Referral for IVF treatment to Tertiary Care can only be made if all access criteria as set out below are fulfilled. Criteria will be reapplied after each unsuccessful fresh and frozen treatment cycle, before any subsequent frozen transfers or a further fresh cycle can commence.
All frozen embryos stored in any centre in the UK must be used before NHS treatment can commence.
Definition of infertility for couples
Neither partner to have undergone voluntary sterilisation or who have undertaken reversal of sterilisation, even if reversal has been self-funded.
Couples must have been cohabiting (at the same address in case of any doubt) in a stable relationship for a minimum of two years.
Couples where one partner has no living biological child can access treatment as long as all other access criteria are met in full.
There is a responsibility on patients to fulfil the following access criteria in the interests of the welfare of the child and the effectiveness of treatment. Centres will conduct tests to ensure that patients adhere to these criteria and, if a patient does not meet the criteria treatment cannot be started.
Body Mass Index (BMI)
The female partner must have a BMI above 18.5 and below 30. Couples should be aware that a normal BMI is best for both partners.
Smoking status must be assessed prior to referral for treatment and again before each treatment cycle.
Both partners must be nonsmoking and nicotine free for at least three months before referral for treatment and couples must continue to be non-smoking and nicotine free during treatment.
Alcohol and drugs
What is the ‘welfare of the child’ assessment?
During a patient’s first consultation at a fertility clinic, their doctor will ask them a number of questions about their medical history to determine the best course of treatment for them. The doctor will also ask the patient a series of questions relating to their social circumstances in person or by asking them to complete a questionnaire.
These questions are part of an assessment, known as the welfare of the child assessment, which clinics are required to perform in order to determine whether the prospective child is likely to face serious medical, physical or psychological harm.
Definition of one full cycle of IVF
One full cycle includes ovulation induction, egg retrieval, fertilisation, transfer of fresh embryos followed by the freezing of suitable embryos and the subsequent replacement of these, provided the couple still fulfil the access criteria. If suitable embryos are frozen these should be transferred before the next stimulated treatment cycle.
No individual (male or female) can access more than the number of NHS funded IVF treatment cycles supported by NHSScotland under any circumstances, even if they are in a new relationship.
Single embryo transfer
Patients with good prognosis are always expected to have single embryo transfer, and this will be discussed with patients at clinic appointments. The single biggest risk of fertility treatment is multiple pregnancy. Further information can be downloaded from the information section of the Fertility Network website www.infertilitynetworkuk.com, or ask staff at your clinic for a copy of Fertility Network’s leaflet.
Number of cycles
Up to two cycles of IVF/ICSI may be undertaken where there is a reasonable expectation of a livebirth. Clinical judgement should be applied to determine this, using an assessment of ovarian reserve before the first cycle. If there has been no or a poor response to ovarian stimulation (<3 eggs retrieved) in the first cycle no further ivf>
Fresh treatment cycles must be initiated by the date of the female partner’s 40th birthday and all subsequent frozen embryo transfers must be completed before the woman’s 41st birthday. If the female partner turns 40 during her first fresh cycle of treatment, no further fresh cycles will be offered.
Each individual treatment cycle, including all frozen transfers, must be completed within 12 months of starting treatment, or (as set out above) before the date of the female partners 41st birthday if this is reached first.
If a couple is referred to Tertiary Care when the female partner is 39, the couple will most likelyreceive one NHS IVF cycle.
Couples should not be placed at the end of the waiting list following an unsuccessful treatment cycle. There is usually a gap of up to 11 months between fresh cycles of IVF for couples who remain eligible.
Number of cycles for couples if female partner aged 40 to 42 years old
In very specific circumstances, for couples where the woman is aged from the day after her 40th birthday, who meet all other criteria, one cycle of treatment may be funded if:
Couples must have been screened for treatment by the time of the female partners 42nd birthday at the latest, and all treatment including any subsequent frozen embryo transfers must be completed by the time the female partner reaches 42+ 364 days.
Therefore, referring clinicians must be realistic when referring couples in this category, both in respect of the additional criteria, and whether they will reach Tertiary Centres in time for screening by the time of the female partners 42nd birthday.
Should circumstances change and couples no longer meet the NHS eligibility criteria, self-funding for any future transfers will be required.
Number of Cycles for couples who have previously self-funded
NHS funding may be given to those couples who have previously paid for IVF treatment, if in the treating clinician’s view, further treatment would be clinically effective.
The National Infertility Group will be considering the following during the next year:
If you would like any further information regarding treatments or referral to the Centre, please get in touch. One of the team will be happy to guide you through the process and answer any questions you may have.