North Central London ICB updates fertility policy

North Central London Integrated Care Board (NCL ICB) has introduced a new single fertility policy, commencing today, that enables those eligible, and under 40, to have three cycles of IVF and six embryos transferred under NHS funding.

ICBs replaced clinical commissioning groups (CCGs) in the NHS in England from 1 July 2022. The NCL ICB has revised the fertility policies from five CCGs that covered five boroughs, subsequently allowing further access to fertility treatments for more patients. The new single policy describes the circumstances where NCL ICB will routinely fund fertility treatments, such as IVF and intrauterine insemination (IUI). Up to six cycles of intrauterine insemination (IUI) are offered to eligible same-sex couples, single people or other couples, under the conditions that the patient(s) have not conceived after six cycles of self-funded IUI.

Sarah Norcross, director of the Progress Educational Trust (PET) said 'NCL ICB to provide up to six embryo transfers from up to three cycles of IVF is good news. But the policy is still not fully compliant with the guidance from the National Institute of Health and Care Excellence (NICE), which does not place a limit on the number of embryo transfers.'

Public feedback when the policy was in draft, highlighted that the majority supported reducing or removing the number of self-funded cycles of IUI required for female same-sex couples and single women to access IVF. However, in light of the Women's Health Strategy (see BioNews 1152), which states that there will no longer be a requirement for same-sex couples to pay for artificial insemination (AI) to prove their fertility status, this new policy will need to be amended. The Women's Health Strategy makes no comment regarding the requirement for single women.

'The commitment to treat single women and same-sex female couples is also welcome' continued Norcross, '...PET hopes that in relation to same-sex couples this policy will be updated to reflect commitments in the Women's Health Strategy to remove the need to self-fund AI to prove their fertility status.'

Amendments were made to the draft policy, following feedback, one of which is to exclude adopted children from the 'previous child criterion', which states that 'at least one individual in the relationship must not have a living child'. Adopted children were initially judged to be inside the scope of this criterion, but this policy now allows access to fertility treatment for those with adopted children. These policies may need to be revised in light of the Women's Health Strategy which aims to remove all non-clinical access criteria to fertility treatment.

Sperm, egg and embryo storage will be funded for a maximum of two years following each IVF cycle according to the new policy. Although, storage is longer for patients due to undergo a gonadotoxic treatment eg, gender reassignment, or under medical care where the condition of treatment may lead to infertility in the future. For patients aged under 32 years, the policy has been updated to include the storage of sperm, embryos and eggs until the patient reaches 43 years of age. For patients aged 32 and over storage will be funded for ten years.

Other key areas of the policy have remained the same, in line with NICE guidelines. These include maintaining the age and BMI criteria for women trying to get pregnant. Also, there should be no evidence of a low ovarian reserve, and that both male and female patients must not smoke.

For eligible patients aged 40-42, the new policy offers one cycle of IVF and two embryo transfers.