Is GP care for IVF patients declining? We think it is. The NHS postcode lottery, tighter criteria for treatment (a third of GPs don’t want to fund IVF at all) and an increasingly obstructive attitude are creating a difficult environment. While most of our fertility patients are well looked after by their GPs, a growing number report sub-standard care.
It all went wrong when GP commissioning groups replaced PCTs. Putting doctors in charge of the purse strings should have made things better for IVF patients. Doctors understand infertility and are more compassionate and proactive, right? Wrong. 20 per cent of the 212 GP consortia still completely ignore NICE guidelines recommending three cycles of IVF treatment to qualifying women under 40. Many consortia place arbitrary and unfair obstacles in the way. Smoker? No treatment. Existing child? Can’t help. Partner has a kid? Terribly sorry. Overweight? There’s the door.
What’s going on? Fertility patients cost the NHS billions of pounds less than obesity, diabetes and alcohol-related illness. GPs should be helping would-be mums in their hour of need, not turning them away. Even when women do manage to get a round of IVF on the NHS, clinic standards in the UK vary enormously. See the wide regional variation in success rates on the HFEA website.
Surely GPs aren’t allowing a culture of hostility towards IVF patients to affect them? That erodes quality of care, not just funding. Several of our patients have been refused pregnancy blood tests and post-treatment scans. Home pregnancy tests will do, they were told. Wrong – that’s medical negligence. Consecutive blood tests and an early scan at 6.5 weeks look for ectopic and multiple pregnancies, more common after fertility treatment. Multiple pregnancies are risky. Ectopic pregnancies can kill.
We’ve had feedback on other GP shortcomings. One doctor had never heard of thrombophilia screening. Another wanted to charge for karyotype (genetic) testing. A third didn’t know what reproductive immunology was. As for our donor-egg patients, while many nurses in GP surgeries will happily administer their depot injection at the start of treatment, some won’t. When challenged, their GP colleagues down the corridor say they’ve never heard of the injection. All they had to do was look it up.
Lack of understanding about fertility treatment is common among GPs. Take pre-treatment blood tests. If GPs agree to pay for them, and manage to schedule them at the right time in your cycle (don’t count on it), they frequently request too few tests. FSH and LH aren’t enough, but are often the norm. (A proper hormone profile should also include TSH and Prolactin.) And most GPs have never even heard of AMH – the best ovarian-reserve test of all. Mid-cycle transvaginal scan? You’d be lucky. If NHS GPs don’t know the key fertility tests, what’s the point of funding a later IVF cycle?
Here’s another fertility procedure GPs won’t fund: the Harmony Test, or non-invasive pre-natal (NIPN) test. Fertility patients are often older. The chance of their baby having a chromosomal abnormality, like Down’s syndrome, is higher. The Harmony Test is 99% accurate at detecting such problems. It removes the need for invasive procedures like CVS and amniocentesis, both miscarriage risks. Those tests are probably more expensive to the NHS than the NIPN test. So it makes financial sense for GPs to refer older IVF patients for this test. Stop press: this might happen soon.
Some NHS GPs hate patients going abroad for IVF treatment. Thankfully, they’re rare. This kind of ignorant discrimination is unacceptable. It makes no sense for the following reasons. First, patients only go abroad because the NHS won’t fund them and UK private clinics are too expensive. Second, self-funded private treatment saves the NHS money – so GPs should be happy. Third, the same strict fertility laws apply across the EU – so patients are just as safe at registered fertility clinics in other member states. Fourth, success rates and care standards are higher at many clinics abroad.
NHS GPs are failing IVF patients. It’s time for them to grow up. Far from being a burden on the state, fertility patients don’t cost the NHS that much. Infertility is a disease (fact). Patients need respect, cooperation and access to the best treatment and care. If GPs won’t provide it, we may need legislation to force them to.
7 Responses
It’s sad to read this, but I know it’s true. I’ve been there myself. Even if I fit all their criteria (NICE guidelines recommended criteria) I was still not offered IVF in England. I was told to ‘keep trying’. What’s the point in keeping trying when the private tests I paid for says it’s highly impossible for me to have a baby? But. I don’t blame the GPs who are overworked and have 3 minutes per patients. I blame the overarching health system which is crumbling due to poor decision-making, civil servants’ ignorance and other political priorities and power hungry individuals that want to set their own agenda.
It’s sad to read this, but I know it’s true. I’ve been there myself. Even if I fit all their criteria (NICE guidelines recommended criteria) I was still not offered IVF in England. I was told to ‘keep trying’. What’s the point in keeping trying when the private tests I paid for says it’s highly impossible for me to have a baby? But. I don’t blame the GPs who are overworked and have 3 minutes per patients. I blame the overarching health system which is crumbling due to poor decision-making, civil servants’ ignorance and other political priorities and power hungry individuals that want to set their own agenda.
I’ve just experienced this myself and I’m so angry & upset.
After failed IVF on the NHS, miscarriages and 10 years of trying for our first at age 45 i paid for private treatment in Spain. It worked I’m just 4 weeks pregnant but my doctor surgery is refusing to help me with the support drugs I need. progesterone & oestrogen which are cheap drugs & available on the NHS. I ran out of meds and the doctor phoned me saying they couldn’t give me them or treat me. That I should go back to my private clinic or try somewhere else! I’m absolutely appalled after 10 years of trying I’m finally pregnant and my GP is making my life stressful! I ended up paying for a private script at Asda pharmacy who offer the drugs at cost price! Surely now am actually pregnant I’m entitled to free prescriptions!!!!
I hope this isn’t the start of more discrimination against ivf and private last resort patients!
Hi Beth , could you give me some advice about Spain ? My GO has monumentally failed me. 3 years , 3 miscarriages in the first 1.5 year and not able to her pregnant after for another 1.5. Now I’m turning 40 in a month. She never mentioned the NICE guidelines ti me of 3 free ivf course in the U.K. before 40. I’m heartbroken from this lack of care.
I’ve just experienced this myself and I’m so angry & upset.
After failed IVF on the NHS, miscarriages and 10 years of trying for our first at age 45 i paid for private treatment in Spain. It worked I’m just 4 weeks pregnant but my doctor surgery is refusing to help me with the support drugs I need. progesterone & oestrogen which are cheap drugs & available on the NHS. I ran out of meds and the doctor phoned me saying they couldn’t give me them or treat me. That I should go back to my private clinic or try somewhere else! I’m absolutely appalled after 10 years of trying I’m finally pregnant and my GP is making my life stressful! I ended up paying for a private script at Asda pharmacy who offer the drugs at cost price! Surely now am actually pregnant I’m entitled to free prescriptions!!!!
I hope this isn’t the start of more discrimination against ivf and private last resort patients!
I started trying at 36 after treatment for endometriosis (which took 15 years of complaining and eventually took a private doctor to have a 5 minute conversation to give me a name for the pain I’d been going through all that time but that’s another story) My private dr told me to go to the GP if I didn’t conceive after 6 months.
So I followed that and I then went through 5 years of poorly timed blood tests, Told we tested at the wrong time for over a year, then It could be menopause but the test doesn’t show it. A month later I was told the test did show signs, but no one seems to be able to give me a straight answer! only that we have to have these tests for them to consider me as a candidate. I went through so many humiliating std tests, blood tests, ultrasounds and internal examinations which surely all add up! finally went and got a referral from my original private dr (who was very annoyed I hadn’t received help sooner) this year only to be treated terribly at the clinic and made to feel stupid, I was asked why I didn’t get there sooner and told I was too old for help on the nhs.
I am broken, they weren’t willing to entertain any hormonal treatment and did not give me any confidence that what they were offering would work and spoke about donor eggs from the start. I was so excited to get help and I came away in tears. I’ve been so stressed and depressed since and I’ve been terrified to try as cost wise it may be my only shot and the GP made it very clear that stress will impact my ability to conceive.
I feel like they led me on for 5 years and now after speaking to the clinic I’ve almost lost all hope.
I feel like repeated poor decisions have now ruined my chance of a natural pregnancy, when 5 years back if someone was paying attention maybe hormonal treatment may have worked. Or at least I would have known sooner and been young enough to make an educated choice.
I’ll add that all the way through this I inquired about egg freezing and was assured I “didn’t need to worry about that now”
So much bad advice, so much heartache. I really hope things change even if it’s not for me. I wouldn’t wish this treatment on anyone, I feel like my menstrual health and fertility have stolen half of my life, be it through the years of pain or the depression and isolation. That’s time I’ll never get back.
Reading this and it hits home hard, was trying for 4 years to conceive with underactive thyroid and pcos getting in the way was difficult to conceive, asked the gp for help over and over and got no where, eventually got referred to hospital for ivf, waited 6 months for an appointment, had assessment bloods taken egg reserve extremely high for my age I’m 42 years old, but on the next part of the ivf journey video call with the doctor said only way i would conceive would be through ivf and not naturally but then went onto say I don’t fit the criteria due to my age and that I have a child from previous relationship, my world came crashing down and my hopes dashed, I do think all this nhs funding should be addressed before any type of bloods etc are taken as its building the hopes up in couples just to be dashed and torn away when it comes to the next step of treatment, I now feel like I’m back at square one with no hope of ever conceiving and no help from gp’s either