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IVF services for the future

When people living in the Southampton, Hampshire, Isle of Wight or Portsmouth (SHIP) areas seek treatment for infertility, their local Clinical Commissioning Group is responsible for funding fertility services (such as In-Vitro Fertilisation, or IVF) to help women become pregnant.

IVF is a high-cost treatment and so it is important to make sure that the Clinical Commissioning Groups (CCGs) across the area offer IVF in the most effective way for the local population. They must also ensure that they balance the funding for this treatment alongside the other pressures on local NHS funding.

 

What happened?

The SHIP-wide ‘Priorities Committee’ reviewed the most recent evidence of clinical and cost effectiveness for IVF and Intra-Cytoplasmic Sperm Injection (ICSI). Please note that for this process the term ‘IVF’ is being used to describe both treatments.

The Committee then prepared a recommendation about the future commissioning of these services which was considered by each of the CCGs. The local CCGs were keen to ensure they did this in light of the views of local people.

 

Why did this happen when it did?

In February 2013 the National Institute for Health and Care Excellence (NICE) published updated clinical guidelines for fertility services. The non-compulsory guidelines included specific guidance for CCGs regarding IVF.

 

How does NHS funding work?

Each CCG is allocated an annual budget which it uses to commission (buy) a wide range of health services and treatments for local people. These services include urgent care services, treatment for long-term conditions, community services, planned operations, x-rays and diagnostic tests.

The CCGs' role includes researching and planning which services are needed by the local population, buying those services in at the best possible price, and monitoring those services to ensure they are delivering what was agreed, and what people need.

The NHS budget is limited so funding for any service or treatment must be balanced against the funding requirements for many other necessary local health services and treatments.

 

What was the IVF policy?

The joint SHIP IVF Access Criteria was as summarised below.

The latest NICE guideline, a non-binding recommendation, is available on their website at www.nice.org.uk/guidance/CG156.

The following table shows the previous SHIP access criteria compared to the 2013 NICE guidelines:

Criteria

Previous SHIP access criteria

2013 NICE guidance

Age of woman at time of referral

Up to 35 years old (treatment must start before the woman is 35)

Up to and including 42 years old

Availability of fresh and frozen cycles

Fresh cycle only

Full fresh cycle and all subsequent frozen cycles

Number of cycles available

One cycle

Three cycles to women under 40 years old (one cycle for women aged 40 to 42 years)

BMI eligibility

Women must have had a BMI of between 19.0 and 29.9 for six months or more

Offer advice to women with a BMI of 30 or more to lose weight in order to increase the success rate and reduce complications during their pregnancy

Smoking status

Couples must be non-smoking for at least 6 months in order to improve the likelihood of success.

Offer advice and refer to a local smoking cessation programme

 

How did we seek your views?

We undertook a period of engagement to gather the views of local people, their representatives, GPs and interest groups on whether funding for IVF is a priority for the NHS and on the access criteria. Each CCG then considered the recommendation from the SHIP Priorities Committee in light of this valuable feedback.

the results for SHIP and Fareham and Gosport CCG are available below.

  

How were the views of local people considered?

All of the feedback will be evaluated on a SHIP-wide and individual CCG area basis. This formed a single report which each CCG used to help them when considering the SHIP Priorities Committee recommendation. The CCG determined to endorse the recommendations. Further details are available in our News section.

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