Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Appendix Assisted Conception services – policy review Report to OJHOSC, 14 May 2009 Comparison of existing and proposed assisted conception policies Proposed changes Criterion Age of woman at time of cycle starting Previous infertility treatment Thames Valley existing policy The time of the cycle of IVF or ICSI or IUI (including DI) starting for the first time is recommended to be progressively lowered in order to achieve the greatest likelihood of success. 2007/8: 36yrs to 39 yrs inclusive (same as previous years) 2008/9: 35yrs to 38yrs inclusive 2009/10: 34yrs to 37yrs inclusive 2010/11: 33yrs to 36yrs inclusive April 2011 onwards: 32yrs-35yrs inclusive Any previous NHS or privately funded IVF/ICSI treatment will be an exclusion criterion. Hampshire/IOW existing policy 36yrs to 39 yrs inclusive Proposals for South Central 30yrs to 34yrs inclusive, with transitional arrangement to include women born between 1 April 1972 and 31 March 1976 inclusive provided treatment commences by 31 March 2010. Any previous NHS funded IVF/ICSI treatment will be an exclusion criterion. Previous selffunders are eligible for one NHS-funded cycle if they have not already received three self-funded cycles. Egg donation No formal policy Any previous NHS funded IVF/ICSI treatment will be an exclusion criterion. Previous self-funders are eligible for one NHS-funded cycle if they have not already received three cycles. No formal policy Transfer of frozen embryos No formal policy No formal policy In vitro maturation No formal policy No formal policy Intra-uterine insemination Unstimulated IUI funded for patients who meet the Thames Valley eligibility criteria for IVF. No formal policy IVF using donated eggs from UK clinics licensed by the HFEA will be commissioned. If a couple has had frozen embryos transferred as part of earlier self-funded treatment the frozen cycles will not be counted when assessing eligibility for NHS funded IVF. Couples eligible for NHS IVF can have only fresh embryos from their NHS funded cycle transferred with NHS funding. References to limits on the number of NHSfunded cycles are for fresh cycles; cycles with frozen embryos are not funded. IVM will not be funded, due to limited evidence of effectiveness. IUI will not be funded, due to lack of clinical and cost-effectiveness 1 Appendix Assisted Conception services – policy review Criterion Gamete storage Report to OJHOSC, 14 May 2009 Thames Valley existing policy No formal policy on sperm storage Hampshire/IOW existing policy No formal policy on sperm storage No formal policy on oocyte and ovarian tissue preservation. No formal policy on oocyte and ovarian tissue preservation. Storage of surplus embryos following a fresh cycle of NHS funded IVF Viable embryos from NHS funded IVF may be frozen and stored for up to 1 year or the female partner’s 40th birthday (whichever is sooner) so that they may be transferred to the woman at a later stage. Specific diagnosed causes of infertility Couples with a diagnosed cause of infertility required to have infertility of only one as opposed to 3 years duration. No formal policy Viable embryos from NHS funded IVF may be frozen and stored for up to 3 years or the female partner’s 40th birthday (whichever is sooner) so that they may be transferred to the woman at a later stage. Couples with a diagnosed cause of infertility required to have infertility of only one as opposed to 3 years duration. No formal policy No formal policy No formal policy HIV infection and sperm washing Surgical sperm retrieval Proposals for South Central Sperm storage will be funded for post-pubertal males under the age of 55 years who are about to undergo medical treatment which is likely to result in long-term sub-fertility. Subsequent procedures using the sperm will not be funded unless the other eligibility criteria are met. . Oocyte (egg) preservation and ovarian tissue preservation are still experimental treatments, and will not be funded. Viable embryos from NHS funded IVF may be frozen and stored for up to 3 years or the female partner’s 40th birthday (whichever is sooner) so that they may be transferred to the woman at a later stage. Women and men with infertility should be treated equally, regardless of the cause of their infertility. Couple must have infertility of at least 3 years duration. Sperm washing will not be funded, due to limited evidence of clinical and costeffectiveness. Surgical sperm retrieval will not be funded because of lack of evidence of effectiveness. Criteria to which no change is proposed Criterion Thames Valley HIOW Childlessness Treatments for subfertility will be funded if the couple does not have a living child from their relationship or from any previous relationship. This includes a child adopted by the couple or in a previous relationship. It is estimated that 66% of all couples attending out patient clinics with fertility problems are both childless. One partner is childless in a further 16% of couples attending subfertility clinic. Once accepted for treatment, should a child be Treatments for subfertility will be funded if the couple does not have a living child from their relationship or from any previous relationship. This includes a child adopted by the couple or in a previous relationship. It is estimated that 66% of all couples attending out patient clinics with fertility problems are both childless. One partner is childless in a further 16% of couples attending subfertility clinic. Proposals for South Central No change 2 Appendix Assisted Conception services – policy review Criterion Thames Valley HIOW adopted or a pregnancy leading to a live birth occur, the couple will no longer be eligible for treatment. Once accepted for treatment, should a child be adopted, or a pregnancy leading to a live birth occur, the couple will no longer be eligible for treatment. Fertility treatment will not be available if the subfertility is the result of a sterilisation procedure in either partner. In addition, the surgical reversal of either male or female sterilisation will not be funded except in exceptional circumstances. If the individual’s situation is thought to warrant such consideration, the patients’ general practitioner should contact the relevant PCT so that such an application might be made. Women must have a BMI of between 19.0 and 30.0 inclusive for a period of 6 months or more before receiving any treatment. They should be informed of this criterion at the earliest possible opportunity in their progress through infertility investigations in primary care and secondary care. GPs are encouraged to provide unambiguous and clear information about BMI criteria to infertile couples. Only non-smoking couples will be accepted on the IVF treatment waiting list. They must be informed of this criterion at the earliest possible opportunity in their progress through infertility investigations in primary care and secondary care. GPs are encouraged to provide unambiguous and clear information to infertile couples. A statement should also be issued at the time of publishing the eligibility criteria, emphasising the importance of an active, healthy lifestyle and highlighting the dangers of smoking and passive smoking, obesity, alcohol and caffeinated beverages as important causes of infertility. Couples not conforming to the HFEA’s Code of Ethics, will be excluded from having access to NHS funded assisted fertility or other treatment. This includes consideration of the ‘welfare of the child which may be born’ which may take into account the importance of a stable and supportive Sterilisation Fertility treatment will not be available if the subfertility is the result of a sterilisation procedure in either partner. In addition, the surgical reversal of either male or female sterilisation will not be funded except in exceptional circumstances. If the individual’s situation is thought to warrant such consideration, the patients’ general practitioner should contact the relevant PCT so that such an application might be made. BMI Women must have a BMI of between 19.0 and 30.0 inclusive for a period of 6 months or more before receiving any treatment. They should be informed of this criterion at the earliest possible opportunity in their progress through infertility investigations in primary care and secondary care. GPs are encouraged to provide unambiguous and clear information about BMI criteria to infertile couples. Only non-smoking couples will be accepted on the IVF treatment waiting list. They must be informed of this criterion at the earliest possible opportunity in their progress through infertility investigations in primary care and secondary care. GPs are encouraged to provide unambiguous and clear information to infertile couples. A statement should also be issued at the time of publishing the eligibility criteria, emphasising the importance of an active, healthy lifestyle and highlighting the dangers of smoking and passive smoking, obesity, alcohol and caffeinated beverages as important causes of infertility. Couples not conforming to the HFEA’s Code of Ethics, will be excluded from having access to NHS funded assisted fertility or other treatment. This includes consideration of the ‘welfare of the child which may be born’ which may take into account the importance of a stable and supportive environment for children as well Smoking HFEA Code of Ethics Report to OJHOSC, 14 May 2009 Proposals for South Central No change No change No change No change 3 Appendix Assisted Conception services – policy review Criterion Age of male partner Same sex couples/ individuals not in a partnership Embryo storage Report to OJHOSC, 14 May 2009 Thames Valley HIOW as the pre-existing health status of the parents. No upper age limit environment for children as well as the pre-existing health status of the parents. No upper age limit Subfertility will be defined as no live birth following insemination at or just prior to the known time of ovulation on at least ten documented non-stimulated cycles or fertility problem demonstrated at investigation. Subfertility treatment will be funded for same sex couples or individuals not in a partnership if those seeking treatment are demonstrably subfertile. In the case of same sex couples in which only one partner is subfertile, clinicians should discuss the possibility of the other partner receiving treatment before proceeding to interventions involving the Subfertile partner. NHS funding will not be available for access to insemination facilities for fertile women who are part of a same sex partnership or those not in a partnership. In circumstances in which those in a same sex partnership or individuals are eligible for subfertility treatments, the other criteria for eligibility for subfertility treatments will apply. Same sex couples and individuals should have access to professional experts in reproductive medicine to obtain advice on the options available to enable them to proceed along this route if they so wish. No formal policy on IVF and embryo storage for women at risk of infertility due to medical treatment. Subfertility will be defined as no live birth following insemination at or just prior to the known time of ovulation on at least ten documented nonstimulated cycles or fertility problem demonstrated at investigation. Subfertility treatment will be funded for same sex couples or individuals not in a partnership if those seeking treatment are demonstrably subfertile. In the case of same sex couples in which only one partner is subfertile, clinicians should discuss the possibility of the other partner receiving treatment before proceeding to interventions involving the Subfertile partner. NHS funding will not be available for access to insemination facilities for fertile women who are part of a same sex partnership or those not in a partnership. In circumstances in which those in a same sex partnership or individuals are eligible for subfertility treatments, the other criteria for eligibility for subfertility treatments will apply. Same sex couples and individuals should have access to professional experts in reproductive medicine to obtain advice on the options available to enable them to proceed along this route if they so wish. No formal policy on IVF and embryo storage for women at risk of infertility due to medical treatment. Proposals for South Central No change No change Requests for funding for IVF, embryo cryopreservation and storage for women about to undergo treatment likely to cause infertility will continue to be considered by PCTs on an individual basis. 4