The results of a survey conducted by a team at St Bartholomew's Hospital in London show that four years since the National Institute of Health and Clinical Excellence (NICE) made the recommendation that women should receive three cycles of IVF on the NHS, that guidance is not being followed and in the case of one unnamed trust - no IVF is being funded at all.
Although the NICE guidelines were devised as guidance for PCTs rather than as a legal minimum, the researchers at St Bartholomew's have called for a common national funding policy to address the disparity in IVF provision around the country.
Facing limited resources, trusts impose restrictions on who is eligible for treatment. Criteria such as weight, age, being a non-smoker and not having any children from previous relationships all contribute to the decision. The survey, conducted between July and September 2008, revealed that half of trusts will not fund treatment for smokers, and some trusts will only fund treatment if women are over 35 years old when natural fertility is thought to decline.
NICE's guidance suggested three funded cycles of IVF for infertile women, each cycle including one fresh embryo transfer and if that failed, as many frozen embryo transfers as possible with available embryos. The research team at St Bartholomew's, led by Parimalam Ramanathan discovered that none of the 148 trusts in England provides this. Of the 29 trusts providing three fresh cycles, 15 do not fund any frozen cycles, 14 are funding only one frozen cycle and only two trusts fund two frozen cycles. Tony Rutherford of the Assisted Conception Unit in Leeds said that if the NICE guidance was implemented in full, everyone would have 'a realistic chance of a successful singleton pregnancy'.
Rutherford also pointed out that the initiative to promote single embryo transfer in an effort to cut the number of multiple births resulting from IVF is being held back by a lack of funding. 'If more cycles were funded on the NHS then one embryo could be transferred to the womb at a time', he said. Multiple births are one of the biggest risks in IVF when more than one embryo is transferred into the womb during one cycle. Clare Lewis-Jones of the National Infertility Awareness Campaign said that 'with the move to single embryo transfer, it is even more important to end this totally unacceptable situation and allow patients access to the treatment promised to them by the government.'
In response. a Department of Health spokesman insisted that the number of PCTs providing three cycles of IVF continues to increase.