The unfair IVF postcode lottery
Reproductive & Gynaecological In England, whether you are able to access NHS fertility treatment depends on your GP’s postcode, with different regions offering different levels of access to NHS IVF and some offering none at all.
The number of clinical commissioning groups (CCGs) in England offering the recommended three NHS IVF cycles to eligible women under 40 has halved in the last five years: just 12 per cent now follow national guidance, down from 24 per cent in 2013.
In contrast, the number of CCGs which have removed NHS IVF has almost doubled in the last year.
Fertility Fairness’ 2017 audit of England’s 208 CCGs reveals the severity of disinvestment in NHS fertility services, with potential further cuts ahead. While the number of CCGs following national guidelines and providing 3 NHS-funded IVF cycles has dropped to 12 per cent, the number of CCGs offering just one NHS-funded IVF cycle has leapt to 61 per cent. There are now seven CCGs that have removed all NHS IVF, and seven per cent of CCGs are currently consulting on removing or reducing NHS fertility treatment.
Fertility Fairness’ data also reveals the best and worst places to live in England in terms of ability to access NHS IVF treatment:
The top 4 areas (ranked position 1) are all in Greater Manchester:
- Heywood, Middleton and Rochdale
- Tameside and Glossop
- Oldham – the birth place of IVF 40 years ago
The worst areas (ranked position 17) do not offer any NHS IVF:
- Herts Valleys
- Cambridgeshire and Peterborough
- South Norfolk
- Basildon & Brentwood
- Mid Essex
- North East Essex
There is a striking north-south divide in terms of NHS IVF provision. Just 24 CCGs offer three cycles: 21 of them are in the north. The three areas in the south are Thurrock, Camden and Luton.
"We are commemorating 40 years of IVF, 40 years of a life-changing technology. However, that achievement means nothing if only those who can afford private IVF benefit."
As well as cutting the number of IVF cycles offered, CCGs are finding alternative ways to reduce provision. National Institute for Heath and Clinical Excellence (NICE) guidelines recommend that eligible couples should have access to three full IVF cycles, where a full cycle of IVF treatment is defined as one round of ovarian stimulation followed by the transfer of all resultant fresh or frozen embryos. However, approaching half of all CCGs (49 per cent) use their own definition of what constitutes a full IVF cycle – and only transfer a finite number of embryos, rather than all resultant embryos.
Some CCGs stipulate entirely arbitrary age criteria for access to NHS IVF, in contravention of NICE’s guidelines stating that eligible women under 40 should be offered three full IVF cycles and eligible women aged 40-42 should be offered one full IVF cycle. Approaching half of all CCGs (48 per cent) do not offer NHS IVF to women aged 40-42; over ten per cent of CCGs refuse access to NHS IVF if women are over 35.
Aileen Feeney, chief executive of leading patient charity Fertility Network and co-chair of Fertility Fairness, said: ‘This year we are commemorating 40 years of IVF, 40 years of a life-changing technology pioneered in England. However, that achievement means nothing if only those who can afford private IVF benefit. The government should be ashamed that, after 40 years of IVF, it is your postcode and your pay packet, and not your medical need, which are the key determinants of whether you will be able to try IVF.’