Millions of women in England face limited access to National Health Service (NHS)-funded in vitro fertilization (IVF) treatment, with nearly 70% of local areas offering only one cycle, despite national guidance recommending three. This disparity, described as a “postcode lottery,” is placing significant emotional and financial strain on couples struggling with infertility.
Data collected by the Progress Educational Trust (PET) reveals that 29 out of 42 integrated care boards (ICBs) – the bodies responsible for NHS budgets locally – currently provide only one cycle of IVF for women under 40 who have been trying to conceive for two years. This falls short of the recommendations set forth by the National Institute for Health and Care Excellence (NICE), which suggests three full cycles for this demographic. Four ICBs reduced access to IVF in the past year, exacerbating the problem.
“Infertility is already incredibly stressful for people, and it puts them under even more pressure, because there is so much riding on whether that one NHS-funded cycle is going to work,” says Sarah Norcross, director of PET. “And for some people, that will be their only chance, because private fertility treatment is so expensive.” A single cycle of IVF at a private clinic can cost upwards of £5,000.
The situation varies significantly across England. Only two ICBs – NHS North East and North Cumbria, and NHS North East London – currently align with NICE guidelines. The entire North West region offers only one cycle of IVF. Of the 29 ICBs offering a single cycle, 19 provide only a partial cycle, meaning not all viable embryos created are transferred during the treatment.
This limited access comes at a time when fertility rates in England and Wales are at a record low. In , the birth rate fell to 1.41 children per woman, below the “replacement level” of 2.1 needed to maintain a stable population without relying on immigration. The NHS estimates that approximately one in seven couples may experience difficulty conceiving.
The issue isn’t simply one of funding, but also of inconsistent implementation of existing guidelines. NICE guidelines, while not legally binding, provide a benchmark for best practice. The lack of a unified national approach means that access to IVF is heavily dependent on where a couple lives.
Health minister Karin Smyth acknowledged the inconsistency in access to NHS-funded fertility services, calling it “unacceptable” in a recent parliamentary response. Revised NICE fertility guidelines are expected this spring, but Norcross expresses skepticism about their potential impact. “Fertility treatment has always been a Cinderella service. It’s always been the one they’ve chosen to cut or to ignore. Nice has recommended three full NHS-funded cycles, for women under 40, for more than 20 years. This has never been implemented across England, unlike in Scotland.”
Norcross advocates for a centralized commissioning process, mirroring the approach taken in Scotland. Scotland implemented a phased approach, beginning with two cycles and gradually increasing to three as capacity allowed, supported by financial modeling. “We see a tried and tested plan that England could follow,” she added.
A Department of Health and Social Care spokesperson stated that they are “working with the NHS to improve consistency” and expect ICBs to commission treatment in line with NICE guidelines. NHS England also emphasized that ICBs are responsible for ensuring fair and accessible services based on local population needs and available resources.
The current situation highlights a significant gap between national recommendations and local implementation, leaving many couples facing difficult choices and limited options in their pursuit of parenthood. The upcoming NICE guidelines may offer a renewed opportunity to address this disparity, but sustained commitment and consistent funding will be crucial to ensuring equitable access to IVF treatment across England.
