According to government recommendations in the UK, infertile couples who meet the correct criteria and who have no children either from their current or a previous relationship, should be entitled to three cycles of IVF treatment paid for by the British National Health Service (NHS). Private IVF treatment is notoriously expensive and generally a last resort for infertile couples, therefore NHS-funded IVF is a lifeline for many couples struggling to get pregnant. The reality of IVF on the NHS, however, does not necessarily reflect these recommendations – the accessibility of treatment and the degree to which it is subsidised vary throughout the UK.
The Postcode Lottery
There has been much criticism in the media in recent years of the IVF ‘postcode lottery’. Different health trusts in different parts of Britain provide varying amounts of NHS-funded treatment. This means that if you live in a certain part of the country you might be entitled to three treatment cycles on the NHS, but in another area you might get only one. This clearly puts some infertile couples at a major disadvantage – fertility experts recommend at least three cycles of treatment per couple, as the chances of a pregnancy resulting from any one cycle are just 15 %. Some couples are therefore going into treatment knowing that this is a ‘one strike and you’re out’ situation, indeed possibly their very last chance of conceiving their own baby. This adds a lot a pressure to an already physically and emotionally stressful situation. Furthermore, if you are a taxpayer like anyone else, why should your address make you any more or any less entitled to NHS treatment?
The NHS Response
The National Health Service knows that the current provision of IVF is problematic and has been working towards harmonising its services and funding across the country. In August 2008, one quarter of all health trusts were offering the recommended three treatment cycles. NHS representatives have acknowledged that there is still a lot of work to be done.
Couples would usually be encouraged to visit the doctor if they have been having unprotected sex regularly for one year without getting pregnant. If this is your situation, no matter where you are in the country, you are entitled to an investigation into the root cause of your infertility. This starts with a visit to your General Practitioner (GP), who will probably refer you on to a fertility specialist. Be aware that if you are overweight, or a smoker, or you are making other lifestyle choices which may be impacting your fertility, your specialist is likely to give you some support in living healthily and send you away to implement some changes before recommending medical treatment for infertility. Of course, this depends on whether or not there is another physical reason for your infertility, such as blocked fallopian tubes.
The acceptance criteria for NHS IVF treatment vary from health trust to health trust, but here is a list of the basic requirements:
- The woman should be between 23 and 39 years old.
- The cause of the fertility problems should have been identified.
- If the reason for the infertility has not been positively identified, the couple should have been infertile for at least three consecutive years.
- The couple should not already have had children, either together or in previous relationships.
You have the option of going for private IVF treatment if you are not able to get a second or third IVF cycle on the NHS. According to Dr Francoise Shenfield of the University College Hospital in London, 75% of IVF cycles in the UK are carried out privately. This, however, is likely to cost you a lot of money. Private IVF clinics in the UK have been known to charge between 2,500 GBP and 8,000 GBP per treatment cycle. The price varies from clinic to clinic. You should make sure that clinic you choose has received a license from the Human Fertilisation and Embryology Authority (HFEA).
Recent reports have indicated that an increasing number of British women, particularly women over 39 (the cut-off age for NHS-funded IVF) are travelling to other parts of Europe, particularly Spain and the Czech Republic, for IVF treatment. These countries have laxer rules about the age of patients and embryo donation. If you are considering travelling abroad for IVF, bear in mind that foreign clinics may not be as closely regulated as British clinics. Some of these clinics may be prepared to implant a higher number of embryos than a British clinic would. While this may be tempting, particularly if you have travelled a long way and spent a lot of money, remember that the increased chance of a multiple pregnancy brings with it a higher risk of complications during pregnancy.