NHS Funding in Wales

In Wales, two full cycles of NHS fertility treatment are currently funded and access criteria are standard across the country.

Historically waiting lists have been lengthy due to the lack of clinics approved by the Welsh Government to provide NHS treatment. More recently however waiting times have reduced.

A specialist services policy was developed for the planning of Specialist Fertility Services for Welsh patients. The policy applies to residents of all seven Health Boards in Wales – view policy

The document:

  • Sets out the circumstances under which patients will be able to access Specialist Fertility services;
  • Clarifies the referral process; and
  • Defines the criteria that patients must meet in order to access treatment

On the 1 April 2010 the entitlement was increased from one full cycle of IVF to two for all women who meet the WHSSC access criteria, with the exception of Armed Forces Compensation Scheme (AFCS) recipients who are entitled to three cycles (see 3.2.9). A cycle includes one fresh and one frozen embryo transfer.

  • In-vitro fertilisation (IVF)
  • Intra-cytoplasmic sperm injection (ICSI)
  • Donor insemination
  • Surgical sperm retrieval methods including:
  • Egg, sperm, embryo and gonadal tissue cryostorage and replacement techniques
  • Other micro-manipulation techniques
  • Egg donation where no other treatment is available
  • IVF surrogacy

Intra-uterine insemination (IUI) is not funded by WHSSC. Funding for IUI is the responsibility of the Health Boards. Where donor sperm is needed to undertake IUI, the donated sperm will be funded by WHSSC, but not the IUI procedure.

Waiting Times

First cycle of IVF/ ICSI

Patients with unexplained fertility who are waiting for IVF/ICSI treatment can expect to wait between 12 and 18 months for treatment. The normal waiting times targets do not apply to IVF treatment for clinical reasons. Patients presenting for their first IVF/ ICSI cycle must wait for a minimum of 12 months before treatment as many will conceive normally during this period, and a maximum of 18 months.  This is applied by all the providers providing a service to Welsh patients. Couples can be expedited before the twelve month waiting time if there is clinical justification for doing so. Clinics should have a robust documented process for expediting treatment.

Second cycle

Patients presenting for their second cycle will not be treated as a new referral and will not be required to wait the mandatory 12 months.

Criteria for Treatment

Female Age

Women who are aged less than 40 years and who meet the access criteria are entitled to two cycles of IVF with or without ICSI. However if the woman reaches the age of 40 during the first cycle of treatment they will not be entitled to a second cycle of IVF.

Women aged between 40 and 42 years who meet the access criteria are entitled to one cycle of IVF with or without ICSI provided the following 3 criteria are also fulfilled:

  • They have never previously had IVF
  • There is no evidence of low ovarian reserve
  • There has been a discussion of the additional implications of IVF and pregnancy at this age

Existing Children

IVF on the NHS is available for couples who do not have any living children (biological or adopted) or where one of the partners does not have any living children (biological or adopted). For single women/men – that the woman/man does not have any living children (biological or adopted).

Body Mass

The couple/single woman must have a body mass index of between at least 19 and up to and including 30. Couples/single women outside this range will not be added to the waiting list.

Sterilisation

Sub-fertility is not the result of a sterilisation procedure in either partner/single woman (this does not include conditions where sterilisation occurs as a result of another medical problem). Couples/single women who have undertaken a reversal should not be referred for treatment.

Smoking

Where either of the couple/single woman smokes the patient is not eligible. Only couples/single women who agree to take part in a supported programme of smoking cessation will be accepted on the IVF treatment waiting list and must be non-smoking at time of treatment.

History of previous treatment

For single women, three or more IVF cycles by a female patient will exclude any further NHS IVF treatment. For couples, three or more IVF cycles by either partner will exclude any further NHS IVF Treatment. Previous cycles whether NHS or privately funded will be taken into account.

Subfertility

Subfertility must be demonstrated before there can be access to NHS funded IVF treatment. Subfertility for heterosexual couples is defined as inability to conceive after 2 years unprotected intercourse or a fertility problem demonstrated at investigation. Subfertility for same sex couples/single women is defined as no live birth following insemination at or just prior to the known time of ovulation on at least five non-stimulated cycles or a fertility problem demonstrated at investigation.

For single women/same sex couples, the non-stimulated cycles may be a achieved through a private arrangement or through NHS-provided IUI with donor sperm.

IVF for Veterans

Armed Forces Personnel who have become infertile as a result of military action and are Armed Forces Compensation Scheme (AFCS) recipients are entitled to 3 full cycles of IVF treatment. All applications for this should be forwarded to Welsh Health Specialised Services via the All Wales IPFR process for consideration in line with guidance from the Independent Medical Expert Group.

If you are struggling to access NHS treatment, have been told you are not eligible by your GP or clinic, you can write to your Health Board to appeal against the decision. We have written some template letters which you may find helpful and which you can personalise to suit your circumstances. You could also copy your letter to your MP or write separately to him/her – visit our campaign section for more details of our campaign for fairer access to NHS fertility treatment.

Template letter to Health Board Wales to request funding

Template letter to Health Board Wales to appeal following refusal of funding