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

The Referral Process

Initial assessment

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 Guys and St. Thomas’ Hospital and Kings College London Hospital.

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/IUI 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.

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 IUI/IVF/ ICSI is indicated for Bromley couples.

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 IUI/IVF/ICSI may be considered for assisted conception such as:

• In-vitro fertilisation (IVF) or
• Intracytoplasmic sperm injection (ICSI)/
• Intrauterine insemination (IUI)

Who can have IVF/IUI/ 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.

Eligibility

The key criteria about eligibility for infertility treatments are as follows:

Fertility treatment will only be offered to couples where the following criteria are met:

• Where there are no living children in the current relationship.
• Where neither partner has children from previous relationships.
• 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.
• Have had unexplained infertility for at least 3 years, taking into consideration both age and waiting list times.
• Persons aged under 23 years old will be considered for treatment where medical investigations have confirmed that conception is impossible without fertility treatment, e.g. following unsuccessful fallopian tube surgery.
• Neither partner should have had more than 2 previous Intrauterine insemination (IUI)/IVF/ICSI attempts (either NHS or privately funded).
• Neither partner should have had any previous NHS funded attempts at IVF or ICSI and not more than three NHS funded attempts at IUI. 
• Women will be only considered for treatment if their BMI is between 19 and 30 (kg/m2).
• Couples should be non-smoking at the time of treatment. Couples who smoke should be referred to smoking cessation.

Additional Requirements

• No individual (male or female) can access more than the number of NHS funded fertility treatments under any circumstances, even if they are in a new relationship.
• There must be no other medical problems making the chance of success less than 20%.
• Women with the BMI>30 should be referred to the appropriate obesity management pathway. 
• IVF cannot be used as a substitute for reversal of sterilization.
• There should be no problems with signing a form concerning the welfare of the child.
• This service will be only be available at agreed providers and will include all clinically prescribed drugs.

Eligible couples will be offered:

• 3 cycles of IUI or
• 1 full cycle of IVF +/- ICSI

Where the eligibility criteria are not met but NHS clinicians feel there are exceptional clinical reasons, a case should be referred to the Individual Funding Requests Panel for consideration.

*NICE Guidance (CG 156, Feb 2013) has been noted but, due to resources prioritisation, assisted conception will continue to be funded according to the current criteria

Chances of success
The chance of a live birth following infertility treatment is:

• 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**

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.  

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