Women over 40 and single people would not get free IVF treatment through the NHS under plans put out for consultation in Wales. The proposals have been criticised by charity Fertility Network UK, which described the proposals as a "major step back."
At the moment, women aged up to 40 are entitled to two free cycles of IVF treatment through the NHS in Wales. Women aged 40 to 42 are entitled to one cycle while it is not recommended for women over the age of 42 because of the reduced chance of success.
The proposed plans would see women over the age of 40 and single people excluded from accessing NHS IVF treatment. Under the changes - a woman would have to be referred for IVF before her 40th birthday and would only be able to receive one cycle of treatment up until their 41st birthday. Women between the age of 40 and 42 will no longer be referred for the treatment. The changes are outlined in the Welsh Health Specialised Services Committee’s (WHSSC’s) new fertility policy, which also include changes to how same-sex couples access NHS-funded-IVF*
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Improvements have however been made to the age a woman is entitled to IVF support as well as the BMI range. The BMI range is proposed to widen from 19-30 to 18-35. This change is based on evidence that suggests the success rate for IVF at all ages for those with a BMI of 30-35 is virtually identical to those with a BMI of 30.
There are also changes to when a same-sex couple could be referred for fertility support. Under the current policy, a same-sex couple is eligible for support after at least six cycles of IUI (where sperm is inserted directly into a woman's womb). The proposed policy change would see this increase to 12 cycles of IUI. IUI is not funded by the WHSSC and varies from health board to health board - this means patients may need to pay private for this treatment.
Health boards provide and fund at least three cycles of IUI in Wales. A spokesperson for the WHSSC said: "There is no expectation that same sex couples will have to pay for IUI. We have proposed that there should be a standardised commissioning policy prior to accessing IVF services. NICE recommend six cycles of IUI, plus another another six cycles if needed."
The plans are currently under public consultation until 27 February 2023. Emma Rees, Fertility Network’s Wales co-ordinator said the changes would have a "massive detrimental effect on fertility patients in Wales." Ms Rees said the plans are concerning because current waiting times for services in the NHS delay the fertility process for women, adding it can take three to four years from starting trying to conceive to actually beginning fertility treatment, which would mean these plans have a detrimental impact on those over 35 who are starting the process of fertility treatment.
However the WHSSC state the proposed change in relation to limiting IVF treatment for women over 40 is based on clinical evidence of effectiveness. According to the WHSSC, the success rate of six embryo transplants for women between 40 and 41 years of age is 11%, and is less than 5% beyond a woman’s 41st birthday.
She said: "We are also deeply concerned about the number of other couples that could be affected if these changes are implemented. In Wales in particular, it can take between three to four years from starting to try to conceive to actually beginning fertility treatment. If you’re under 35, you have to have been trying for two years before your GP will refer you for further tests in secondary care; if you’re over 35, you have to have been trying for a year before a referral for tests such as laparoscopies.
"However, current waiting times for gynaecological tests and procedures can be as long as three years in some parts of Wales. There can then be a slight wait to begin treatment at a fertility clinic. This means that women in their mid to late 30s, who are hoping to become mums, but who may not have yet met a partner prepared to commit to parenthood or who aren’t ready yet to begin trying, perhaps for financial reasons, may find they are denied NHS help for their fertility problems."
Patients who have previously self-funded egg preservation will also not be eligible for future IVF support on the NHS if needed.
Part of the changes propose removing the current policy of a "watchful wait" which would reduce the time the patient is waiting to receive treatment. The proposed changes are a normal part of the WHSSC's work to review policies on a regular basis to ensure they reflect the most up to date clinical evidence.
You can respond to the public consultation by February 27 here.
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