Male BMI and age ‘should not be used to ration access to IVF’

A man’s weight, age and other “arbitrary criteria” should not be used to ration access to NHS fertility services such as IVF, a campaign group has said.

Fertility Fairness said England’s Clinical Commission Groups (CCGs) are rationing access to NHS fertility services by setting their own access criteria, including male body mass index (BMI) and age.

It said these criteria do not form part of the National Institute of Health and Clinical Excellence’s (Nice) fertility guidelines and should not be used to determine who can or cannot be referred for IVF or Intracytoplasmic sperm injection (ICSI).

Fertility Fairness said its 2018 audit of England’s 195 CCGs reveals that more than a quarter (27%) now use a man’s BMI to determine whether a couple can be referred for IVF on the NHS.

Fourteen CCGs (8%) stipulate men must be aged below 55 in order to have NHS fertility treatment.

A quarter of CCGs insist a woman’s Anti-Mullerian hormone (AMH) level and/or antral follicle count (AFC) is at a specific level, and 91% do not allow couples to access IVF on the NHS if one of the couple has a child from a previous relationship, which it described as social rationing.

As well as introducing extra “access to NHS IVF” criteria, the vast majority of CCGs (87%) ration NHS fertility services by refusing to provide the recommended three full IVF cycles, the group added.

Nice recommends Government funding for three full IVF cycles, but funding varies across the country and access is often described as a postcode lottery.

It means six out of 10 IVF cycles in the UK are funded by patients themselves, according to the the Royal College of Obstetricians and Gynaecologists (RCOG).

Fertility Fairness said seven CCGs (3.6%) have removed NHS IVF entirely (all are in the South), while 20% offer one full IVF cycle and 40% offer only one partial IVF cycle (transferring a finite number of embryos).

Fewer than a quarter (23%) offer two IVF cycles, it said.

In the last two years, 30 CCGs (15.3%) have slashed NHS fertility services, and one in 10 is currently consulting on cutting or removing NHS fertility treatment.

Fertility Fairness co-chairwoman Sarah Norcross said: “It is shocking to see CCGs introducing their own ‘access to IVF’ criteria, as well as reducing the number of IVF cycles they offer.

“It is not the CCG’s job to decide the criteria for accessing NHS fertility services.

“Nice has accessed the evidence in its guideline and developed access criteria for NHS patients and they do not include male BMI, male age, a woman’s AMH level or whether or not a couple has a child from a previous relationship.

“What criteria will CCGs introduce next – star signs and shoe size? CCGs need to remove their extra ‘access to IVF’ criteria now.”

Nice recommends that IVF should be offered to women under the age of 43 who have been trying to get pregnant through regular unprotected sex for two years, or who have had 12 cycles of artificial insemination.

But the final decision about who can have NHS-funded IVF in England is made by CCGs, and their criteria may be stricter than those recommended by Nice.

Aileen Feeney, co-chairwoman of Fertility Fairness and chief executive of the charity Fertility Network UK, said: “Fertility Network is extremely concerned about the effect that reducing access to NHS IVF has on already distressed patients.

“Infertility is a devastating disease causing depression, suicidal feelings, relationship breakdown and social isolation; removing the recommended clinical help or making it harder to access is cruel and economically short-sighted.

“Access to NHS treatment should be according to medical need and not your postcode.”

She added that anyone affected can join Fertility Network’s #Scream4IVF campaign, which is calling for fair access to IVF in the UK. A petition is available to be signed at www.scream4IVF.org.

An NHS England spokesman said: “Ultimately these are decisions for local GPs who rightly decide how best to balance the various competing demands on the NHS.”