We love the NHS
It almost goes without saying that there is huge support for the NHS. The vast majority of people support the founding principles of a service free at the point of delivery, available to all and funded largely by taxation.
But there’s an argument that our attachment to the NHS means that we don’t demand enough of the NHS. That we sometimes tolerate a level of service that would be unacceptable in other areas of our lives. This is the experience of a growing number of people going through fertility treatment.
Although we love the NHS and we are very lucky to be able to receive free fertility treatment, which is for some people their only option, for others it has caused a lot pain and disappointment due to lengthy delays and restrictions.
Many other people have had positive and successful fertility journeys with the NHS too, we are not here to judge. We are NOT talking here about which is ‘better’ or ‘worse’ but how private and NHS fertility treatment differs to enable you to make informed decisions about your personal journey.
Things to think about with NHS IVF provision:
Patients have told me what they wish they had known about NHS IVF treatment before their journey started to enable others to be better informed. Things people mentioned, included:
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.
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.
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 now the NHS only offers one funded cycle so if you may need more than one private treatment might be something to consider as you can look for multi cycle treatment programmes, where you can purchase two or three cycles for a discounted rate.
Many clinics in the UK partner with Access Fertility who offers inclusive multi cycle treatment packages. 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.
Check your eligibility:
One key aspect you need to check is your NHS eligibility. You are not eligible for NHS provision if:
Women under 40
According to NICE, women aged under 40 should be offered 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, the current cycle will be completed, but further cycles shouldn’t be offered. If tests show IVF is the only treatment likely to help you get pregnant, you should be referred straight away.
Women aged 40 to 42
The NICE guidelines also say women aged 40 to 42 should be offered 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’ve been informed of 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 be referred straight away.
NHS trusts across England and Wales are working to provide the same levels of service. But the provision of IVF treatment varies across the country, and often depends on local CCG policies.
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, only 1 cycle of IVF may be routinely offered, instead of the 3 recommended by NICE.
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 Timelapse technology, Embryoglue or blastocyst. The NHS does not include these additional elements as part of the cycle because it says there is little evidence to prove the effectiveness, which seems fair. Some private clinics offer these treatments but don’t necessarily recommend them for the same reasons but at least you have the option in a private clinic, where/if the consultant feels that it would be beneficial in your specific case.
Do lots of research: the add-ons mentioned above are available in private 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 about your treatment. You can also research the different clinics and procedures, medications and prices. You can find out more about add-ons on the HFEAs website:
Flexibility: the majority of us have experienced the NHS appointment system. We wait for an appointment and do anything we can to drop everything to get there because if you can’t make that slot you might be waiting for another month or more. This can cause havoc with work commitments and getting appointments at the right time, which is key for fertility treatment. Private clinics offer a greater flexibility for appointments and might even be open at weekends or evenings. Work will be disrupted either way but the lack of flexibility with timings in the NHS, and the significant delays in waiting for appointments etc is a major factor to think about.
Ease of contact: in 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 clinic environment where they provide you with patient portals and dedicated staff who you can call any time. Where you might need to inject yourself in a restaurant toilet at 9.00pm and make a mistake, this is very important.
Choice: a key point to consider is that the choice of clinic you can access may be limited with NHS provision based on postcode or the agreements in place. You may therefore receive a choice of two or three clinics. If you were paying privately you could choose wherever you wanted based on success rates and other factors. Fertility clinics should be chosen very carefully and you can get advice on this through the HFEA too: 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 clinic. Many private 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 IVF 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 clinics are just interested in making money. That they charge you the main price but then there are other things you need that are not included in the main price so you can end up paying much more than the initial cost you saw. That they aren’t any more organised than the NHS and don’t always give a superior service.
People criticise the add-ons that private clinics advertise even though they are not evidence-based. Clinics say that they show all the options because that’s what patients actually want 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 clinics have nicer surroundings, free parking, shorter wait times, greater choice of treatments and clinics, more flexibility around your commitments and greater dedicated care. You should bear in mind though that some private clinics are based within an NHS hospital. In these situations the clinics are restricted by the NHS Trust in what they can and can’t do in terms of building and parking facilities.
For many people who aren’t eligible for NHS fertility treatment then private treatment may be your only option. With private treatment you don’t have to change doctors or clinics after the first cycle, unless you wished to do so. With the NHS, once you have completed your one-three cycles you will then need to transfer to a private clinic and pay for any further treatment you wish to try.
Choosing IVF with a private clinic doesn’t always guarantee better odds of making a baby and it doesn’t always guarantee a better service but what it can guarantee are shorter waiting times, a quicker turnaround for results and more flexibility to fit around your schedule.
Given the financial aspect and the fact the NHS treatment 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.