Where do you live?
No, really, what is your exact address? Because if you want to get IVF on the NHS that is probably the most important question you will ever answer.
Depending if you live in England, Scotland or Wales the treatment offered and who can get it is different. In England, it can even be different from one street to the next.
The rules are changing but will not come into effect until 2024 at the earliest.
Sound complicated? It is.Follow me for a full tour of what you can get where and how in this crazy, patchwork system.
Who decides what’s NICE?
Access to fertility treatment should be equal for everybody. Guidelines are set out by the National Institute for Clinical Excellence with that aim.
Here’s what they say:
- Women aged under 40 years – 3 full cycles of IVF.
- Women aged 40–42 years – 1 full cycle of IVF.
- Cancer patients who could be left infertile should be offered the option to freeze eggs or sperm.
But there’s a catch, these are guidelines and not rules. In the real world, local healthcare boards decide who gets IVF and who doesn’t.
Why Access To Care Differs
The criteria used by local Integrate Care Boards (ICBs) tend to fall into a few main categories:
- Weight / BMI
- Relationships – do you or your partner already have a child? Are you single or in a same-sex relationship?
- Healthy lifestyle – moderate drinking, smoking
Want the best chance of IVF on the NHS? Just be under 40, live in the right area, don’t smoke, don’t drink too much and don’t be overweight. And to really maximise your chances of qualifying you should be in a long-term heterosexual relationship with someone who doesn’t already have children.
Hmmm…these criteria are getting tighter and tighter. Not everyone can squeeze through.
Of course, there needs to be a way to ration public money for fertility. But it’s heartbreaking when your dreams are the ones caught on the wrong side of the cut off.
The Initial Tests
The first thing to do when you can’t get pregnant is to ask the right questions to find out why not. Your GP should send you for blood tests if you’ve been trying for one year without success.
The NHS investigations cover:
- Blood work
- Semen analysis
- Screening for infections such as Chlamydia
- Looking for damage to reproductive tubes
- Investigating for endometriosis
Or as Harley Street infertility consultant Dr Gedis Grudzinskas puts it: Is the semen okay? Are the tubes working? Are you ovulating?
As you gather more information your doctor will suggest next steps for testing or treatment.
Get Print Outs
Ask for a paper copy of all these test results. If you end up paying privately for IVF you can use your NHS results – so long as they are up to date. That could save you a few pounds.
Single women and same-sex couples are currently required to undergo multiple rounds of IUI (Intra Uterine Insemination) before being eligible for IVF in England and Wales. In future rounds of IUI will be done on the NHS – which already happens in Scotland.
Testing to Breaking Point
Every month counts when you are trying to conceive. The wait between NHS referrals and appointments can feel painfully slow. Patients are waiting up to a year to get diagnostic testing and even longer for treatment.
Covid-19 only made the situation worse. Doctors’ groups and health charities point out that waiting a long time for tests means patients are older when they finally start IVF, which means their chance of a baby drops.
The Royal College of Obstetricians and Gynaecologists raised concerns in their “Better For Women” report back in 2019 “..many [women] experience long delays in gaining access to appropriate secondary care and this is often when they are at an age when their fertility is declining rapidly.”
Fertility investigations are not usually classed by the NHS as urgent. But they can certainly feel that way. Sarah Norcross, head of the fertility charity Progress Educational Trust, says that as far as patients are concerned, “…
such treatments are a matter of considerable urgency.”
Mix and Match Testing
One way to get results faster is to pay for private tests. Then use those results to get referred for NHS treatment.
Dr Grudzinskas often recommends couples pay for a semen analysis before anything else. It’s helpful to rule that out as a cause early on. And if male factor is an issue then you are well-placed to make a plan.
Another option is the Anti-Mullerian Hormone test. This helps judge the number and quality of eggs. It can be a crucial clue as to how urgently you need to undergo treatment.
Speak to your doctor once you have the results.
Possible NHS Treatment Paths
Depending on your test results there are three possible approaches:
- Medicine – drugs to support ovulation. (clomifene, metformin, gonadotrophins)
- Surgery – fallopian tube surgery for blockage or scarring, laparoscopy for endometriosis, correcting blockage in the testes
- Assisted conception – IVF, ICSI (intracytoplasmic sperm injection), IUI (intrauterine Insemination), surgical sperm extraction
If surgery or drugs are judged the way forward for you then you are in luck. The NHS usually pays for those.
IVF on NHS cost
Fertility testing, drugs and surgery are generally available on the NHS, but, when it comes to full IVF treatment it’s a different story. Take a typical package of a stimulation cycle, egg collection and embryo transfer.
The NHS pays a benchmark of roughly £3,300 for one cycle of IVF and one follow-up frozen embryo transfer. It’s hard to make an exact comparison to what you might pay privately in the UK but – once drugs and blood work are included – a figure somewhere around £5,000 and upwards is realistic.
However, whether you will get a full IVF cycle, a partial one or none at all depends on where exactly you live.
Yes, it’s the infamous postcode lottery. Let’s look more closely at this muddled map.
You may be interested in reading: IVF cost in the UK – a guide to private IVF costs
IVF Postcode Lottery
Access to IVF varies wildly from one end of the country to the other.
In Scotland, three rounds of IVF are offered. In Cornwall, it’s just one. Six areas in England provide no IVF at all to those over the age of 35. (Source: Fertility Network UK).
The NHS pays for 60 per cent of IVF treatments in Scotland. In London and East Anglia, it’s 20 per cent.
And in 1 out of every 5 areas, patients get just one extra frozen embryo transfer if their first transfer fails. In a full cycle all frozen embryos are used.
No wonder some people move house solely to access IVF.
One 29-year-old told researchers the NHS wouldn’t treat her because her partner had a child from a previous relationship. After months of feeling depressed, she found out she could get 3 free rounds of IVF elsewhere; “We moved within about three weeks of finding that out and got the funding”.
The industry regulator calculates there has been a double-digit drop in funding in some parts of England (figures for 2015 -2019). But the true figure is almost certainly greater. The growing numbers of UK patients who choose to travel abroad for IVF are not included in the HFEA data.
Many families are missing out on fertility treatment because of their postcode.
Chief executive of charity Fertility Network UK, Gwenda Burns, worries patients are forced to “…either find financially crippling amounts of money for private treatment or endure the extreme distress of being childless-not-by-choice”.
Some patients find their own solutions. Like the many who hop on a plane for fertility treatment abroad. There’s no official data on the numbers making this choice. That means even more people are paying privately for IVF than we officially know about.
Things ARE Changing – But When?
In 2022 there was a wide-ranging review of women’s health care in England. Access to fertility treatment was looked at as part of the Women’s Health Strategy.
The review made a number of suggestions. One is that only clinical reasons should be used to decide if someone qualifies for IVF.
It also said it should be easier for single women, and people in female same-sex relationships to access IVF on the NHS. So no more paying for multiple rounds of IUI before you can even ask for treatment.
There’s also good news for those whose partner already has a child. That should no longer be grounds to rule you out.
Nothing in the review tackles the problem of regional variations in availability. However, it will be easier to find out what treatment patients are offered in other areas. Although it’s not clear how that helps.
The question is when exactly changes will come into effect. And can you wait that long?
NHS vs Private IVF
At the age of 32, Kathryn Carr* felt lucky to be able to access three cycles of IVF in her part of northeast England.
It took six months to complete all the usual blood tests and a hysteroscopy. She then waited almost a year for IVF – but started IUI more quickly. Sadly, each of her three treatment cycles ended in disappointment.
There is a reason that the NICE guidelines suggest 3 cycles of IVF and it’s this: it ups your chances of a successful pregnancy to 45-53 per cent. But after three IVF rounds the likelihood of having a baby drops.
That didn’t deter Kathryn. Her clinic suggested an endometrial biopsy to check out her womb – but said they couldn’t offer her the immune therapy she wanted. And anyway, she had used up all her NHS treatment.
She and her husband were determined to explore every avenue so turned to a private clinic where she was given a biopsy. Kathryn was disappointed this hadn’t been recommended earlier, “…it could have made a huge difference to my earlier rounds. The results allowed our new clinic to tailor our treatment to suit us.”
Add On Treatments
Additional medication such as blood thinners and steroids were offered to support IVF cycles and early pregnancy. She was also given an endometrial scratch designed to help embryos implant. Her NHS clinic had begun to offer the same – but was unusual in doing so at that time.
Some clinics do offer exactly the same types of treatment regardless of whether the patient is NHS or private. Other centres are known for providing additional services such as assisted hatching and immunological testing. These are controversial because trials have not so far produced clear evidence they are effective.
Dr Grudzinskas points out that the NHS cannot provide any treatment which hasn’t been approved by NICE. He advises patients should check the latest HFEA information before making any decision.
In the end, Kathryn went for IVF abroad to a private clinic for her IVF because of the much lower cost. She found NHS staff very caring – but adds “…I felt that the private clinics were more invested in making it work.” Eight years after first being treated by the NHS she finally had her baby – a boy.
You may be interested in reading: IVF Costs Abroad Explained
Where Does That Leave You?
There are huge regional differences in what the NHS offers fertility patients. Getting the right combination of age, weight, relationship status and postcode to fit together can feel a bit like trying to get all the colours to line up on a Rubik’s cube. It’s frustrating.
The NHS will never be able to help everyone who wants fertility treatment. And there has to be some way of sorting through all the potential patients and picking who to treat. But when it’s you who loses out it can be devastating. Some can fund private treatment, but for others the high cost makes that impossible. Until the same guidelines are followed everywhere in the UK some people will always feel that they have been treated unfairly.
It’s not the end – fertility treatment on the NHS
Sure, access to IVF on the NHS will always be rationed somehow. But charities are actively campaigning on the issue. And they report some progress in convincing CCGs to increase the number of IVF cycles they offer. And Scotland looks positively keen to improve access.
One key argument is that cutting budgets by removing IVF funding does not save money in the long run. Repeated studies suggest that around half of people experiencing infertility suffer from depression. Perhaps you can relate to that.
Healthcare funding bodies have a statutory responsibility to source services that meet the needs of the whole population – and that includes fertility. Patients who need medical help to start a family may not have equal access to IVF just yet – but the NHS is a good place to start when you are not getting pregnant and want to know why.
You may be interested in reading: Why do Brits go abroad for IVF Treatment?
IVF on NHS in England
If you are in England then figuring out what the NHS will pay for can be very tricky. It cannot be said often enough that IT ALL DEPENDS WHERE YOU LIVE.
You MUST speak to your GP to find out what the rules are in your area and if you qualify for help.
ICBs (Integrated Care Boards) decide who is eligible in their local area.
You might find they set a limit of 1 or 2 IVF cycles. Or a limit on the number of frozen embryos that will be transferred (FET) if your first transfer doesn’t work out. Remember, it is possible to store your embryos and use them later as a self-funded patient.
Who is eligible for IVF on NHS in England
|IVF on NHS – Who is eligible in England?||Example criteria (depends on specific region)|
|Children||No children from previous relationships for either partner.
(Roughly 90 per cent of CCGs rule out couples if one person already has a child.*)
|BMI||Below BMI of 30
Above BMI of 19
|Lifestyle||– Non-smoker – some areas specify how long you must wait after quitting smoking.
– Attending a quit programme
– Alcohol consumption – moderate or none
– Recreational drugs
|Relationship status||Stable co-habiting relationship for 1 year. Or 2 years. Or 3.
Some areas do not fund treatment for same-sex couples.
IVF on NHS in Scotland
Living in Scotland gives you the best chance of anywhere in the UK of getting your IVF treatment on the NHS.
Scotland provides the ‘gold standard’ of three full IVF cycles for all infertile couples who meet the criteria. To count as infertile you must have a diagnosed condition causing infertility. Or still not be pregnant after two years of regular intercourse or six donor inseminations.
Those over 40 get 1 full cycle, so long as treatment starts before they turn 42.
Who is eligible for IVF on NHS in Scotland
- Stable, co-habiting relationship for at least two years.
- Healthy weight, non-smoking, alcohol and drug-free.
|IVF on NHS in Scotland - Who is eligible?||Criteria|
|Children||Healthy weight, non-smoking, alcohol and drug-free.|
|Relationship||Stable, co-habiting relationship for at least two years.
Same-sex couples get DI (donor insemination) cycles before being offered IVF
IVF on NHS in Wales
The good news is that in Wales the rules are made centrally and so are the same for everyone across the country.
The bad news is an ongoing review of the rules may make it harder for some people to access NHS fertility treatment.
The changes being considered are wide-ranging and could mean that there is NO IVF funding for women over 40, single women or those in same-sex relationships. Anyone who has previously paid to have their eggs or sperm frozen could also be excluded. Women under 40 will now be offered two partial IVF cycles instead of full ones. A partial IVF cycle will count as one fresh embryo transfer and up to 5 frozen embryo transfers.
A final decision is due later in 2023.
Currently, women between 20 and 40 years old can have 2 full cycles of IVF (so all frozen embryos can be used). From ages 40 – 42 Wales offers 1 cycle of IVF – provided there are no signs of low ovarian reserve.
The Welsh Health Specialised Services Committee
- Age: under 55 for men, over 20 for women
- Three previous IVF cycles – including privately funded– rules you out.
- BMI – between 19 and 30
|IVF on NHS in Wales - Who is eligible?||Criteria|
|Children||No previous children – for at least one partner|
|Age||Men under 55, Women over 20|
|Healthy Lifestyle||BMI – between 19 and 30
|Previous Treatment||Three previous IVF cycles - including privately funded – rules you out.|
IVF on NHS in Northern Ireland
In 2020 Northern Ireland committed to offering three full cycles of IVF for eligible women. But that is yet to come into effect – and Stormont has said it depends on getting enough funding from the UK government.
Patients must be below 40 years old or 40-42 with no evidence of low ovarian reserve. They are offered 1 cycle of IVF – counted as 1 fresh embryo transfer and 1 frozen embryo transfer
Who is eligible for IVF on NHS in Northern Ireland
- BMI from 19 up to 30
- Neither partner previously sterilised
- 3 previous IVF cycles would rule you out
- Must meet HFEA requirements on welfare of child
|IVF on NHS in Northern Ireland - Who is eligible?||Category|
|Welfare||Must meet HFEA requirements on welfare of child|
|Healthy Lifestyle||BMI from 19 up to 30|
|Relationships||Same-sex couples qualify|
|Previous Treatment||3 previous IVF cycles would rule you out
Neither partner previously sterilised
IVF on NHS eligibility – “take home” message
- Where you live matters – check out the rules for IVF on the NHS locally to you.
In England – every area is different.
- In Scotland you get the same access to IVF no matter where you live. It’s also the same wherever you live if you are in Wales or Northern Ireland.
- Different areas offer different numbers of IVF cycles; 1, 2 or 3. For women over 40 it’s usually just one.
- Find out the rules on eligibility sooner rather than later. The criteria usually centre on; age, weight, whether your partner has children… If you don’t qualify then it’s better to know now.
- Remember that you need to have been trying and failing to get pregnant for a year before your GP will refer you for any tests. That’s 12 months of regular, unprotected sex. The rules are different for same sex couples and IUI.
- You have the right to a copy of your test results. Private clinics will often accept NHS test results so long as they are up to date – saving you a bit of money.
- Think about whether it’s worth paying for a semen analysis. It’s quick and easy to check if that’s contributing to infertility. And it’s helpful to know.
- Not all NHS-funded IVF cycles are equal. In some areas there’s a limit to how many follow up frozen embryo transfers you can have – what’s known as a ‘partial cycle’.
- Know that previous IVF cycles count towards the total you are allowed on the NHS. Even if you paid for a private cycle.
- AMH (anti-Mullerian hormone) is only measured by the NHS once you are actually referred to a fertility clinic – but if it’s low you may not qualify for treatment. If you are worried this might affect you then discuss with your doctor if it’s a good idea to get the test done privately.
IVF on NHS – funding eligibility in the UK – final thoughts
The provision of IVF on the NHS varies hugely from one region to another. Working out whether your particular combination of age, weight, relationship status and postcode will allow you to access IVF on the NHS – can sometimes feel like trying to line up all the colours on a Rubik’s cube.
The NHS will never be able to treat everyone who wants fertility treatment. And there has to be some way of sorting through all the potential patients and picking who to treat.
But when it’s you who loses out it can feel devastatingly harsh. Some are able to fund private treatment – but for others the high cost makes it impossible to pay for IVF privately. Until the NICE guidelines are applied uniformly across the UK then some people will always feel that they have been treated unfairly.
*Patient’s name has been changed