NICE calls for an end to postcode lottery of IVF treatment

The NHS should stop rationing fertility treatment and provide 3 full cycles of IVF treatment to women aged under 40 who have failed to get pregnant after 2 years of trying, and 1 full cycle for some women aged 40-42, says NICE.

The new quality standard – which compliments the NICE fertility guideline – emphasises the importance of treating fertility and aims to end the postcode lottery of treatment and support for people with fertility problems.

Currently, fewer than 1 in 5 Clinical Commissioning Groups (CCGs) in England are offering the full number of NICE-recommended cycles, according to an investigation by Fertility Fairness.

More than half of CCGs only offer 1 cycle to eligible couples while people with fertility problems in the Vale of York are refused IVF treatment altogether. Seven other CCGs were claiming to offer three cycles of IVF when in fact they only offered 1.

Mid Essex CCG has recently revised its policy for funding specialist fertility services and will now only fund exceptional clinical cases, as it seeks to make £8 million in savings.

NICE updated its fertility guideline in February last year to extend IVF treatment to some women aged between 40 and 42 years, if they have not conceived after 2 years of regular unprotected intercourse, or 12 cycles of artificial insemination where 6 or more are by intrauterine insemination. However, few CCGs have updated their fertility policies to include this recommendation.

Professor Gillian Leng, Deputy Chief Executive of NICE, said: “Infertility is a recognised medical condition. People affected, who include 1 in 7 heterosexual couples, should be able to receive treatment as a core NHS service.

“Some parts of England are doing very well in offering the full NICE-recommended number of IVF cycles for all eligible women up to the age of 42. This is particularly true in the North, in areas like Northumberland, Oldham and Cumbria.

“Others are still to introduce a cycle of IVF for women between the ages of 40 and 42, but have at least committed to providing 3 full cycles of IVF to women under 40-years-old, such as Camden and Gloucestershire. But, many areas are not even doing this.

“Infertility can have a potentially devastating effect on people’s lives: it can cause significant distress, depression and possibly lead to the breakdown of relationships. It is unacceptable that parts of England are choosing to ignore NICE recommendations for treating infertility. This perpetuates a postcode lottery and creates inequalities in healthcare across the country.”

Susan Seenan, Chief Executive of Infertility Network UK and co-chair of Fertility Fairness, said: “It is totally unacceptable that ten years on from the initial NICE recommendations, access to fertility treatment still depends entirely on where you live. Patients are still suffering as a result of CCGs ignoring national guidance and cutting services. We are therefore delighted that NICE has published this quality standard which reinforces the cost and clinical effectiveness of this treatment.”

Anna Bradley, Chair of Healthwatch England, said: "Sadly, the so called 'postcode lotteries' created by the inconsistent decisions at local level is causing widespread inequality, resulting in unnecessary confusion and frustration for patients and their loved ones. Ultimately, this raises some very serious questions about whether NICE treatments should indeed be made mandatory.  

"We therefore fully support this move by NICE, and would urge anyone who is being denied access to a NICE recommended treatment to get in touch with their local Healthwatch for help in challenging the decision.”

Sally Cheshire, Chair of the Human Fertilisation and Embryology Authority (HFEA), added: “We support implementation of the NICE fertility quality standard, and will continue to work with commissioners to ensure that whatever resources are allocated for IVF are done so in a way that secures the highest quality care and treatment for patients.”

The quality standard also emphasises that people who are preparing to have treatment for cancer that is likely to result in fertility problems are given the option of freezing their embryos or sperm ahead of treatment.

In May this year, Thanet CCG ruled against offering a patient who had undergone chemotherapy the opportunity to freeze her eggs because they did not agree with NICE’s guidance.

The CCG was taken to the High Court where the judge, Justice Jay, pointed out that the CCG was wrong to not follow NICE’s guidance because they simply disagreed with it. The policy was therefore found to be unlawful.

Infertility can have a potentially devastating effect on people’s lives

Prof Gill Leng, NICE

Patients are still suffering as a result of CCGs ignoring national guidance and cutting services

Susan Seenan, Fertility Fairness