Unequal access to fertility treatment and no clear criteria for who should receive NHS-funded fertility treatment; these are the findings of a survey by British fertility doctors to be published in the journal Human Fertility in September. In response, the British Fertility Society - the organisation representing professionals working with assisted conception - has issued a series of recommendations on social criteria for access to NHS-funded fertility treatment.
The BFS surveyed fertility clinics in England and their results show a wide disparity of access to treatment. They also show PCTs have a variety of social criteria to determine who should qualify for fertility treatment. The British Fertility Society is setting out recommendations on criteria such as previous children, obesity, smoking, single-sex parenthood etc, to help Primary Care Trusts decide who should receive NHS-funded fertility treatment.
The survey found that:
 Number of cycles has increased, but there are still 'black holes '. Despite recommendations, 16% of clinics report decreased support for fertility treatment.
Only one cycle is offered in vast majority of cases. Only 9% of respondents reported 2 cycles of treatment being provided.
There is a wide disparity on the social criteria used for acceptance onto an NHS-funded programme, especially as regards existence of previous children, high BMI, smoking, etc. For example, half of the clinics said that their Trust wouldn 't fund treatment if either partner had had a child previously.
The British Fertility Society has written to every Primary Care Trust in England and Local Health Board in Wales asking them to meet government fertility targets, and setting out recommended criteria for NHS funding of fertility treatment.
The BFS makes eleven recommendations on social criteria for NHS treatment, including:
Waiting times for treatment should be the same as for any other medical condition
No woman should be able to commence NHS-funded treatment after the age of 40
Women who are obese must initiate a weight reduction programme and those severely overweight (defined as having a BMI of 36 or more) should not receive treatment until their weight has reduced.
Single women and same sex couples should be treated the same way as heterosexual couples
If people have had children from a previous relationship, they should not be excluded from access to NHS treatment
Dr Mark Hamilton, Chair of the British Fertility Society, said: "Continued inequality of access to treatment is unacceptable in a state-funded health service and the source of considerable distress to a great number of people with fertility problems."
Summary of recommendations of the British Fertility Society for national criteria for NHS funding of assisted conception
1. Definition of infertility
In the absence of an obvious pathological cause infertility is defined as follows:
In the absence of any physical cause infertility is defined as the inability to conceive despite regular unprotected sexual intercourse over a period of at least 2 years.
2. Previous children
If the couple have no children they should qualify for funding. If either partner has a child/children from a previous relationship, but not the current relationship, they should qualify for NHS funding provided there has been consideration of the welfare of the child.
Where funds permit, couples, who already have a child from the current relationship and who have involuntary infertility, should receive funding, though childless couples should have priority. Treatment in these cases should be provided on the same basis as those with no children.
3. Age of female
No treatment cycle should be started after female 's 40th birthday; no patient place on the waiting list within 6 months of the 40th birthday but treatment funded up until the 40th birthday of the female partner; no age limitation on the use of frozen embryos created during an NHS funded cycle carried out before the female partners ' 40th birthday.
4. Unexplained infertility
Unexplained infertility should be treated by a phased approach according to the female partner 's age and duration of infertility.
5. Age of male partner
Paternal age should not be included in criteria for acceptance in NHS programmes.
6. Previous sterilisation
A history of sterilisation in either partner will normally exclude a couple from NHS funding of assisted conception or surgical reversal of male and female sterilisation although there may be exceptional cases where funding is agreed in these cases.
7. Weight
Women with a body mass index of < 19 and > 29 should be referred for advice from a dietician, warned of the potential risks in pregnancy, if appropriate, provided with access to exercise advice and offered psychosocial support. NHS funding of their treatment should be deferred until they demonstrate response to these interventions. Assisted conception may be provided if the BMI is < 36.
8. Smoking
Smoking should not be an exclusion criterion but patients who smoke should be given advice about its implications. In addition, all smokers should be given the opportunity to be referred to a smoking cessation programme.
9. Previous self funded treatment
NHS funding should not be provided to those who have already received the number of NHS funded cycles currently supported by their PCT. NHS funding should be provided to those patients who have had previously self- funded treatment irrespective of the number of cycles providing the clinical circumstances warrant further treatment.
10. Same sex couples and single women
Single women and same sex couples should be eligible for up to six cycles of NHS funded donor insemination treatment provided assessment of the Welfare of the Child has been undertaken in line with the Human Fertilisation and Embryology Authority Code of Practice, 2004. After failed donor insemination treatment or in the presence of an indication for IVF allocation of cycles should be on the same basis as for heterosexual couples.
11. Waiting times
Commissioners should ensure that waiting times for NHS referrals for infertility diagnosis and treatment are consistent with national targets for other medical conditions.
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