criteria depends on which part of the UK you live and in some cases there's a postcode lottery.
We put together some FAQs as it relates to NHS Fertility Funding so you make an informed decision before going to the NHS.
Why should the NHS pay for fertility treatment and IVF?
Infertility is a medical condition and as with any other medical condition it is deserving of treatment.
Infertility has been recognised by the World Health Organisation as a disease, they define infertility as an ‘impairment of function’ and a ‘disease of the reproductive system’.
The importance of funding fertility treatment is also highlighted by the well-recognised and devastating psychological impact the disease can have. Infertility can lead to stress, anxiety, clinical depression and the breakdown of relationships.
Fundamentally the purpose of the NHS is to provide treatments that ‘improve our health and wellbeing’ and keep us ‘mentally and physically well’. Fertility treatment fulfills both those purposes.
The NHS funds many treatments which are not life-saving for things such as acne to warts because they improve our wellbeing. Fertility treatment fits within this policy that good health is also about the quality of life.
What is available on the NHS?
Fertility treatment falls broadly into three categories: medicines to assist fertility, surgical procedures and assisted conception.
Fertility medicines and surgical procedures are routinely funded across the UK. However assisted conception procedures - such as IVF and ICSI - remain subject to wide regional variation in England and this is known as the postcode lottery.
In Scotland, Wales and Northern Ireland provision for assisted conception treatment is set centrally by the devolved Governments so there is no postcode lottery.
Can anyone have fertility treatment on the NHS?
No, fertility services are subject to strict access criteria that relate to clinical factors affecting fertility (such as age and Body Mass Index) and also to welfare assessments of any potential children.
In some areas of England access criteria are overly restrictive and have no clinical justifications. For instance some areas limit access to women over 30 or under 35, these criteria are nothing more than attempts to limit costs and their use should not continue.
What should IVF commissioning look like?
The National Institute for Health and Clinical Care Excellence (NICE) is responsible for issuing evidence-based recommendations on the provision of health services.
These recommendations are developed by experts and are based on two key considerations:
(1) clinical effectiveness and
(2) cost effectiveness.
It is the duty of commissioners to try to provide services in line with the guidance published by NICE.
In 2004 and 2013 NICE published guidelines recommending that 3 cycles of IVF should be provided to people with fertility problems (subject to access criteria).
Unfortunately in England over 80% of commissioners currently fail to meet these recommendations. In the devolved nations Wales currently offer 2 full cycles of IVF and Northern Ireland offers 1 partial cycle. Scotland used to offer 2 full cycles which has now changed to 3.
Why are 3 full cycles of IVF so important?
In a cycle of IVF the ovaries are stimulated, and all viable eggs are harvested and fertilised so that they can develop into embryos. Once an embryo has been implanted in the womb any remaining embryos that have been created can be preserved for later treatment. A full cycle of IVF is defined by National Institute for Health and Clinical Care Excellence (NICE) as the transfer of the first fresh, and any resultant frozen embryos. A second cycle of IVF would involve a fresh round of ovarian stimulation and repetition of the above process.
Three cycles of IVF maximises not only the clinical chances of pregnancy (bringing the chances of a successful pregnancy up to 45-53% from a single cycle success of 20-35%), but also represents the most cost effective use of resources. Some couples may not produce many high quality embryos in a cycle so limiting them to just one full cycle can really reduce their chance of a successful pregnancy.
While many areas do not meet the guidelines to provide three cycles of IVF, many also do not use the NICE definition of a single ‘full’ cycle. This is confusing for patients and is an inefficient use of resources.
Fertility treatment on the NHS in England
In England fertility services - are commissioned locally by GP led groups (known as Clinical Commissioning Groups or CCGs). There are 209 of these decision-making bodies across England often working independently of each other.
As a result what you can access depends on where you live. This is known as the ‘postcode lottery’. Unfortunately over 80% of CCGs in England currently fail to commission the 3 full cycles of IVF recommended by NICE.
Fertility treatment on the NHS in Northern Ireland
IVF treatment in Northern Ireland falls below the average of the UK with only one partial cycle of IVF being offered.
Fertility treatment on the NHS in Scotland
Waiting times for IVF treatment in Scotland have recently fallen, but 3 cycles of IVF are provided to couples fitting criteria. Couples aged between 40-42 are eligible for 1 cycle of IVF subject to other criteria.
Fertility treatment on the NHS in Wales
In Wales only 2 cycles of IVF are provided to women under the age of 40. Couples aged between 40-42 are eligible for 1 cycle of IVF.
Am I entitled to funding if I am single or in a same sex relationship?
The most recent NICE guidelines recommend that after six unsuccessful cycles of IUI all women (regardless of sexual orientation and relationship status) should be eligible for IVF.
In England most CCGs offer IVF to same sex couples, however they are frequently required to self-fund their IUI. Some CCGs do also offer IVF to single women, however the best way to find out whether you are eligible in your local area is to consult your GP.
In Northern Ireland same sex couples are eligible for IVF treatment provided that they are in a ‘stable relationship’.
In Scotland same sex couples will be eligible for IVF where there is unexplained infertility following six to eight cycles of donor insemination or an appropriate.
In Wales IVF is available for single women and same sex couples after five non-stimulated cycles or if there is a known fertility problem.
I'm eligible for NHS Funding but the wait times are more than a year. I don't want to wait that long. What are my options?
If you are eligible to get NHS Funding, we have excellent news for you. You may be able to get private IVF treatment within the EU (subject to some exceptions) and either get funded for it after a pre-approved application with NHS or get reimbursement for the eligible portion of the treatment subject to a certain criteria.
If you are a UK resident, there are two routes — S2 and EU Directive Route through which you can avail of NHS funding even if you are getting treated abroad. One thing to note is that you won't be able to get full funding or 100% reimbursement through these above routes. Generally, NHS funds or reimburses costs and treatments abroad that are normally available to you through NHS which inturn depends on which area you live.
These routes are available until December 31, 2020 after which they are subject to change on account of Brexit. We suspect these routes will still be available after this date in some shape or form, probably specific to each country in the EU with it's own set of criteria.
This means you can still get funded for private treatments at our partner clinics in the EU subject to eligibility criteria for a planned treatment even if it is beyond December 31, 2020 if you can get your application pre-approved with the NHS before this date.
You can take a look at our fertility options available for you here. We will be monitoring the developments through these above routes beyond December 31, 2020 so you can get maximum benefit of getting partially or fully funded without any wait times for your fertility treatment. Subscribe to our blogs at the end of the page below to stay updated on latest updates.
I cannot access fertility treatment with the NHS, what are my other options?
If you cannot access fertility treatment with the NHS, we have low cost options available for you if you are willing to travel outside of UK. A lot of countries have top notch fertility clinics at affordable prices, for example, IVF treatment in Czech costs £1,700 (based on FX rates at the times of writing) compared to £3,750 in the UK for a basic IVF procedure without medication and add-ons. That's less than half the price in the UK.
The savings are greater if you include medication and other add-ons. You will incur flight and accommodation costs but given really cheap flights to the EU from low cost carriers, flight expenses are negligible compared to the overall procedure. As for accommodation, we have designed our programs in such a way that you will be able to get the preliminary tests and investigations done in your area wherever you are and fly to EU only for egg collection and transfer. With this you will only have to stay in the EU for a few days, usually less than a week. All-in-all you will still be saving a lot when you travel to EU for your IVF treatment.
The savings are much larger when you go for second or third cycle if first doesn't end up being successful, increasing your affordability of number of cycles and so increasing your chances of conception. You will be saving even more if you go the egg donor option as the cost of IVF with egg donor in the UK can go upwards of £10,000 compared to less than half of that in the EU. You also get a wider variety of egg donors in some countries like Spain and Czech Republic.
We'd be more than happy to go over your options. Chat with us here (opens in Facebook Messenger) or in the chat bubble to the right.