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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
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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
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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.
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