NHS IVF provision and private fertility clinics

We are incredibly fortunate in the UK to have the NHS. Rarely have we appreciated our health service more than in the past 18 months, as it supported us through the Covid-19 pandemic. For those eligible to receive free fertility treatment through the NHS, it is an option to create a family that they otherwise couldn’t afford. Here we share some key information when considering NHS IVF provision, and compare this to what you might expect from private fertility clinics. It isn’t a judgement of which is ‘better’ or ‘worse’, but rather a view of the options so you can make the most informed decision that’s right for you.

NHS provision and private fertility clinics

What we wish they’d told us about NHS IVF provision:

Patients have told us what they wish they had known about NHS IVF treatment before their journey started. So you can be better informed, here is a list of the main considerations:

  1. Look up the CCG (Clinical Commissioning Group) policy on fertility treatments for your council: Every council has a different policy on eligibility, funding, and treatment. You’ll want to ensure that you do nothing to endanger your eligibility which could be, for example, to pay for a cycle privately before you start IVF with NHS. If you are unclear about the policy, discuss it with your IVF clinic. You can find the CCG policy for your council online
  2. Expect delays, lots of delays: this is important to bear in mind if you are someone who is 35 and above, but especially over 38 and starting out on your fertility journey. Timing is key to the IVF process and, as we all know, the chances of successful treatment fall significantly for those over 40 years old. Therefore, you may need to think about the potential 10-18 month wait to start your treatment on the NHS.
  3. Look up the number of funded cycles available in your area: the success rates for people falling pregnant on their first cycle is up to around 25-30%. The majority of people, and especially those in the older age bracket, are likely to need more than one cycle of IVF. In many places the NHS only offers one funded cycle, therefore if you may need more than one, private treatment might be something to consider.

    Many private fertility clinics in the UK partner with Access Fertility for our Multi-Cycle Programme. This package allows you to purchase two or three cycles for a discounted rate. Access Fertility also offers refund plans where, if you don’t have a baby after your treatment is complete, you can receive a full or partial refund. NHS clinics do not provide these type of options. Find out more about Access Fertility programmes here. Read our blog about the cost of private treatment here.
  4. Check your eligibility: One key aspect you need to check is your NHS eligibility.
    • Women under 40: According to NICE, women aged under 40 should receive 3 cycles of IVF treatment on the NHS if:
      • they’ve been trying to get pregnant through regular unprotected sex for 2 years
      • they’ve not been able to get pregnant after 12 cycles of artificial insemination

        If you turn 40 during treatment, you can complete the current cycle, but can’t pursue further cycles. If tests show IVF is the only treatment likely to help you get pregnant, you should get a referral straight away.
    • Women aged 40 to 42: The NICE guidelines also say women aged 40 to 42 should receive 1 cycle of IVF on the NHS if all of the following criteria are met:
      • they’ve been trying to get pregnant through regular unprotected sex for 2 years, or haven’t been able to get pregnant after 12 cycles of artificial insemination
      • they’ve never had IVF treatment before
      • they show no evidence of low ovarian reserve (where eggs in your ovaries are low in number or quality)
      • they understand the additional implications of IVF and pregnancy at this age

        Again, if tests show IVF is the only treatment likely to help you get pregnant, you should get a referral straight away.
    • NHS trusts across England and Wales are working to provide the same levels of service. But the NHS IVF provision varies across the country, and often depends on local CCG policies.
  5. Additional criteria: CCGs may have additional criteria you need to meet before you can have IVF on the NHS, such as:
    • not having any children already, from both your current and any previous relationships
    • being a healthy weight
    • not smoking
    • falling into a certain age range (for example, some CCGs only fund treatment for women under 35)

      In some cases, they may only offer 1 cycle of IVF, instead of the 3 recommended by NICE.
  6. Check out any restrictions: you need to check the small print for your CCGs policy in your area, as in some areas you will not be entitled to any of the ‘add-ons’ such as time-lapse technology, embryo glue or blastocyst. NHS IVF provision does not include these additional elements, because it says there is little evidence to prove their effectiveness. Some private fertility clinics offer these treatments, but don’t necessarily recommend them, for the same reasons. However, at least you have the option in an IVF private clinic, if the consultant feels that it would be beneficial in your specific case.
  7. Do your research: the add-ons mentioned above are available in private fertility clinics, but you don’t have to have them. Even if a doctor recommends something, you can still say ‘no’ if you want to. The HFEA is the governing body for fertility clinics and you can find information on there about the effectiveness and risks associated with each procedure. The better informed you are about the process and what is involved/the options, the more confident you can be in discussions with either your private or NHS consultant. You can find out more about add-ons on the HFEAs website
  8. Flexibility: the majority of us have experienced the NHS appointment system. We wait for an appointment and drop everything to get there, because if you can’t make that slot, you might be waiting a long time for another one. This can cause havoc with work commitments and getting appointments at the right time, which is key for fertility treatment. Private fertility clinics offer a greater flexibility for appointments and might even be open at weekends or evenings. There will be disruption either way, but the lack of flexibility with timings and the significant delays are major factors to consider.
  9. Ease of contact: with the NHS, it is difficult to call your consultant or nurse to ask a question, if you’re lucky enough to have the same doctor each time. This is something which is much easier in a private IVF clinic, where they provide you with patient portals and dedicated staff who you can call any time. If you need to inject yourself in a restaurant toilet at 9.00pm and make a mistake, this is very important!
  10. Choice: a key point to consider is that the NHS may limit your choice of clinic depending on your postcode. You may receive a choice of just two or three clinics. Conversely, if you were paying privately, you could choose wherever you wanted, based on success rates and other factors. You should choose your clinic very carefully – for more advice on this, visit the HFEA website: https://www.hfea.gov.uk/choose-a-clinic/

It is important to note that you may be one of the lucky ones who accesses NHS treatment through a private IVF clinic. Many private fertility clinics also treat a percentage of NHS patients, so you would get access to the same doctors, treatment and facilities as someone paying privately. This is not guaranteed of course, and waiting times can still typically be longer than private patients, but it might be a risk worth taking.

It is always worth doing your own research on clinics in your area before you get the call for the appointment, so that you can make the best decision when provided with your options.

Private fertility clinics

It may surprise you that 6 in every 10 infertility treatment cycles are privately funded. This could be as a result of the strict NHS eligibility criteria and limited funded cycles in certain areas e.g. only one funded cycle is provided in many areas.

Some people complain that private IVF clinics are just interested in making money. That they charge you the main price but then there are hidden extras, so you end up paying much more. Others argue they aren’t any more organised than the NHS and don’t always give a superior service.

People criticise the add-ons that private fertility clinics advertise even though they are not evidence-based. Clinics say that they show all the options to give patients choice, and if that clinic doesn’t seem to offer it, they will go elsewhere. However it doesn’t mean they actively recommend add-ons unnecessarily, and they use the HFEA guidelines. The key is to do your own research. Even if a consultant recommends something, ultimately, you don’t have to have it.

On the whole we get feedback that private fertility clinics have nicer surroundings, free parking, shorter wait times, greater choice of treatments and clinics, more flexibility and greater dedicated care. You should bear in mind though that some private IVF clinics are based within an NHS hospital. In these situations NHS Trust may restrict the clinic in what they can and can’t do in terms of building and parking facilities.

private fertility clinics - London women's clinic

For many people who aren’t eligible for NHS IVF provision then private IVF treatment may be your only option. With private treatment you don’t have to change doctors or clinics after the first cycle, unless you wish to do so. With the NHS, once you complete your cycles you will need to transfer to a private fertility clinic and pay for any further treatment you wish to try.

Summary

Choosing IVF with a private fertility clinic doesn’t always guarantee better odds of making a baby and it doesn’t always guarantee a better service. However, what it can guarantee are shorter waiting times, a quicker turnaround for results and more flexibility to fit around your schedule.

Given the financial cost and the fact the NHS IVF provision is free, it can seem like a ‘no brainer’ to have your ‘free go’, but there is a lot more involved than people realise. Hopefully this article gives you some things to consider to make sure that, whatever decision you make, it’s the right one for you.

If you’re unsure about what to do next, or still have questions you’d like to answer, why not arrange a free 30min fertility chat with Kelly, our fertility nurse? Alternatively, arrange a call with one of our patient advisors, who would be happy to talk through the options with you.

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Call Access Fertility for a free no obligations chat to discuss your options.