‘Everyone should have equal access to fertility treatment, no matter where they happen to live’

One of the guiding principles of our work at Fertility Network UK has been our belief that everyone should have equal access to fertility treatment, no matter where they happen to live. We would like to see the guidance set by the National Institute for Health and Care Excellence (NICE) followed across the UK and for everyone who is eligible to get the medical help they need.

The NICE guidance is based on detailed research looking at the most effective way to care for those with fertility problems. A group of experts in the field worked with NICE, alongside patient representatives. Following careful analysis, NICE concluded three full cycles of IVF was what should be offered to eligible patients of 39 and under, and one full cycle to eligible patients of 40 to 42. NICE guidance looks at the price of treatment too, and health economists analysed the costs and benefits to make sure that this would be cost-effective as well as clinically effective.

England: a complete postcode lottery

The NICE fertility guideline was published in 2013, but sadly many patients are still not able to benefit from this expert guidance. In England, there is a complete postcode lottery where individual areas make their own rules about how much fertility treatment should be available. Both Wales and Northern Ireland have national policies on fertility treatment, but it’s only in Scotland that NICE guidance is currently followed.

In England, it’s not just the number of cycles available which differs from one area to another. Some of those who commission treatment have decided to redefine what counts as an IVF cycle, so people get a set number of embryo transfers instead of a full cycle (which includes as many frozen transfers as necessary). A variety of different rules are used to decide who can have treatment too, so some areas have set their own age guidance or won’t allow treatment when one partner has a child from a previous relationship.

A commitment to improve access for some

The recent Women’s Health Strategy addressed some areas of inequality in current provision, making a commitment to remove additional barriers to IVF for female same-sex couples. It stated that there would no longer be a requirement for them to pay for IUI privately to prove their fertility status. It also promised to remove non-clinical criteria used to restrict access to fertility treatment, such as one partner having a child from a previous relationship. The aim is to create more equality in access to fertility services. It wasn’t clear from the Strategy when these changes might be implemented.

Sadly the Strategy didn’t give much guidance on what could be done to address the postcode lottery itself, but did state a commitment to ensure “greater transparency” by exploring mechanisms to publish data on the provision of IVF across the country. Knowing your local area is very poorly served when it comes to IVF doesn’t do much to help you if you need fertility treatment.

Fertility Network working to ensure patients’ views are heard

Current changes in the way the NHS is structured with areas coming together to commission treatment means some have been reviewing their fertility policies to align them. Recently we’ve been delighted to work with commissioners in North Central and also North East London to help them to ensure patient views are part of their considerations. In North Central London, we were part of the Fertility Policy Steering Group and helped to ensure patient views were taken into consideration at every stage of the policy development. Interestingly, both areas have come up with policies which look set to improve the care offered to fertility patients.

We always want to ensure that patient involvement is meaningful rather than just ticking a box to claim that patients have been “consulted”. It is important that the views of patients and experts in the field are taken into consideration when reviews take place. They give insights into what really matters and what commissioners need to consider.

Fertility policy reviews & how we can help

At Fertility Network we’re always keen to work with those looking at fertility policy reviews, and welcome approaches from local commissioners who want meaningful engagement with their local patient communities. It’s very clear that when commissioners look carefully at the evidence, and talk to experts, patients and local people, the overwhelming conclusion is that they move closer to what NICE recommends, which is something Fertility Network UK would very much welcome.

Further info on NHS funding in the UK is available here.