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Paying for IVF out of pocket is expensive — shockingly so. Do you qualify to have your IVF on the National Health Service in England?

Private IVF treatment in the UK is expensive. Really expensive. Once you include the consultations, pre-treatment investigations, medications, and any additional services you require, such as intracytoplasmic sperm injection or an egg donor, you'll easily spend (way) upwards of £5,000 per cycle. [1] If you're one of the approximately 3.5 million people in the UK to be facing fertility challenges, the first thing you'll do is hope you can rely on the National Health Service. 

As the number of Clinical Commissioning Groups that offer a full three NHS-funded IVF cycles to eligible women under 40 has halved over the last four years, you may, however, find out that that's just not true — and that you may end up having to think about how to choose a fertility clinic in the UK for private IVF. 

Are You Eligible for NHS-Funded IVF Treatment?

Guidelines set forth by the National Institute for Health and Care Excellence, NICE, recommended that:

  • Women under 40 be offered three full cycles of IVF on the NHS, with or without ICSI, if they have been unable to conceive naturally over the course of two years or after 12 unsuccessful cycles of artificial insemination, six of which were intrauterine insemination (IUI) cycles. 
  • Women aged between 40 and 42 be offered one IVF cycle, with or without ICSI, on the NHS if they haven't previously undergone IVF (whether privately or on the NHS), if there's no evidence that they have a low ovarian reserve, and once the risks of IVF and pregnancy at their age have been discussed with them. [2]

In addition to those basics, NICE offers a variety of comments noting that certain patient circumstances — like drinking too much, using nicotine, and being overweight — reduce the odds of IVF success, and advising that women who are looking to undergo IVF should be aware of these things. It doesn't outright state that people in these groups shouldn't be able to receive IVF on the NHS, however. When you take a deeper look at the NICE guidelines, it becomes clear that they are evidence-based and actually quite reasonable. 

Even the three-cycle limit has a sound reason. Women under 40 have, on average, a 20 to 35 per cent chance of getting pregnant during each cycle of IVF, and their odds of conceiving through IVF go down with each successive cycle, NICE points out, while the cost goes up. Most women under 40 who need IVF to conceive have a 45 to 53 per cent chance of getting pregnant over the course of three IVF cycles, while their chances of conceiving do not increase if they have more than three cycles. In short, NICE states, it has "recommended three IVF cycles as it is both the most cost effective and clinically effective number for women under the age of 40". [3]

The IVF Postcode Lottery: Your Local Clinical Commissioning Group Has The Ultimate Power

While each Clinical Commissioning Group in England will take the NICE guidelines into account, they're ultimately able to set their own access criteria for NHS-funded IVF cycles [4]. Whether or not you'll be able to receive IVF on the NHS entirely depends on where in England you live, in other words. This is referred to as the IVF postcode lottery, and it's risen to infamy already. (The situation, the campaign group Fertility Fairness points out, "stands in stark contrast with the rest of the UK" — "In Scotland, Wales and Northern Ireland, access criteria and provision are standardised and patients within each of the devolved nations have equality of treatment.") 

To take one example, the Manchester Clinical Commissioning Group includes such IVF access criteria as:

  • You must be childless, defined as neither you nor your partner having any living biological or adopted children from your current or any previous relationship. 
  • Your infertility can't be due to a previous voluntary sterilisation. 
  • Before commencing IVF treatment, your BMI has to be between 19 and 29. 
  • If you're a part of a couple, neither partner can smoke or use any nicotine products. 
  • Your alcohol intake must not exceed the guidelines set forth by the Department of Health, and you can't use any recreational drugs. [5]

Should you decide to click on that last reference, you'll notice that the URL contains the term "brick wall". For too many people who were counting on NHS-funded IVF to start or expand their family, that just about sums their experience up. (To make it even more depressing, the Fertility Fairness campaign's data reveals that Manchester is actually the best place to live if you're hoping for NHS-funded IVF treatment!) 

It doesn't end with strict access criteria, either — seven CCGs now no longer offer IVF on the NHS at all, and a further seven per cent are currently considering reducing access to IVF treatment, or eliminating it altogether. Sixty-one per cent of CCGs now offer no more than one IVF cycle, while a shockingly low 12 per cent actually follows NICE guidelines. [6]

Fertility Fairness co-chair and chief executive of the charity Fertility Network UK Susan Seenan represents a lot of angry patients when she said:

"This National Fertility Awareness Week 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."

I Do Qualify For NHS-Funded IVF: What Now?

To find out what your clinical commissioning group offers in terms of IVF coverage, contact them directly or find their policy online. [7]

Should you qualify for NHS-funded IVF, you'll want to be aware you may be in for a bit of a wait; the NHS itself doesn't even offer an average time frame, and merely states that "in some areas, waiting lists can be very long", as well as that you'll still have to pay for the prescription drugs you will require for IVF yourself in most cases. You may, however, not be aware that it is possible to have your NHS-funded fertility treatment done at a private clinic too, in some cases. This could cut your waiting list short. [5]

Note that, while your clinical commissioning group may consider the transfer of frozen embryos resulting from previous efforts to still be part of the same cycle [8], this is not always the case. Fertility Fairness warns:

"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 3 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."

Finally, a note for those people who think they may end up choosing a private IVF clinic in the UK — since privately-funded IVF cycles count towards the total number of cycles you are eligible to receive under the NHS [2], it makes sense to explore NHS-funded IVF before transferring to private fertility treatment, especially if you are under 40 and have more time. 

I Think Private IVF Is The Better (Or Only Available) Way To Go: What Now?

Are you overweight? Do you or your partner already have a child (from a previous marriage)? Are you over 40? Does your CCG simply not offer IVF? Do you prefer to start treatment right away, knowing that your odds of IVF success are better the younger you are? Are you hoping to make use of "extras", such as endometrial scratching or the ability to have several embryos transferred in one cycle, which the NHS does not routinely offer? You're in a perfect position to understand why, despite the high cost of IVF, a majority of IVF cycles, 58.7 per cent, are funded privately [9]. 

While you're exploring the right private fertility clinic in England for your needs, be aware that some clinics offer a "no pregnancy, money back" guarantee, while many others offer multi-cycle discounts. Parts of your fertility treatment may also be covered by any private health insurance policies you may have, such as those that BUPA offers. 

Looking around for the right clinic can both ensure that you have the best chance of getting pregnant, and that you make an expensive procedure slightly less financially painful. 

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