Levelling up in London?

If you're a fertility patient in the London borough of Camden you're one of the more fortunate Londoners in terms of access to NHS-funded fertility treatment. Camden is currently the only area in the capital city to provide up to three partial cycles of IVF, the rest offer London's citizens just one partial IVF cycle, or two embryo transfers. However, the advantages of living in Camden could be about to disappear because the borough's fertility policy is now up for review, with patients being asked to give their views on what a new policy should provide before a decision is announced in the second half of 2021.

The outward trigger for the policy review is the creation of a new clinical commissioning group (CCG) in April 2020. The new North Central London CCG, brought together five previously separate London CCGs: Camden, Barnet, Enfield, Haringey and Islington, which all had their own fertility policies with different treatments provided, and slightly different eligibility criteria. The big question now is: will North Central London CCG level up or level down with its new fertility policy?

The National Institute for Health and Care Excellence (NICE) recommends that all clinically eligible fertility patients under 40 in England and Wales are offered three full cycles of IVF, where a full cycle is defined as one fresh embryo transfer after ovarian stimulation, plus the transfer of all viable frozen embryos resulting from that ovarian stimulation; women aged between 40-42 should be offered one full IVF cycle. However, this recommendation is not mandatory, and the result is that massive disparities in the provision of NHS-funded fertility treatment exist, alongside inequities in the criteria to access help.

If you're one of the one in six couples struggling with the heartbreak of infertility, Scotland is far and away the best place to live in the UK, as it provides three full cycles of IVF. In England, what you are entitled to depends on your GP's postcode, with the vast majority of CCGs ignoring the national guidance, three areas not providing any NHS treatment at all, and only 20 CCGs (15 percent) providing three cycles of IVF, according to data from patient charity Fertility Network.

However, not all of these 20 CCGs provide three full IVF cycles. Instead, they ration the care offered by limiting the number of frozen embryo transfers possible within an IVF cycle. Camden is one of the areas that does this, so although it is unique in London in offering three IVF cycles, it, like many other CCGs, has ignored the NICE guidance and redefined what an IVF cycle is, deciding that it comprises one fresh embryo transfer and just one frozen embryo transfer, rather than all resulting frozen embryo transfers.

In Wales, there is equality in provision in that all areas offer the same number of cycles, however, patients can only access up to two IVF cycles and these are not full cycles – instead they consist of one fresh embryo transfer and one frozen embryo transfer. In Northern Ireland, the situation is even worse: although everyone is offered the same help, eligible patients can only access a partial IVF cycle – one fresh embryo transfer and one frozen embryo transfer.

So what will the new North Central London CCG do as it seeks to reconcile five different fertility policies? Will it decide to give everyone what Camden residents are currently entitled to – three partial IVF cycles? Or will the bar be lowered and just one partial cycle offered, in line with current policies from Barnet, Enfield and Haringey, or perhaps the two embryo transfers that Islington offers?

There are other discrepancies in the treatments offered. Same sex couples in Enfield and Haringey can currently access NHS funding for intrauterine insemination (IUI), but same sex couples in Barnet, Camden and Islington cannot. In addition, if patients wishing to use donor eggs have self-funded the provision of their donor gametes, they can access NHS-funded IVF in Barnet, Enfield and Islington, but not in Camden and Haringey.

Slight differences in eligibility criteria also exist. In Barnet, women have to be under 42 to be able to access IVF, but in the other four areas the cut-off age is under 43. Same sex couples and single women under 36 have to jump through more hoops in Barnet, Camden, Enfield and Islington before they can access funding for fertility treatment. They need to self-fund 12 rounds of IUI to prove their infertility before they are eligible for help, while same sex couples and single women in Haringey only have to self-fund 6 six rounds of IUI before accessing NHS-funded fertility treatment.

Aligning fertility policies when CCGs merge doesn't always lead to patients being worse off. When South West London CCG standardised its fertility policies in March 2020, bringing together the former CCGs of Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth, it was good news for fertility patients in Croydon. It meant access to one partial cycle of NHS-funded fertility treatment was reinstated in Croydon, after the service had been decommissioned in 2017. Let's hope there's a similar story across the river in north London.

The public's views on North Central London CCG's fertility policy review are being sought from 10 May – 9 July 2021 here.