Assisted conception funding

Infertility services in Bromley

Infertility is when a couple cannot get pregnant, despite having regular unprotected sex.  Around one in seven couples may have difficulty conceiving.

Some women get pregnant quickly, but for others it can take longer. It is a good idea for a couple to visit their GP if they have not conceived after a year of trying.   Women aged 36 and over and anyone who is already aware they may have fertility problems should see their GP sooner.  The GP can check for common causes of fertility problems and suggest lifestyle changes or treatments that could help. You can read more on www.nhs.uk

What treatment is available?

Investigations, diagnosis and conservative treatments for infertility are routinely available on the NHS. Types of fertility treatment available in primary or secondary care include:

• Advice on lifestyle changes to aid a natural conception such as weight loss and smoking cessation.
• Medical treatment for lack of regular ovulation.
• Surgical procedures – such as treatment for endometriosis.

If infertility is diagnosed, or after all treatments and recommended lifestyle changes have been tried and infertility remains unexplained, a referral to an Assisted Conception Unit for IVF / ICSI may be considered for assisted conception such as:

• In-vitro fertilisation (IVF) or
• Intracytoplasmic sperm injection (ICSI).

Who can have IVF / ICSI on the NHS in Bromley?

NHS Bromley Clinical Commissioning Group has a Treatment Access Policy (TAP) which sets out the treatments funded by the local NHS.   This is a shared policy with other CCGs in south east London (SEL) and has been approved by our Governing Body.   Having a shared policy ensures that there is equality of treatment across south east London.

The SEL TAP includes the arrangements for funding treatment for infertility and states that one cycle of treatment (IVF/ICSI) is available for eligible couples.   You can read more in the policy and full list of eligibility criteria for NHS funding of infertility treatment here. The key criteria about eligibility for infertility treatments are as follows:

• Couples should be living together and in a stable relationship. 
• The partner who is to receive treatment must be aged between 23 and 39 years old (up to 39 years and 364 days) at the time of treatment. 
• Couples who have been diagnosed as having male factor or female factor problems or have had unexplained infertility for at least 3 years, taking into consideration both age and waiting list times. 
• Women will only be considered for treatment if their BMI is between 19 and 30 
• Couples should be non-smoking at the time of treatment. 
• Fertility treatment will only be offered to couples where the following two criteria are met: 
• where there are no living children in the current relationship
• Where neither partner has children from previous relationships. 
• The female partner should not have had any previous NHS funded attempts at IVF or ICSI and not more than three NHS funded attempts at IUI. 
• Eligible couples will be offered: 3 cycles of IUI, and / or 1 full cycle of IVF +/- ICSI. 

Where is infertility treatment delivered and how are referrals made?

When appropriate, the GP may opt to refer a couple to a local NHS consultant for routine investigations, treatments, and surgery. For Bromley couples this secondary care is likely to be delivered at the Princess Royal University Hospital in Orpington. Once couples have gone through the primary and secondary care sub-fertility pathways appropriate to them and an NHS consultant has deemed them clinically ready for IVF / ICSI the hospital will facilitate an onward referral to an Assisted Conception Unit (ACU) where the couple will complete their treatment. Staff at the Assisted Conception Unit will assess a couple’s eligibility for NHS funding at initial appointment and advise them on next steps.

Bromley couples have a choice between the ACU at Guy’s and St Thomas’ Hospital, at London Bridge, and the ACU at King’s College Hospital, at Denmark Hill. There is a close link between the departments at PRUH and Denmark Hill as those sites are managed by the same King’s College Hospital NHS Trust and referral and information sharing will be straightforward. However, offering choice to patients is important to commissioners and Bromley CCG has a longstanding partnership with the ACU at Guy’s and St Thomas’ Hospital. The team at the PRUH should facilitate onward referral to the ACU at Guy’s should the couple take this option.

Couples are advised to research the relevant provider websites for outcome details and visit their preferred provider unit before making their informed choice. Impartial information about the clinics can be found using the Human Fertilisation & Embryology Authority website https://www.hfea.gov.uk/

The CCG acknowledge that some couples will be referred for their routine fertility investigations and treatments to hospitals closer to home but which are situated in neighbouring boroughs. However, out of area hospitals should also facilitate an onward referral to an ACU (or an internal referral if that hospital is Guy’s or King’s) when IVF / ICSI is indicated for Bromley couples. A referral back to GP or contact with the CCG is not required if the couple opt for an ACU at Guy’s or King’s. This is because staff at the Assisted Conception Units will assess a couple’s eligibility for NHS funding on the CCG’s behalf and communicate with the CCG when matters arise.

If the ACU a couple wishes to be treated at is not situated at either Guy’s or King’s then the treating ACU administrative team should contact the CCG for prior approval at BROCCG.fertilityfundingrequests@nhs.net The referring ACU should complete, on behalf of the couple, the Bromley CCG Eligibility Checklist for Fertility Funding (download below) and a case by case decision will be taken by the CCG.

Bromley CCG will only fund IVF / ICSI for eligible couples referred by an NHS consultant to be treated by an NHS provider of assisted conception.

Chances of success

The chance of a live birth following infertility treatment is consistent for the first three cycles of treatment, but the effectiveness after three cycles is less certain*

However, the most significant factor affecting the chances of a live birth following infertility treatment varies with female age and the optimal female age range for invitro fertilisation is 23-39 years.   Chances of a live birth per treatment cycle are:

• greater than 20% for women aged 23-35 years
• 15% for women aged 36-38 years
• 10% for women aged 39 years
• 6% for women aged 40 years or older* 

*NICE: Fertility: assessment and treatment for people with fertility problems, 2013

Where can I find out more?

If you are registered with a Bromley GP Practice and seek further advice about the eligibility criteria for NHS funding of infertility treatment and the South East London Treatment Access Policy contact Bromley CCG on 0203 930 0100. or email BROCCG.fertilityfundingrequests@nhs.net

There is more information on the NHS choices website at www.nhs.uk and at the UK Fertility Network at www.fertilitynetworkuk.org