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
- 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 Welsh health Specialised Services Committee (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:
- micro-epididymal sperm aspiration (MESA);
- testicular sperm extraction (TESE); and
- percutaneous epididymal sperm aspiration (PESA)
- 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.
First cycle of IVF/ ICSI
Following referral into specialised fertility services patients should be offered an outpatient appointment within the 26 week referral to treatment target. As the normal waiting times targets do not apply to IVF treatment for clinical reasons the referral to treatment clock is stopped at the first attended outpatient consultation.
Patients with unexplained infertility will only be listed for IVF, with or without ICSI, treatment if it is demonstrated that the couple have not conceived after 2 years (this can include up to 1 year before their fertility investigations) of regular unprotected sexual intercourse.
Couples must have been cohabiting in a stable relationship for a minimum or 2 years.
Same sex couples/single women/single men with unexplained infertility will only be listed for IVF, with or without ICSI, treatment if it is demonstrated that they have not conceived following insemination at or just prior to the known time of ovulation on at least six non-stimulated cycles.
Patients presenting for their first IVF/ICSI cycle must wait for a minimum of twelve months before treatment as many will conceive normally during this period. This is applied by all the clinics providing a service to Welsh patients.
Couples can be expedited before the twelve month waiting time if there is a clinical justification for doing so (see CP38 doc section 3.1). Clinics should have a robust documented process for expediting treatment.
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
Due to the associated risks with teenage pregnancies patients will need to be at least 20 years old to access IVF treatment. 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 (up to their 43rd birthday) 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
Men must be aged 55 years or younger in order to access IVF treatment.
IVF on the NHS is available for:
(1) Couples where one of the partners does not have any living children (biological or adopted).
(2) Single women or men who do not have any living children (biological or adopted).
Women accessing IVF treatment must have a body mass index (BMI) of between at least 19 and up to and including 30. Female patients with a BMI below 19 that are ovulating normally may be treated at the discretion of the treating clinician.
Patients outside this range will not be added to the waiting list and should be referred back to their general practitioner for management where required.
Sub-fertility is not the result of a sterilisation procedure in either partner/single woman/single man (this does not include conditions where sterilisation occurs as a result of another medical problem). Couples/single women/single men who have undertaken a reversal should not be referred for treatment.
Where either of the couple/single woman/single man smokes the patient is not eligible. Only patients 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 patients, three or more IVF cycles by the 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 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/single men is defined as no live birth following insemination at or just prior to the known time of ovulation on at least six non-stimulated cycles or a fertility problem demonstrated at investigation.
For same sex couples/ single women/single men, the non-stimulated cycles may be achieved through a private arrangement or through NHS-provided IUI with donor sperm.
Change of partner whilst waiting for IVF treatment
If a couple consent to treatment but during the waiting period for treatment the couple break up then treatment cannot commence. If one or both of the partners wish to proceed with treatment with either a new partner or by themselves then the clinic that is providing the treatment needs to be notified. The new couple/individual will need to attend a consultation where the fertility history of the couple/individual needs to be reviewed, treatment options explained and discussed and if the couple/individual still meet the eligibility criteria consent to proceed with treatment.
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.
Putting things right – raising a concern
If you have been told that you do not meet the criteria for treatment and are unhappy with the decision then you will need to provide further information to your clinician. If the referring clinician believes that there are exceptional clinical grounds for treatment then an Individual Patient Funding Request (IPFR) can be made to WHSSC demonstrating exceptionality. The IPFR application form and accompanying information can be found here.
The request will then be considered by the All Wales IPFR Panel.
If you are not happy with the decision of the All Wales IPFR Panel then you have a right to ask for this decision to be reviewed. The grounds for the review, which are detailed in the All Wales Policy: Making Decisions on Individual Patient Funding Requests (IPFR) must be clearly stated. The review should be undertaken, by your Local Health Board (LHB).
If you are unhappy with the care provided during treatment or the clinical decision to withdraw treatment provided under this policy, you should be guided to the LHB for NHS Putting things Right
For services provided outside NHS Wales you should be guided to the NHS Trust Concerns Procedure, with a copy of the concern being sent to WHSSC.