Couples are being turned down for NHS fertility treatment in some areas of England because the man is too old or too fat, despite neither criteria forming part of national guidelines or being proven to affect the success of IVF.
Ninety-one per cent of local clinical commissioning groups (CCGs) also refuse access to IVF on the NHS if one of the couple has a child from a previous relationship, a process criticised as social rationing by the campaign group Fertility Fairness.
The group carried out an audit of 195 CCGs and found that 27% of them used a man’s body mass index (BMI) to determine whether a couple could be referred for IVF. Fourteen CCGs, or 8%, stipulated that men must be younger than 55.
The National Institute for Health and Care Excellence (Nice) guidelines, which advise CCGs on best practice, says men with a BMI of 30 or over should be informed that they are likely to have reduced fertility. Nice also says couples should be told that “female fertility [and to a lesser extent] male fertility decline with age”.
Neither male age nor weight affect the success rate of IVF, according to Raj Mathur, a gynaecologist and Fertility Fairness committee member. “Male age and BMI are not in the Nice guidance as criteria for IVF and there is no strong evidence of impact on clinical outcomes of IVF,” he said.
Mathur also criticised the quarter of CCGs that insist a woman’s anti-Müllerian hormone (AMH) level and/or antral follicle count (AFC) should be at a specific level. AMH is a hormone secreted by cells in developing egg sacs. Doctors can investigate the number of eggs a woman has left by measuring AMH in her blood or by counting the number of egg-containing follicles, known as her AFC, using a vaginal ultrasound scan.
“AMH and antral follicle count are in the Nice guideline as predictors of ovarian response, but not as predictors of the chance of having a baby through IVF. Commissioners are making unjustified extrapolation in using them for rationing,” said Mathur.
As well as introducing extra access to NHS IVF criteria, the vast majority of 87% of CCGs ration NHS fertility services by refusing to provide the recommended clinically effective and cost-effective treatment for infertility – three full IVF cycles:
3.6% of CCGs, all in the south, have removed NHS IVF entirely
40% offer only one partial IVF cycle, transferring a finite number of embryos
20% offer one full IVF cycle, transferring all viable fresh and frozen embryos
23% offer two IVF cycles.
13% offer three IVF cycles.
In the last two years, 30 CCGs, or 15.3%, have slashed NHS fertility services, and one in 10 are consulting on cutting or removing NHS fertility treatment.
Sarah Norcross, the co-chair of Fertility Fairness, 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.
“What criteria will CCGs introduce next: star signs and shoe size? CCGs need to remove their extra ‘access to IVF’ criteria now.”
Aileen Feeney, the co-chair of Fertility Fairness and chief executive of the charity Fertility Network UK, said: “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.”
