IVF patients 'facing postcode lottery' after NHS budgets slashed

NHS fertility services have suffered their biggest cuts since national standards for IVF were introduced in 2004, a report has indicated.

Just 12 per cent of NHS clinical commissioning groups (CCGs) in England offer three full cycles of IVF, in line with national best practice guidance, down from 24 per cent in 2013.

Campaign group Fertility Fairness heavily criticised the “postcode lottery” facing patients, saying cash-strapped CCGs are increasingly stipulating “entirely arbitrary” criteria to limit access to services.

This is in contrast to patients in Scotland, Wales and Northern Ireland, where IVF access is nationally standardised.

The National Institute for Health and Clinical Excellence (NICE) recommends three cycles of IVF for women under 40 and one cycle for some women aged 40-42.

In its 2017 audit of NHS-funded fertility treatment, Fertility Fairness found the majority of CCGs (88 per cent) did not offer the recommended three full cycles of NHS-funded IVF to eligible couples.

A total of 61 per cent of the NHS’s 208 CCGs now offer just one round of funded IVF to eligible couples – up from 49 per cent in 2013.

The findings, launched at the start of National Fertility Awareness Week, show 4 per cent of CCGs offer no NHS-funded treatment at all.

In these areas, eligible couples are forced to spend thousands of pounds for private treatment. And, while the average cost of a single cycle reported by CCGs was £3,483 in 2017, this also masks major variation. A cycle in some areas costs up to £5,788, while others charge as little as £1,343.

The four areas that offer the most comprehensive IVF access are all in Greater Manchester, the birthplace of IVF 40 years ago.

The lowest ranked CCGs, offering no funded IVF according to Fertility Fairness, were Herts Valley, Cambridgeshire and Peterborough, Croydon, South Norfolk, Basildon and Brentwood, Mid-Essex and North East Essex.

A further 14 CCGs are deliberating making reductions to their current offering.

The report says: “In 2004 NICE issued a clinical guideline on infertility, which recommended that all eligible couples should have access to 3 full cycles of IVF where the woman is aged under 40.

“An update in 2013 further recommended that women aged between 40-42, meeting specific criteria, should have access to 1 full cycle. According to NICE a full cycle of IVF treatment should include 1 round of ovarian stimulation followed by the transfer of any resultant fresh and frozen embryos.

“Despite this clear and long-standing guidance, IVF provision across England has remained consistently below the NICE recommendations and is subject to considerable regional variations.

“This ‘postcode lottery’ stands in stark contrast with the rest of the UK. In Scotland, Wales and Northern Ireland, access criteria and provision are standardised and patients within each of the devolved nations have equality of treatment.”

Professor Adam Balen, chair of the British Fertility Society and member of the Fertility Fairness steering committee, said “infertility is a real disease” and that it was not right that patients in some areas should be forced to pay for treatment.

“As a clinician, I am dismayed to see these figures,” he said.

“This is yet more evidence of a worrying trend where NHS funding available for IVF is being severely eroded, thanks to the decisions made by CCGs. I meet people every day who are desperate to become parents and for them IVF is the only option.

“Many patients will not be able to self-fund and nor should they; we have an NHS for a reason and that is to underpin the wellbeing of the UK.”

And Professor Balen warned there were further restrictions highlighted by the report that are often under-reported. This includes 61 per cent of CCGs that only offer a “partial cycle” of IVF, or areas varying their definition of “childlessness”, or age-limits in the eligibility criteria.

“[Fertility Fairness] have also shown that some CCGs are applying additional restrictions such as childlessness or age that are not recommended by Nice,” he said. “That leaves us with just a handful of CCGs that are properly funding IVF and we now have seven CCGs across the UK who aren’t funding it at all! That’s a postcode lottery by any other name and is vastly unfair.”

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.”

A spokesperson for NHS England rejected the suggestion that setting a tariff price for these services would improve provision, as it would mean some areas with above average services would cut back.

NHS England said: “Ultimately these are legally decisions for CCGs, who are under an obligation to balance the various competing demands on the NHS locally while living within the budget parliament has allocated.”

But it added that work to benchmark prices would help show up unjustified variations in costs and it was working to standardise definitions of what an NHS-funded “cycle” constitutes.