'Worrying' trend in NHS IVF provision

The number of CCGs in England offering the recommended number of IVF cycles to its patients is falling, with two CCGs in Essex decommissioning their assisted conception services altogether. 

According to the National Institute for Health and Care Excellence (NICE), the body responsible for issuing evidence-based recommendations on the provision of health services, all eligible couples should have access to three full cycles of IVF, where the woman is aged under 40. In 2013, NICE updated its guidance to also recommend that certain eligible women aged 40—42 should also have access to one full cycle.

However, the latest data from Fertility Fairness, which campaigns for equal access to assisted conception services in the UK, shows that fewer than one in five CCGs are meeting the NICE guideline in full, representing a fall of six percent since 2013. Twenty-four percent of CCGs currently offer two cycles, falling by seven percent since last year, and the number of CCGs offering just one cycle has risen by five percent since 2014 to 57 percent.

The figures draw attention to the rising disparities in current levels of access. For those seeking fertility treatment on the NHS, Fertility Fairness says the North is the best place to live in England; Cheshire, Warrington, Wirral and Merseyside currently work together as a North West commissioning collaborative to enable the recommended full three cycles be provided to its patients.

The places with the lowest provision of fertility services on the NHS are Essex and London. Fertility Fairness states that in Essex, both North East Essex CCG and Mid Essex CCG have cut NHS fertility services completely, except in isolated, complex medical circumstances. Basildon and Brentwood CCG are consulting on doing the same, and in London, every CCG, bar one, offers just one NHS-funded cycle of IVF.

Fertility Fairness claims that one of the barriers to many CCGs becoming NICE-compliant is the cost of IVF services. There is currently no national tariff in England for tertiary fertility services meaning that some CCGs are paying as much as £6000 for a single cycle of IVF while others are paying £1379.

Sarah Norcross, co-chair of Fertility Fairness and director of the Progress Educational Trust, which publishes BioNews, said: '[This] data demonstrates that by working collaboratively clinical commissioning groups can implement the NICE guideline in full. Even with budget constraints, Cheshire, Warrington, Wirral and Merseyside have, over the last year, improved their fertility service. We want to encourage commissioners in the South, especially in Essex, to learn from these collaborative groups, to improve their provision and to end the NHS fertility treatment postcode lottery.'

As a result of the reversal of what had previously appeared to be an upward trend in fertility service provisions, the Co-Chairs of Fertility Fairness have now called on Public Health Minister Jane Ellison MP to arrange a meeting to discuss the issues. More broadly, the organisation is urgently calling on the Government to fully implement the NICE guideline including the provision of three full cycles of IVF regardless of locality, standardise the eligibility criteria that is being used across England and to develop a national tariff in England for tertiary fertility services.

Speaking to Fertility Fairness, 34-year-old Kirsty and her husband, who have been trying to conceive for three years, describe their frustration after moving from the North of England where they were eligible for access to three funded IVF cycles, to the South where they can only access one, as 'heart-breaking'.

She said: 'Infertility is not a choice, treatment is not a luxury, and allocating treatment based on postcode is discriminatory. It astonishes me that following the NICE guideline is not compulsory.'

Fertility Fairness notes that difficulty in conceiving is the second most common reason for women to visit their GP and, on average, one in seven couples will have difficulties in conceiving in the UK.