Fertility Fairness Audit
Male BMI and age, and other arbitrary criteria should not be used to ration access to NHS fertility services, says Fertility Fairness
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.’
Notes for editors
For media interviews with Fertility Fairness, contact Fertility Fairness co-chair Sarah Norcross on 07817-439180 or 020 7278 7870, or Fertility Fairness co-chair Aileen Feeney on 07966-395987 or firstname.lastname@example.org
For case studies, contact: Natalie Aminoff digital communications officer Fertility Network UK on 07507-708243 or email email@example.com
- National Institute of Health and Care Excellence (NICE) guideline recommends three full cycles of IVF for women under 40 years and one full cycle for women aged 40-42. According to NICE, a full cycle of IVF treatment should include one round of ovarian stimulation, followed by the transfer of any resultant fresh and frozen embryos.
- The Freedom of Information (FOI) audit was undertaken for Fertility Fairness by the charity, the Progress Educational Trust (PET). PET sent out Freedom of Information requests to 195 clinical commissioning groups in England in July 2018 and the data has been updated with any changes made up to 16 October 2018.
- 3.Scotland offers the IVF Gold Standard: three full IVF cycles for clinically eligible women under the age of 40, plus one full IVF cycle for women aged between 40-42, and provision if either you or your husband has a child from a previous relationship. Wales provides two full IVF cycles for clinically eligible women under the age of 40, plus one full IVF cycle for women aged between 40-42, and allows access to treatment if either you or your husband has a child from a previous relationship. Northern Ireland provides just one partial IVF cycle for women under 40 and allows access to treatment if either you or your husband has a child from a previous relationship.
- There last few years have seen sustained disinvestment in NHS fertility services in England. However, data from 2018 cannot be directly compared as the number of clinical commission groups (CCGs) in England varies: Fertility Fairness’ 2017 audit of CCGs was based on 208 CCGs; the 2018 audit is based on 195 CCGs.
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- #Scream4IVF is Fertility Network’s campaign for fair access to IVF in the UK. It asks the public to donate their #Scream4IVF on social media, and gives a voice to couples with fertility problems so that their frustrations can be heard. Fertility Network aims to collect 100,000 signatures in an online petition so that the issue of unfair IVF access can be debated at Westminster.
- Key findings of The Impact of Fertility Problems 2016 from Fertility Network UK with Middlesex University London highlighted: 90 per cent of respondents reported feeling depressed; 42% suicidal; nearly 50% of respondents reported on average feeling sad, out of control, frustrated, helpless, fearful and worried nearly all of the time. For further information, see http://fertilitynetworkuk.org/wp-content/uploads/2016/10/SURVEY-RESULTS-Impact-of-Fertility-Problems.pdf
- Fertility Week 29 Oct – 4 Nov seeks to change perceptions, provide support and raise funds for everyone struggling with fertility issues. http://fertilitynetworkuk.org/youarenotalone-fertility-week-29-oct-4-nov-2018/
- Fertility Fairness is a multidisciplinary umbrella organisation representing the major patient and professional bodies working in the field of fertility. Fertility Fairness campaigns for fair and equitable access to NHS-funded fertility services in accordance with national recommendations issued by NICE. This includes the right of eligible couples to receive up to three full cycles of IVF treatment regardless of where they happen to live.