Fertility Fairness Audit
England’s clinical commission groups are rationing access to NHS fertility services by setting their own access criteria, including male body mass index (BMI) and age, according to latest figures released by campaign group Fertility Fairness at the start of Fertility Week 29 October – 4 November. These additional access criteria do not form part of the National Institute of Health and Clinical Excellence’s (NICE’s) fertility guidelines and should not be used to determine who can, or can’t, be referred for NHS IVF or ICSI.
Fertility Fairness’ 2018 audit of England’s 195 CCGs reveals that 27 per cent of CCGs now use a man’s BMI to determine whether a couple can be referred for NHS IVF. Fourteen CCGs (8 per cent) stipulate men must be aged below 55 in order to have NHS fertility treatment. A quarter of CCGs insist a woman’s anti-Mullerian hormone (AMH) level and/or antral follicle count (AFC) is at a specific level, and 91 per cent do not allow couples to access NHS IVF if one of the couple has a child from a previous relationship (social rationing).
As well as introducing extra ‘access to NHS IVF’ criteria, the vast majority of CCGs (87 per cent) ration NHS fertility services by refusing to provide the recommended clinically-effective and cost-effective treatment for infertility – three full IVF cycles:
- seven CCGs (3.6 per cent) have removed NHS IVF entirely (all are in the south)
- 40 per cent offer only one partial IVF cycle (transferring a finite number of embryos)
- 20 per cent offer one full IVF cycle (transferring all viable fresh and frozen embryos)
- 23 per cent offer two IVF cycles
- just 13 per cent of CCGs provide three IVF cycles
In the last two years, 30 CCGs (15.3 per cent) have slashed NHS fertility services, and one in ten CCGs is currently consulting on cutting or removing NHS fertility treatment.
Sarah Norcross, co-chair of Fertility Fairness, said:
‘It is shocking to see CCGs introducing their own ‘access to IVF’ criteria, as well as reducing the number of IVF cycles they offer. It is not the CCG’s job to decide the criteria for accessing NHS fertility services. NICE has accessed the evidence in its guideline and developed access criteria for NHS patients and they do not include male BMI, male age, a woman’s AMH level or whether or not a couple has a child from a previous relationship. What criteria will CCGs introduce next; star signs and shoe size? CCGs need to remove their extra ‘access to IVF’ criteria now.’
Consultant gynaecologist and Fertility Fairness committee member Raj Mathur, said: ‘Male age and BMI are not in the NICE guidance as criteria for IVF and there is no strong evidence of impact on clinical outcomes of IVF. AMH and antral follicle count are in the NICE guideline as predictors of ovarian response, but NOT as predictors of the chance of having a baby through IVF. Commissioners are making unjustified extrapolation in using them for rationing.’
Aileen Feeney, co-chair of Fertility Fairness and chief executive of leading national charity Fertility Network UK said:
‘Fertility Network is extremely concerned about the effect that reducing access to NHS IVF has on already distressed patients. Infertility is a devastating disease causing depression, suicidal feelings, relationship breakdown and social isolation; removing the recommended clinical help or making it harder to access is cruel and economically short-sighted. Access to NHS treatment should be according to medical need and not your postcode. We urge anyone affected to join Fertility Network’s #Scream4IVF campaign calling for fair access to NHS IVF in the UK; with your help we can reach 100,000 signatures and hold a debate on the issue at Westminster. Sign the petition at www.scream4IVF.org and share your #Scream4IVF during Fertility Week.’