Where do you live? No, really, where exactly? Because when it comes to getting fertility treatment on the NHS that could be the most important question you ever answer.
How much NHS IVF treatment you get – if you even get any at all – depends on which street you live in and who controls the public money spent on health in your area.
IVF access is different for England, Scotland and Wales. And on top of that – in England, it’s different for each individual area. It’s complicated – as they say.
Who decides what’s NICE?
The body set up to decide which drugs and treatments should be available on the NHS is called NICE (National Institute for Health and Care Excellence). It was founded in 1999 to give independent advice on how to best help patients while still providing value for money.
When it comes to IVF this is what NICE has to say…
- Women aged under 40 years should be offered 3 full cycles of IVF.
- Women aged 40–42 years should be offered 1 full cycle of IVF.
- Cancer patients who could be left infertile should be offered the option to freeze eggs or sperm.
(The sharp-eyed among you will have noticed the term ‘full IVF cycle’ and be wondering how you can have half a cycle. We’ll come to that.)
So what does the NHS pay for?
It can be very hard to pinpoint exactly what is causing infertility – and maybe you are one of those left without a clear reason. But it is still important to ask all the right questions.
Infertility consultant Dr Gedis Grudzinskas breaks it down into helpful starting points for his patients: Is the semen okay? Are the tubes working? Are you ovulating?
There is a recommended NHS treatment pathway and it includes thorough fertility screening. Your GP can refer you for this once you have been trying to get pregnant for one year without success.
The process covers:
- Blood work
- Ovulation
- Semen analysis
- Screening for infections such as Chlamydia
- Looking for damage to reproductive tubes
- Investigating for endometriosis
Private clinics are usually willing to use your NHS test results – so long as they are up to date. Just ask your doctor for a printed copy.
Alternatively, Dr Gedzinskas often recommends that couples pay for a semen analysis as it’s helpful to quickly rule that out as a cause.
I AMH…
The AMH test is used to judge ovarian reserve levels. It can be a crucial clue as to how urgently you need to undergo treatment – but it is only offered to NHS patients who are already approved for IVF. Ask if the place which does all your other NHS tests offers this test as a self-funded option.
Treatment
Once you have a diagnosis there are three main treatment areas:
- Medicines – drugs to support ovulation. (clomifene, metformin, gonadotrophins)
- Surgery – fallopian tube surgery for blockage or scarring, laparoscopy for endometreosis, correcting blockage in the testes
- Assisted conception – IVF, ICSI (intracytoplasmic sperm injection), IUI (intrauterine Insemination), surgical sperm extraction
If your doctor judges that drugs or surgery are the right approach for you then they are generally paid for by the NHS.
So far, so sensible.
IVF on NHS cost
Now we come to IVF costs.
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 can expect to pay privately – but once drugs and blood work are included -then a figure somewhere around £5,000 and upwards is realistic.
IVF costs covered by patient privately range from £5,000 upwards.
But what you get on the NHS depends entirely on where you live.
What’s that you say? A postcode lottery? You are absolutely right.
You may be interested in reading: IVF cost in the UK – a guide to private IVF costs
IVF Postcode Lottery
The most poorly served area is East Anglia – in 2019 just 1-in-5 IVF cycles was publicly funded. That’s a lower share than any other part of the UK. Compare that to Wales where it’s 2-out-of-5. Or to the North West and North East where more than half of IVF cycles are free to patients.
Some people even think about moving house just to qualify for better NHS fertility treatment.
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.
The HFEA says,
‘…We do not have any powers to regulate the commissioning of NHS IVF services, but encourage those who do to follow NICE guidelines which recommend that patients under the age of 40 and without children should receive three full IVF cycles.’
Human Fertilisation and Embryology Authority (HFEA)
The only region to increase the share of free IVF cycles is Scotland: up to four per cent in five years – 62 per cent of cycles were funded at the last count.
Pure Dead Brilliant
The Scottish government has said that it will look at paying for even more fertility treatment because it is worried about the effects of an ageing population. One idea on the table is offering more than the current three IVF cycles per patient – so that more people can go home carrying a baby.
In March 2021, Scotland’s economy secretary Fiona Hyslop said, “There is no single magic bullet…Instead, this report proposes a series of innovative steps to build a sustainable population’.
But these regional differences are failing patients as far as Gwenda Burns, the chief executive of charity Fertility Network UK is concerned. She worries that the situation forces them to “…either find financially-crippling amounts of money for private treatment or endure the extreme distress of being childless-not-by-choice’.
Their research suggests that six CCGs in England do not help any women at all over the age of 35. And 20 per cent offer only a partial or reduced cycle – with perhaps just one frozen embryo transfer offered. A full cycle being one where all of the embryos created are transferred – either fresh or frozen.
Ha’way, mam – IVF on NHS story
At the age of 32, Kathryn Carr* felt lucky to be able to access three cycles of IVF on the NHS in her part of north east England.
It took her and her husband six months to complete all the usual blood tests and a hysteroscopy. Then the initial wait for IVF was around a year – but she was able to start IUI at the fertility clinic before then. Sadly, each of her treatment cycles ended in disappointment.
There is a reason that the NICE guidelines suggest three 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 medication she wanted. And anyway she had used up all her NHS treatment.
The couple were determined to explore every avenue so turned to a private clinic. She was disappointed the biopsy hadn’t been recommended earlier, “…it could have made a huge difference to my earlier rounds of IVF. The results allowed our new clinic to tailor our treatment to suit us.”
Same Difference?
When going private Kathryn found that additional medication such as blood thinners and steroids were offered to support IVF cycles and early pregnancy. She was also given an endometrial scratch 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 looking for an IVF on NHS or private IVF. 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 Gedzinskas points out that the NHS cannot provide any treatment which hasn’t been approved by NICE. He advises patients to check the latest HFEA information on additional treatments – IVF add-ons. That way they can make an informed decision.
In the end, Kathryn went for IVF abroad to a private clinic because of the much lower cost. She reflects that the NHS staff who helped her were very caring – but she adds
“…I felt that the private clinics were more invested in making it work and achieving a pregnancy.”
Kathryn Carr*
Eight years after first being treated by the NHS she finally had her baby – a boy.
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.
IVF on NHS in England
If you are in England then figuring out what the NHS will pay for can be very tricky.
Clinical Commissioning Groups (CCGs) make the final decision on who is eligible for IVF. CCGs have complete independence to make decisions for their area. Indeed when asked about IVF funding for this article NHS England told us to refer all questions to the local level.
(It’s different in Wales, Scotland and Northern Ireland – but we’ll come back to that.)
CCGs are basically local doctors who work with patients, hospitals and others to decide what health services are needed in the area. Then they choose who to pay to provide that service.
And here’s where it gets even stickier… There is no obligation for CCGs to offer any of the treatments that NICE recommends. They make their own rules about who gets IVF and who doesn’t.
And – as discussed – they can limit the number of cycles you get down to one or two. Also the number of FET (frozen transfers) that you can have. You do have the option to pay for the storage of your embryos and use them later as a private patient. If you can afford it.
Typically the rules on who is eligible break down into a few different groups.
Who is eligible for IVF on NHS in England
| IVF on NHS – Who is eligible? | |
| 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.*) |
| Weight | 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. |
*Source Fertility Network UK
Again – and this cannot be emphasised enough – IT ALL DEPENDS WHERE YOU LIVE. And that is why you MUST speak to your GP to find out what is available in your area and if you are eligible.
IVF on NHS in Scotland
If you happen to be in Scotland you have the best chance of anywhere in the UK of getting your IVF treatment on the NHS.
Scotland provides the ‘gold standard’ of three full NHS IVF cycles for all infertile couples who meet the access criteria.
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.
- One partner must have no children of their own and no legal-parenthood of any child.
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.
| IVF on NHS in Scotland – Who is eligible? | |
| Women under 40 | 3 full cycles of IVF |
| Over 40 and under 42. | 1 full cycle (treatment should start before 42nd birthday) |
IVF on NHS in Wales
Decisions on access criteria are decided centrally. So wherever you are in Wales you are entitled to the same level of IVF treatment.
The access criteria is set by the Welsh Health Specialised Services Committee.
Who is eligible for IVF on NHS in Wales
- No previous children – for at least one partner
- Age: under 55 for men, over 20 for women
- Three previous IVF cycles – including privately– rules you out.
- BMI – between 19 and 30
- Non-smoking
| IVF on NHS in Wales – Who is eligible? | |
| Women 20 – 40 years old | Up to 2 cycles of IVF |
| Women 40 – 42 years old | 1 one cycle of IVF – provided they show no signs of low ovarian reserve. |
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 now says it depends on getting enough money from the UK government.
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? | |
| Under 40 or 40-42 with no evidence of low ovarian reserve | 1 cycle of IVF – counted as 1 fresh embryo transfer and 1 frozen embryo transfer |
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
