Do you get free IVF on the NHS? It depends…

IN ADDITION TO “DOGS”, “MEN” AND “YOUNG CHILDREN” (I IMAGINE), some women will struggle to get fertility treatment on the NHS. Here’s the lowdown.

What's the official guidance on how should get IVF on the NHS?

The National Institute for Health and Care Excellence (NICE) publishes guidelines for the English and Welsh NHS on a wide assortment of medical issues – one of which is the appropriate treatment and care of people with certain medical conditions.

When it comes to fertility treatment, it advises the following:

• “In women aged under 40 years who have not conceived after 2 years of regular unprotected intercourse or 12 cycles of artificial insemination (where 6 or more are by intrauterine insemination), offer 3 full cycles of IVF, with or without ICSI. If the woman reaches the age of 40 during treatment, complete the current full cycle but do not offer further full cycles.”
• “In women aged 40–42 years who have not conceived after 2 years of regular unprotected intercourse or 12 cycles of artificial insemination (where 6 or more are by intrauterine insemination), offer 1 full cycle of IVF, with or without ICSI, provided the following 3 criteria are fulfilled:
  • they have never previously had IVF treatment
  • there is no evidence of low ovarian reserve (as measured by an AMH level test, an FSH level test, or an antral follicle count)
  • there has been a discussion of the additional implications of IVF and pregnancy at this age.”
• “Where investigations show there is no chance of pregnancy with expectant management (that is, through offering advice and support about timings and lifestyle changes for natural conception) and where IVF is the only effective treatment, refer the woman directly to a specialist team for IVF treatment.”
• “In women aged under 40 years any previous full IVF cycle, whether self- or NHS-funded, should count towards the total of 3 full cycles that should be offered by the NHS.”
• “Take into account the outcome of previous IVF treatment when assessing the likely effectiveness and safety of any further IVF treatment.”
• “Healthcare providers should define a cancelled IVF cycle as one where an egg collection procedure is not undertaken. However, cancelled cycles due to low ovarian reserve should be taken into account when considering suitability for further IVF treatment.”

What's meant by a “full cycle” when it comes to IVF on the NHS?

According to NICE, the term “full cycle”… “is used to define a full IVF treatment, which should include 1 episode of ovarian stimulation and the transfer of any resultant fresh and frozen embryo(s)”. 

Say you end up with nine embryos; one of those embryos is transferred fresh and the other eight wait things out on ice. (NHS patients must pay for storage, like private patients.) According to the NICE definition, a “full cycle” means that if the fresh embryo is unsuccessful, you could continue transferring the other frozen embryos until you become pregnant and have a baby. And if all the transfers are unsuccessful, you should be entitled to two more cycles. 

Do all NHS fertility units have to follow the official guidance on IVF?  

No: the NICE guidelines are just guidelines – and the local clinical commissioning groups (CCGs) in England that make the final decision often limit you to fewer than three full cycles. Not only that, but they also have different, less generous, definitions of what a “full cycle” actually is. They also have stricter criteria about who gets a cycle at all. 

For example, the CCG in Sutton has the following rules: 

• You're allowed a maximum of one cycle. 
• A “cycle” is defined as one fresh cycle (i.e. one fresh embryo transfer) and one frozen transfer. 
• You must be between the ages of 23 and 40. 
• You must have been trying to conceive for at least two years. 
• You must have no living children from a current or previous relationship (for both partners).
• No treatment is available for women between the ages of 40 and 42. 

To find out what your local CCG offers, visit Fertility Network UK. Then choose your country (e.g. England), and you'll be able to download a spreadsheet of all the CCGs there.

Not sure which CCG you’re with? The simplest “CCG postcode lookup” tool I could find is this one from Stephen Keable.

If you live in Scotland, Wales or Northern Ireland, there are no local variations in funding:

• In Wales you're eligible for two full cycles of NHS fertility treatment. (There's more info on the Fertility Network UK website here.)
• In Scotland you can get three full cycles of NHS fertility treatment. (There's more info on the Fertility Network UK website here.)
• In Northern Ireland, you're only allowed one cycle of NHS fertility treatment – and the definition of a “cycle” is a lot stricter. (There's more info on the Fertility Network UK website here.)

Does the NHS pay for your fertility medication in addition to your treatment?

No. Unless you’re exempt from paying prescription charges, you’ll have to fork out for your fertility drugs. (You’ll be getting a LOT of drugs, so do yourself a favour and buy a three-month or yearly prescription prepayment: it will save you an absolute fortune.)

You'll also have to pay for storage of any frozen embryos, which is normally a few hundred pounds a year. 

Is it possible to have IVF on the NHS after having tried private treatment?

NICE has guidance on this question (above), but each CCG/region will have its own rules and you'll need to speak to your local NHS fertility department to find out. 

Any more questions about NHS-funded IVF treatment?

The Fertility Fairness website has tons of information.

I'm not eligible for NHS treatment (or I want to see what the private options are like). How much does it cost to go private? 

I have an article all about the cost of private IVF treatment! Read it here.