17 December 2015
Article by Megan Jones, National Assembly for Wales Research Service
In vitro fertilisation (IVF) is an assisted conception technique that can help those with fertility problems to have a baby.
IVF involves removing eggs from the ovaries and fertilising them with sperm in a laboratory. One or more fertilised eggs, or embryos, are then placed into the woman’s womb to grow and develop. ‘In vitro’ refers to the glass container in the laboratory where fertilisation takes place – hence the term ‘test tube baby’.
The NHS funds a limited amount of IVF treatment for eligible patients and this blog post relates to that NHS funded IVF treatment. Patients unable to access NHS funding, or who plan to pay for their own treatment, have the option of approaching private fertility clinics.
Cardiff University School of Medicine reports that infertility currently affects around one in six couples, and it is estimated that one in three sperm that are currently injected during IVF fail to stimulate the egg.
The last three years have seen a year on year increase in the number of patients accessing IVF treatment on the NHS in Wales.
According to figures published in July 2015 by the Health Minister, Mark Drakeford, in response to a written question by Darren Millar, the number of patients accessing both first cycle and second cycle IVF treatment in Wales has increased significantly since 2012/13.
The National Institute for Health and Clinical Excellence (NICE) issued updated guidelines in February 2013 to the NHS on assessing and treating people with fertility problems.
The guidance states that couples may be eligible for up to three cycles of IVF treatment on the NHS if:
- the woman is under 40 years of age at the time of treatment; and
- has not conceived after two years of regular unprotected intercourse.
If the woman reaches the age of 40 during treatment, the current cycle will be completed, but no further cycles will be offered.
Furthermore, the new guidance published in February 2013, extends the age range of women who may be offered fertility treatment. If a woman aged 40–42 years has not conceived after two years of regular unprotected intercourse, she will be offered one full cycle of IVF, provided the following three criteria are met:
- she has never previously had IVF treatment.
- there is no evidence of low ovarian reserve.
- there has been a discussion of the additional implications of IVF and pregnancy at this age.
The NICE guidelines only cover clinical criteria, and an All Wales Assisted Fertility Working Group has considered and developed additional social criteria. The access criteria for IVF in Wales were put in place in July 2005, with the aim of ensuring a fair and consistent service across Wales. An updated commissioning policy for specialist fertility services was published by the Welsh Health Specialised Services Committee in October 2015. This sets out the full criteria for access to NHS funded specialist fertility services in Wales and the rationale behind these criteria. Eligible women in Wales are offered up to two cycles of IVF treatment on the Welsh NHS.
The access criteria include these elements:
- Female age: Women younger than 40 who meet the access criteria are entitled to two cycles of IVF treatment. Women aged 40-42 who meet the access criteria are entitled to one cycle of IVF treatment, provided they meet the three additional criteria for older women listed above.
- Existing children: For couples, they have no living children (biological or adopted) together, or where one partner does not have any living children (biological or adopted). For single patients, that the woman/ man has never had a biological or adopted child;
- Body mass: The patients must have a body mass index of 19 – 30. Patients outside this range will not be added to the waiting list;
- Sterilisation: Sub-fertility is not the result of a sterilisation procedure.
- Smoking: Where a patient smokes, only patients who agree to take part in a supported programme of smoking cessation will be accepted on the IVF treatment waiting list and must be non-smoking at time of treatment;
- History of previous treatment: For single patients, three or more IVF cycles by the patient will exclude any further NHS IVF treatment. For couples, three or more IVF cycles by either partner will exclude any further NHS IVF treatment.
- Subfertility: Subfertility must be demonstrated before there can be access to NHS funded IVF treatment. Subfertility for heterosexual couples is defined as inability to conceive after 2 years unprotected intercourse or fertility problem demonstrated at investigation. Subfertility for same sex couples or single patients is defined as no live birth following insemination at or just prior to the known time of ovulation on at least six non-stimulated cycles or fertility problem demonstrated at investigation;
- HEFA: Patients not conforming to the Human Fertilisation and Embryology Authority (HFEA) Code of Practice will be excluded from having access to NHS funded assisted fertility treatment.
Patients must satisfy all elements of the access criteria to qualify for treatment, though exceptional cases falling outside the criteria may be referred to a panel for review.