01 Mar The Great British IVF Robbery?
If you’re over 40, you may qualify for state-funded IVF. Or maybe not. The recently updated NICE guidelines on fertility treatment, non-legally binding and ignored by most GPs, recommend that women aged 40 to 42 have access to IVF treatment on the NHS. The bad news? Several caveats apply to the access criteria.
First, women between 40 and 42 only qualify for one free IVF cycle. The under-40s are allowed three. It’s a cruel limitation. Older patients need more attempts, not less. Six out of seven IVF cycles fail at this age. Even if older patients qualify for a free cycle, the chance of it succeeding is low. So they have to go private before they know it. Not fair.
More bad news. If you’re over 40, and you’ve had IVF treatment before, you won’t qualify. That’s harsh, especially if your previous treatment was done privately and saved the NHS money. IVF doesn’t, in any case, cost the NHS that much. It should be helping, not hindering.
Caveat number three. If you’re over 40 and have low ovarian reserve, you don’t qualify. That’s a shame: a multi-cycle approach, or minimal stimulation, might have worked. The NHS says an AMH level of 5.4 pmol/L or less disqualifies women aged 40 to 42. But look at the research. Many patients we have helped have succeeded with an AMH below that. Oddly, the AMH requirement doesn’t apply to the under 40s.
As for egg donation, the NICE guidelines are vague as to who qualifies. The rules also fail to mention the shortage of donors in the UK, especially at NHS-only clinics. There’s no ethical position on egg-sharing, other than to recommend counselling beforehand. Here’s what the NHS should have said: egg sharing is wrong.
It’s tempting to suggest the NICE guidelines on IVF aren’t fit for purpose. Many couples under 40 are currently lucky to get one cycle of IVF, not the recommended three. Only one in ten GP groups follow the NICE guidelines. One in five have cut IVF funding altogether. GPs hold the power and the purse strings, not NICE.
Welcome to the Great British IVF Robbery, where patients’ dreams are dashed by the state and diverted to overpriced private clinics. The flawed NICE criteria – flawed because they’re not being followed – offer hope and heartache at the same time. Why publish guidelines if no-one wants to be guided by them?
Lord Winston, the high-profile fertility expert, has called British private fertility clinics ‘exploitative’. He correctly predicted that IVF provision would suffer as clinical commissioning groups took over from PCTs. Disparity of IVF funding has indeed increased, forcing more patients into private care. Compare how much the NHS spends on obesity and smoking. The fertility budget is tiny in comparison.
Let’s look at the figures. The cost of IVF at UK private fertility clinics is seriously inflated. Not so long ago, Lord Winston calculated that the cost price of an IVF cycle was about £1,000. An IVF cycle, with all the extras, now costs a private patient at least £6,000 in the UK. Some clinics, in London especially, charge much more. That’s quite a mark-up.
UK fertility clinics make more money from multi-cycle offers, marketed as benefiting the patient when they usually don’t (another unethical practice the HFEA has failed to control). Treatment costs will rise further after Brexit, as competition weakens, supply costs rise and American-style pricing moves in.
Until lawmakers accept that IVF treatment is a public right, the private fertility industry in the UK will continue to exploit patients. It’s time to act. Politicians must allow fairer access to state-funded fertility treatment to everyone who needs it.