Frequently Asked Questions
1. What does infertility mean?
2. What is IVF?
3. What is ICSI?
4. Why should the NHS pay for fertility treatment?
5. What is available on the NHS?
6. Can anyone have fertility treatment on the NHS?
7. What should IVF commissioning look like?
8. Why are 3 full cycles of IVF so important?
9. What are the risks of IVF?
10. Fertility treatment on the NHS in England
11. Fertility treatment on the NHS in Northern Ireland
12. Fertility treatment on the NHS in Scotland
13. Fertility treatment on the NHS in Wales
14. Am I entitled to funding if I am single or in a same sex
relationship?
15. Who are Fertility Fairness?
16. What is Fertility Fairness trying to achieve?
17. What do Fertility Fairness do?
18. How can I get involved with the Fertility Fairness
campaign?
19. I am currently undergoing, or trying to gain access to,
fertility treatment. What support is available to me?
20. I cannot access fertility treatment on the NHS, what are
my other options?
What does infertility mean?
Infertility is the inability to conceive after regular, unprotected
sex and it is estimated to affect one in six couples in the UK.
While there are many clear causes of infertility - such as
blocked fallopian tubes - it is not always possible to pinpoint
the cause for infertility. In fact for around 25% of couples their
infertility remains unexplained.
What is IVF?
IVF (in vitro fertilisation) is a treatment for infertility, in
which eggs are removed from a woman's body and fertilised
with sperm in a laboratory. The embryo is later transferred
returned to the woman’s womb to continue developing.
For more information about the process please see the NHS
website here or the HFEA website here.
What is ICSI?
ICSI (intracytoplasmic sperm injection) is a variation of in
vitro fertilisation (IVF) in which, a single sperm is injected
directly into an egg in order to fertilise it. The fertilised egg is
then transferred to the woman's womb.
For more information about the process please see the HFEA
website here.
Why should the NHS pay for fertility treatment and IVF?
Infertility is a medical condition and as with any other medical
condition it is deserving of treatment.
Infertility has been recognised by the World Health
Organisation as a disease, they define infertility as an
‘impairment of function’ and a ‘disease of the reproductive
system’.
The importance of funding fertility treatment is also
highlighted by the well-recognised and devastating
psychological impact the disease can have. Infertility can lead
to stress, anxiety, clinical depression and the breakdown of
relationships.
Fundamentally the purpose of the NHS is to provide
treatments that ‘improve our health and wellbeing’ and keep
us ‘mentally and physically well’. Fertility treatment fulfills
both those purposes.
The NHS funds many treatments which are not life-saving for
things such as acne to warts because they improve our
wellbeing. Fertility treatment fits within this policy that good
health is also about the quality of life.
What is available on the NHS?
Fertility treatment falls broadly into three categories:
medicines to assist fertility, surgical procedures and assisted
conception.
Fertility medicines and surgical procedures are routinely
funded across the UK. However assisted conception
procedures - such as IVF and ICSI - remain subject to wide
regional variation in England and this is known as the
postcode lottery.
In Scotland, Wales and Northern Ireland provision for assisted
conception treatment is set centrally by the devolved
Governments so there is no postcode lottery. To find out more
see below.
Can anyone have fertility treatment on the NHS?
No, fertility services are subject to strict access criteria that
relate to clinical factors affecting fertility (such as age and
Body Mass Index) and also to welfare assessments of any
potential children.
In some areas of England access criteria are overly restrictive
and have no clinical justifications. For instance some areas
limit access to women over 30 or under 35, these criteria are
nothing more than attempts to limit costs and their use should
not continue.
What should IVF commissioning look like?
The National Institute for Health and Clinical Care Excellence
(NICE) is responsible for issuing evidence-based
recommendations on the provision of health services.
These recommendations are developed by experts and are
based on two key considerations:
(1) clinical effectiveness and
(2) cost effectiveness.
It is the duty of commissioners to try to provide services in
line with the guidance published by NICE.
In 2004 and 2013 NICE published guidelines recommending
that 3 cycles of IVF should be provided to people with fertility
problems (subject to access criteria).
Unfortunately in England over 80% of commissioners
currently fail to meet these recommendations. In the devolved
nations Scotland and Wales currently offer 2 full cycles of
IVF, and Northern Ireland offers 1 partial cycle.
Fertility Fairness wants to ensure that all commissioners
provide the same service, the recommended 3 cycles.
Additionally in England Fertility Fairness strongly supports
the introduction of a national tariff price for IVF and the
standardisation of access criteria.
To learn more about our goals please see here.
Why are 3 full cycles of IVF so important?
In a cycle of IVF the ovaries are stimulated, and all viable
eggs are harvested and fertilised so that they can develop into
embryos. Once an embryo has been implanted in the womb
any remaining embryos that have been created can be
preserved for later treatment. A full cycle of IVF is defined by
National Institute for Health and Clinical Care Excellence
(NICE) as the transfer of the first fresh, and any resultant
frozen embryos. A second cycle of IVF would involve a fresh
round of ovarian stimulation and repetition of the above
process.
Three cycles of IVF maximises not only the clinical chances
of pregnancy (bringing the chances of a successful pregnancy
up to 45-53% from a single cycle success of 20-35%), but also
represents the most cost effective use of resources. Some
couples may not produce many high quality embryos in a
cycle so limiting them to just one full cycle can really reduce
their chance of a successful pregnancy.
While many areas do not meet the guidelines to provide three
cycles of IVF, many also do not use the NICE definition a
single ‘full’ cycle. This is confusing for patients and is an
inefficient use of resources.
To learn more please see here.
What are the risks of IVF?
As with any medical treatment IVF poses potential risks. The
most common risk is multiple pregnancy, where multiple
embryo transfer causes the mother to become pregnant with
multiple babies. This risk has been reduced through the
introduction of elective single embryo transfer (eSET), where
only one embryo is transferred during a cycle.
To learn more please see the HFEA website here.
Fertility treatment on the NHS in England
In England fertility services - are commissioned locally by GP
led groups (known as Clinical Commissioning Groups or
CCGs). There are 209 of these decision-making bodies across
England often working independently of each other.
As a result what you can access depends on where you live.
This is known as the ‘postcode lottery’. Unfortunately over
80% of CCGs in England currently fail to commission the 3
full cycles of IVF recommended by NICE.
To find out what services are commissioned in your area see
here.
Fertility treatment on the NHS in Northern Ireland
IVF treatment in Northern Ireland falls below the average of
the UK with only one partial cycle of IVF being offered.
To see more information on fertility treatment on the NHS and
criteria in Northern Ireland please follow the link here.
Fertility treatment on the NHS in Scotland
Waiting times for IVF treatment in Scotland have recently
fallen, but only 2 cycles of IVF are provided to couples fitting
criteria. Couples aged between 40-42 are eligible for 1 cycle of
IVF.
To see the criteria for fertility treatment on the NHS in
Scotland please follow the link here.
Fertility treatment on the NHS in Wales
In Wales only 2 cycles of IVF are provided to women under
the age of 40. Couples aged between 40-42 are eligible for 1
cycle of IVF.
To see the criteria for fertility treatment on the NHS in Wales
please follow the link here.
Am I entitled to funding if I am single or in a same sex
relationship?
The most recent NICE guidelines recommend that after six
unsuccessful cycles of IUI all women (regardless of sexual
orientation and relationship status) should be eligible for IVF.
In England most CCGs offer IVF to same sex couples, however they
are frequently required to self-fund their IUI. Some CCGs do also
offer IVF to single women, however the best way to find out
whether you are eligible in your local area is to consult your GP.
In Northern Ireland same sex couples are eligible for IVF treatment
provided that they are in a ‘stable relationship’.
In Scotland same sex couples will be eligible for IVF where there is
unexplained infertility following six to eight cycles of donor
insemination or an appropriate.
In Wales IVF is available for single women and same sex couples
after five non-stimulated cycles or if there is a known fertility
problem.
Who are Fertility Fairness?
Fertility Fairness are an umbrella organization campaigning
for equal access to fertility treatments. We are supported by
professional bodies and patient support groups and were
previously known as the National Infertility Awareness
Campaign.
To learn more about who our steering committee are please
see here.
To learn more about our supporters see here.
What is Fertility Fairness trying to achieve?
Fertility Fairness has been campaigning for more than 20 years
for equal access to a full range of appropriate NHS
investigations and fertility treatments.
Currently the main focus of Fertility Fairness’ work is to
ensure that all eligible couples have access to the appropriate
number of full cycles of IVF treatment on the NHS.
To learn more about our goals please see here.
What do Fertility Fairness do?
Fertility Fairness run a variety of programmes designed at
improving access to fertility services: we engage with both
national and local policymakers, we draw attention to areas
failing to meet NHS guidelines, we support commissioners in
their decision making and we provide vital information on
service provision.
How can I get involved with the Fertility Fairness campaign?
The best way you can help us to improve the provision of
fertility treatment is to raise awareness of the need for fertility
services.
There are several ways to do this,
In England
1. Getting in touch with us to let us know about your
problem here
2. Writing to your local MP
3. Writing to your local Clinical Commissioning Group
(CCG). Commissioners have a statutory duty to take
account of public demand for services and this is a
simple way to make your voice heard.
4. Attending public meetings -some CCGs hold public
consultations when reviewing IVF commissioning,
Fertility Fairness regularly posts updates about these on
our website.
5. Letting us know if you are prepared to speak to the
media. By raising awareness you will help stop decisionmakers ignoring the needs of people with fertility
problems. For more information see here.
In the Devolved Nations
1. Getting in touch with us to let us know about your
problem here
2. Writing to your local MSP, AM or MLA.
3. Letting us know if you are prepared to speak to the
media. By raising awareness you will help stop decisionmakers ignoring the needs of people with fertility
problems. For more information see here.
I am currently undergoing, or trying to gain access to, fertility
treatment. What support is available for me?
Infertility Network UK, an associate of Fertility Fairness,
offers helplines, information and support groups for those
suffering from fertility problems.
For more information on the help available see here.
I cannot access fertility treatment on the NHS, what are my
other options?
Across the UK if fail to meet the access criteria, you may be
able to gain treatment through an Individual Funding Request.
This possibility should be discussed with your GP who would
need to nominate you, however these are often subject to
‘clinical exceptionality’ requirements which can be very
difficult to meet.
For those who can afford it then treatment in the private sector
is another option. The details of all providers can be found
here on the HFEA website.
In England, if you have been denied fertility treatment in your
local area please let us know and we can help you to contact
your MP and local CCG to emphasise the importance of
commissioning fertility services. For more information see
here.