Survey of NHS fertility treatment across England shows inequalities;
fertility doctors set out social criteria access to treatment
29 Aug 2006
Unequal access to fertility treatment, poor planning to meet Government
targets, and no clear criteria for who should receive NHS-funded
fertility treatment; these are the findings of a survey by British
fertility doctors to be published in the journal Human Fertility in
September. In response, the British Fertility Society – the
organisation representing professionals working with assisted conception – has
issued a series of recommendations on social criteria for access
to NHS-funded fertility treatment.
The BFS surveyed fertility clinics in England to establish how
Primary Care Trusts are implementing the NICE guidance on fertility.
Two years after publication of the NICE guidance, the survey results
show a wide disparity of access to treatment, with little planning
on how to implement the guidance in full.
They also show PCTs apply a wide variation of social criteria
to determine who should qualify for fertility treatment, and the
BFS is setting out a recommendations on criteria such as previous
children, obesity, smoking, single-sex parenthood etc, to help
PCTs decide who should receive NHS-funded fertility treatment.
The survey found that:
- Number of cycles has increased, but there are still ‘black
holes’. Despite the NICE recommendations, 16% of clinics
report decreased support for fertility treatment.
- Only one cycle is offered in vast majority of cases. Only 9%
of respondents reported 2 cycles of treatment being provided.
- There is little indication of PCTs making any long-term plans
to implement the NICE guidance, and no reassurance that the full
guidance will be implemented (in contrast to Scotland)
- There is a wide disparity on the social criteria used for acceptance
onto an NHS-funded programme, especially as regards existence
of previous children, high BMI, smoking, etc. For example, half
of the clinics said that their PCT wouldn’t fund treatment
if either partner had had a child previously.
The British Fertility Society has written to every Primary Care
Trust in England and Local Health Board in Wales asking them to
meet government fertility targets, and setting out recommended
criteria for NHS funding of fertility treatment.
The BFS makes eleven recommendations on social criteria for NHS
treatment, including:
- Waiting times for treatment should be the same as for any other
medical condition
- No woman should be commence NHS funded treatment after the
age of 40
- Women who are obese must initiate a weight reduction programme
and those severely overweight (defined as having a BMI of 36
or more) should not receive treatment until their weight has
reduced.
- Single women and same sex couples should be treated the same
way as heterosexual couples
- If people have had children from a previous relationship, they
should not be excluded from access to NHS treatment
The recommendations will be published in full in the September
issue of the journal Human Fertility. A summary of the
recommendations is attached. Infertility Network UK, the main fertility
patient group, supports these recommendations.
Dr Mark Hamilton, Chair of the British Fertility Society, said:
Continued inequality of access to treatment is unacceptable in
a state-funded health service and the source of considerable distress
to a great number of people with fertility problems. We are presenting
the recommendations to the PCT’s and Local Health Boards
with the intention that they provide a basis for consistent application
of social as well as medical criteria for access to State funded
fertility treatment in England and Wales. They are similar to core
recommendations currently before the health minister in Scotland.
As Health Minister Caroline Flint pointed out in a recent letter
to PCTs, “the persistent inequality of provision is hard
to bear, and hard to understand for those affected”.
Lead author of the study, Mr Richard Kennedy (Coventry) said:
The results of this survey suggest that there is no sense of
any long term planning for the provision of fertility services
and provide no reassurance that full implementation of the NICE
guidance will be achieved as was recommended by the Secretary of
State for Health over 2 years ago. There is considerable disparity
across England and Wales in the commissioning arrangements relating
to a range of social criteria applied for acceptance into NHS fertility
programmes. If we are to see an end to inequity of access across
the United Kingdom there must be an explicit plan for the provision
of three fresh cycles of IVF and consistency in the criteria used
for NHS treatment. The criteria we propose, if adopted by all PCT’s
in England and Wales, would standardise access to treatment. We
must use the findings of this survey to pursue the goal of full
implementation of the NICE Guideline.
Notes for Editors
- This press release is taken from, Implementation of the NICE
Guideline – Recommendations from the British Fertility
Society for National Criteria for NHS funding of Assisted Conception.
Authors R Kennedy, C Kingsland, A Rutherford, M Hamilton, W Ledger,
to be published in Human Fertility in September. A pdf.
of the paper can be found at http://www.fertility.org.uk/news/documents/HumanFertilitypaper.pdf
- 64 licensed fertility clinics in England and Wales were surveyed
in May and July 2005. 37 of the 64 units replied; these units
were based in England.
- A summary of recommendations is attached.
The BFS has also issued a statement
on fertility, obesity and social values as a follow up
to this statement.
For more information: please contact the British Fertility Society press office
Summary of recommendations of
the British Fertility Society for national criteria for NHS funding
of assisted conception
Definition of infertility
In the
absence of an obvious pathological cause infertility is defined
as follows:
In the absence of any physical cause infertility is defined as
the inability to conceive despite regular unprotected sexual intercourse
over a period of at least 2 years.
Previous children
If the couple have no children
they should qualify for funding. If either partner has a child/children
from a previous relationship, but not the current relationship,
they should qualify for NHS funding provided there has been consideration
of the welfare of the child.
Where funds permit, couples, who already have a child from the
current relationship and who have involuntary infertility, should
receive funding, though childless couples should have priority.
Treatment in these cases should be provided on the same basis as
those with no children.
Age of female
No treatment cycle should be started
after female’s 40
th birthday; no patient place on the waiting list within 6 months
of the 40 th birthday but treatment funded up until the 40 th birthday
of the female partner; no age limitation on the use of frozen embryos
created during an NHS funded cycle carried out before the female
partners’ 40 th birthday.
Unexplained infertility
Unexplained infertility
should be treated by a phased approach according to the female
partner’s age and duration of infertility.
Age of male partner
Paternal age should not be
included in criteria for acceptance in NHS programmes.
Previous sterilisation
A history of sterilisation
in either partner will normally exclude a couple from NHS funding
of assisted conception or surgical reversal of male and female
sterilisation although there may be exceptional cases where funding
is agreed in these cases.
Weight
Women with a body mass index of < 19
and > 29 should be
referred for advice from a dietician, warned of the potential risks
in pregnancy, if appropriate, provided with access to exercise
advice and offered psychosocial support. NHS funding of their treatment
should be deferred until they demonstrate response to these interventions.
Assisted conception may be provided if the BMI is < 36.
Smoking
Smoking should not be an exclusion criterion
but patients who smoke should be given advice about its implications.
In addition, all smokers should be given the opportunity to be
referred to a smoking cessation programme.
Previous self funded treatment
NHS funding should
not be provided to those who have already received the number of
NHS funded cycles currently supported by their PCT. NHS funding
should be provided to those patients who have had previously self-
funded treatment irrespective of the number of cycles providing
the clinical circumstances warrant further treatment.
Same
sex couples and single women
Single women and same sex
couples should be eligible for up to six cycles of NHS funded
donor insemination treatment provided assessment of the Welfare
of the Child has been undertaken in line with the Human Fertilisation
and Embryology Authority Code of Practice, 2004. After failed
donor insemination treatment or in the presence of an indication
for IVF allocation of cycles should be on the same basis as for
heterosexual couples.
Waiting times
Commissioners should ensure that
waiting times for NHS referrals for infertility diagnosis and treatment
are consistent with national targets for other medical conditions.
BFS Executive Committee
July 2006
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