At its meeting on 7 November 2017, the Governing Body of the three Bristol, North Somerset and South Gloucestershire Clinical Commissioning Groups decided to keep existing policies covering fertility treatment in place.
This followed a public consultation exercise held between July and September 2017 and will mean that the current age limits for women and men will remain the same.
A spokesperson for the CCGs said, “We listened to the feedback from the consultation and its clear that we need to look further at any possible proposals to change fertility treatment criteria. The Governing Body agreed to review the overall approach to fertility commissioning during the overall planning process for 2018/19.”
As part of our consultation principles, we report back on what you said to us about the proposal and what our response was. A summary of this can be found in the ‘You Said, We Did’ report below.
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This report summarises feedback we received during our consultation on eligibility for fertility treatment and what we have done as a result.
About the proposal
Bristol, North Somerset and South Gloucestershire CCGs proposed to introduce a policy to make fertility treatments available to women between the ages of 30 and 35 (from 30th birthday to 35th birthday). The CCGs would consider making treatments available in exceptional circumstances outside this age range.
We were not proposing to withdraw funding for fertility treatment altogether, as has happened in other areas of the country. The proposal would mean moving funding for fertility treatment from “Criteria Based Access” to “Prior Approval” (see jargon buster for definitions).
Bristol, North Somerset and South Gloucestershire Clinical Commissioning Groups currently fund fertility treatment for approximately 400 couples a year, who meet the current criteria for treatment, at a cost of almost £1.9 million per year. This is for women up to the age of 40, provided they meet the eligibility criteria.
Patients in Bristol, North Somerset and South Gloucestershire who qualify for NHS funded treatment are offered one full cycle of fertility treatment. NICE recommends up to three full cycles of fertility treatment for couples. However, local policy has been to fund the first, and most expensive, cycle rather than three cycles so that fertility assessment and treatments can be made available to more people. Under this proposal, we would continue to fund one cycle for eligible couples.
Summary of proposed eligibility changes:
Current criteria for NHS funded fertility treatment:
- Prospective mother’s age should be less than 18 weeks before their 40th birthday
- Prospective father or female partner in a same sex couple should be younger than 54 years
- No restriction on IVF if one partner has children by a former partner
Proposed criteria for NHS funded fertility treatment:
- Prospective mother’s age should be aged between their 30th and 35th birthday
- Prospective father or female partner in a same sex couple should be younger than 52 years*
- Neither partner should have any living children to access fertility assessment and treatment
*Note: recent media coverage has highlighted the impact of age on male fertility. This clinical evidence is not available to evaluate at this time as the report has not been published and therefore it cannot be taken into account when reviewing this policy. We will continue to monitor and review as appropriate.
Clinical evidence shows that treatment between the ages of 30-35 offers the highest possible chances of success. Under the proposal, future fertility treatment will be focused on the age group where natural conception success rates have started to fall but fertility treatment still offers couples the best chance of having a baby.
According to the National Institute for Health and Clinical Excellence about 94 out of every 100 women aged 35 who have regular unprotected sexual intercourse will get pregnant within 3 years of trying. Conception success rates reduce significantly for women after the age of 35. For example, amongst women aged 38, only 77 out of every 100 will conceive within 3 years. This proposal would offer NHS funded treatment to patients with the highest average chance of success.
This proposal would reduce the average number of couples accessing NHS funded fertility treatment from approximately 400 a year to approximately 200 per year across Bristol, North Somerset and South Gloucestershire.
Patients who wish to access fertility treatment will continue to have the option to self-fund treatment or seek funding via the Individual Funding Request Panel where there are exceptional circumstances outside age ranges proposed.
Criteria Based Access [CBA] – Where a CCG has published a policy setting out eligibility criteria. If clinicians are content that the patient meets the criteria, they may proceed to treat without seeking funding approval.
Prior Approval [PA] – Where a CCG has published a policy setting out eligibility criteria. Clinicians, where they feel patients meet the criteria, must seek funding approval from the commissioners prior to treating.
Individual Fund Request [IFR] – Where a CCG has published a policy stating that certain treatments are not routinely funded. Treatment will only be funded via agreement from commissioners in exceptional circumstances
Clinical pathway – A systematic way of treating and managing diseases in the NHS. A clinical pathway outlines the way a patient should be cared for through the NHS system from first presentation, followed by testing and diagnosis and through to completion of treatment.