Infertility and assisted conception

Infertility

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

You can read more about infertility at nhs.uk.

If you think you may need help conceiving, make an appointment with your GP to discuss your options.

Available treatments

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 for assisted conception treatment may be made.

The following assisted conception treatments are available on the NHS:

Eligibility

Not everyone is eligible for assisted conception treatment. Read section 6 of our policy to find out more about eligibility.

Where the eligibility criteria are not met but clinicians feel there are exceptional clinical reasons, cases can be referred to the Individual Funding Requests (IFR) panel for consideration.

Fertility preservation

Fertility preservation usually involves the harvesting and freezing of eggs or sperm that may be thawed for use in future assisted conception treatment.

It can also involve the creation of embryos for freezing that may be implanted in the womb later.

Eligibility

Fertility preservation is only available on the NHS to patients whose ongoing medical condition or treatment is causing, or is likely to cause, permanent harmful effects on sperm or egg production.

Read section 13 of our policy to find out more about eligibility.

FAQ

If you have concerns about your fertility, you should visit you GP in the first instance and they can advise what investigations you may need. Around 1 in 7 heterosexual couples may have difficulty conceiving. 84% of women in the general population will conceive within 1 year if the woman is aged under 40 years AND they do not use contraception and have regular sexual intercourse (every 2 – 3 days). This increases to 92% after 2 years and 93% after 3 years.

NHS South West London Clinical Commissioning Group has a policy which sets out eligibility criteria for Assisted Conception Treatments funded by the NHS.

The key eligibility criteria are as follows:

Commissioning status
The prospective mother must be a registered patient of a GP practice in SWL at the time of commencing on the ACT pathway. Patients already on the ACT pathway, who move to SWL and register with a GP practice in SWL will be treated in line with this policy.

Sub-fertility or infertility
Patient either has an identified cause of sub-fertility/infertility or have had 24 months of unexplained infertility. For single women or same-sex female couples this means 12 cycles of unstimulated IUI over at least 12 months.

Sterilisation  
Neither the patient or their partner, if they have one, should have undergone previous sterilisation.


Follicle Stimulating Hormone (FSH) level


Highest ever level of FSH taken between day two and five of the cycle must be less than or equal to 8.9iu/L.


Anti-Mullerian hormone (AMH) level


AMH level has always been equal or greater than 5.4pmol/l.

Childlessness
The couple have no living child from their current relationship and at least one of the prospective parents does not have any living children from a previous relationship. A child adopted by a patient or adopted in a previous relationship is considered to have the same status as a biological child.

Welfare of the child
Each patient and their partner, if they have one, must conform to the HFEA ‘Code of Practice’ to be able to access to NHS-funded ACT.

Age of woman
Prospective mothers must be aged no more than 42 years old (i.e. before their 43rd birthday) at start of the full IVF/ICSI treatment cycle. Please note that this policy only applies to adults only.

Body mass index (BMI)
Prospective mothers must have a BMI of between 19 and 30 for a period of at least six months prior to commencement of treatment.

Smoking status
Each patient and their partner, if they have one, must have been non-smokers for at least six months prior to commencement of treatment.

Alcohol and recreational drug use
Each patient and their partner, if they have one, must give assurances that their alcohol intake is within Department of Health guidelines and they are not currently using recreational drugs.

Number of IUI cycles of treatment
SWL CCG commissions up to 12 NHS-funded unstimulated IUI cycles for eligible patients. Please note that IUI for single women and same-sex female couples is not routinely funded.

Number of IVF/ICSI cycles of treatment
SWL CCG commission one NHS-funded IVF/ICSI cycle for eligible patients. Please note that patients who previously have had NHS-funded IVF/ICSI or those who have had more than two full cycles of IVF/ICSI either privately or NHS-funded will not receive any further NHS-funded IVF/ICSI.

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

SWL CCG will fund one full cycle of IVF/ICSI for eligible patients with proven sub-fertility. It will consist of one fresh embryo transfer followed by one Frozen Embryo Transfer (FET), if good quality embryos were frozen as part of the cycle. A successful fresh embryo transfer (in terms of a live birth) would make the couple ineligible for a FET.

Patients who had eggs or sperm frozen due to medical reasons (as per fertility preservation policy) will be eligible for two FETs, as in these circumstances a fresh embryo transfer is not available for them.

NICE recommends three cycles of IVF; however, SWL CCG will fund one cycle. The reason for this decision is that, within currently available resources, we wish to enable more individuals to have access to IVF treatments rather than place restricted entry to a smaller number of individuals who are offered three cycles of NHS-funded IVF.

Around one in seven couples may have difficulty conceiving.

84% of women in the general population will conceive within one year if the woman is aged under 40 years and they do not use contraception and have regular sexual intercourse (every 2 – 3 days). This increases to 92% after two years and 93% after three years.

If you do not meet the eligibility criteria in full, then SWL CCG will not fund your IVF treatment.

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

Yes, if the prospective mother has an identified cause of sub-fertility/infertility or has had 12 cycles of unstimulated IUI over at least 12 months.

No, they cannot as IVF would require a surrogate mother and surrogacy is not funded in England due to legal reasons. However, they are eligible for fertility investigations should this be required.

Surrogacy is legal in the UK but the Surrogacy Arrangements Act 1985 makes commercial surrogacy illegal.

The legal parentage remains with the mother carrying the child – regardless of whether the child is genetically related or not. If the host mother wishes to keep the child she has been carrying, it is her right to do so.

Therefore, the funding of surrogacy arrangements and associated conception treatments raises numerous legal and ethical issues which present significant risks to commissioners at present.

The UK government is currently undertaking a review of the current law on surrogacy, but at present the legal mother remains the person who gives birth to the child, which raises many legal questions around surrogacy.

The success rate of IVF depends on the age of the woman undergoing treatment, as well as the cause of the infertility (if it’s known).

Younger women are more likely to have a successful pregnancy. IVF isn’t usually recommended for women over the age of 42 because the chances of a successful pregnancy are thought to be too low.

No, you cannot claim back money for privately funded IVF treatments. However, if you meet the full eligibility criteria then you will be eligible for NHS funded IVF.

No, you cannot mix private and NHS-funded treatments.

If you are eligible for NHS funded IVF then all aspects will be paid for by the NHS. However, if you need a donor egg or sperm the costs associated with the procurement and transportation will have to be paid by you.

GPs can only undertake tests as described in the policy to investigate infertility.

Additional tests (e.g. anti-Mullerian hormone test, hepatitis B serology, HIV) and drug prescriptions are covered in secondary or tertiary care provider tariffs (package of care) and should not be undertaken by primary care.

This also includes requests from private providers, whether the treatment is NHS- or self-funded.

Prospective mothers who are EU passport holders are eligible for all treatments including IVF. There are no changes anticipated during the transition period for EU citizens, which currently runs until 31st December 2020.

As part of the negotiations the rights of EU citizens to NHS treatments including IVF will be determined.

Eligibility for IVF is determined by the commissioning status of the prospective mother. If the prospective mother must pay the immigration health surcharge, then she is not eligible for NHS funded IVF.

Amendments to the NHS (Charges to Overseas Visitors) Regulations 2015 were introduced into Parliament on 19 July 2017. As a result, from 21 August 2017, assisted conception services are no longer included in the scope of services.

Please check with your IVF provider to discuss next steps, as they are responsible for ensuring that services can be offered safely. Services are expected to resume soon after 11th May 2020, once appropriate safety measures are put in place.

There are several NHS providers in London you can go to for your IVF. You should speak to your doctor about which services to use or check the government regulator for services:

Before you can start treatment, your provider must have authorisation for your treatment from SWL CCG.