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Infertility and assisted conception

Infertility is when a couple cannot get pregnant, despite having regular unprotected sex.

Around one in seven couples may have difficulty conceiving. If you think you may need help conceiving, make an appointment with your GP to discuss your options.

What treatment is available for infertility?

Investigations, diagnoses, and conservative treatments for infertility are routinely available on the NHS. Types of fertility treatment available include:

  • advice on lifestyle changes to aid a natural conception, such as weight loss and smoking cessation
  • medical treatment for lack of regular ovulation
  • surgical procedures, such as treatment for endometriosis

A referral for assisted conception can be made if infertility is diagnosed, or after all treatments and recommended lifestyle changes have been tried and infertility remains unexplained.

Types of assisted conception include:

Am I eligible for assisted conception?

Not everyone is eligible for assisted conception treatment. To be considered for treatment you must meet the following eligibility criteria:

Status

The prospective mother must be a registered patient of a GP practice in South West London at the time of commencing assisted conception investigations and treatment.

Patients who start their assisted conception investigations or treatment and then move to and register with a GP practice in South West London will be treated in line with our policy.

Sub-fertility or infertility

The patient either has an identified cause of sub-fertility/infertility or has had 24 months of unexplained infertility.

For single women or same-sex female couples this means 12 cycles of unstimulated intrauterine insemination (IUI) over at least 12 months.

Sterilisation 

Neither the patient nor their partner, if they have one, should have undergone previous sterilisation.

Anti-Mullerian Hormone (AMH) level

AMH level has always been equal or greater than 5.4pmol/l within the last 6 months.

Follicle stimulating hormone (FSH) level

Highest ever level of FSH taken between day 2 and 5 of the cycle must be less than or equal to 8.9iu/L. 

However, if the levels are above 8.9 and below 11.8 and the Anti-Mullerian Hormone (AMH) is above 5.4 then your treating clinician may decide to seek funding approval using AMH only.

Childlessness

The couple has no living child from their current relationship and at least one of the prospective parents does not have any living children from a previous relationship.

A child adopted by a patient or adopted in a previous relationship is considered to have the same status as a biological child.

Welfare of the child

Each patient and their partner, if they have one, must conform to the HFEA ‘Code of Practice’ to be able to access to NHS-funded assisted conception.

Age of woman

This policy only applies to adults.

Prospective mothers must be no more than 42 years of age (before their 43rd birthday) at the start of the full in vitro fertilisation (IVF) or intra-cytoplasmic sperm injection (ICSI) treatment cycle.

Body mass index (BMI)

Prospective mothers must have a BMI of between 19 and 30 for a period of at least six months prior to commencement of treatment.

Smoking status

Each patient and their partner, if they have one, must have been non-smokers for at least six months prior to commencement of treatment.

Alcohol and recreational drug use

Each patient and their partner, if they have one, must give assurances that their alcohol intake is within Department of Health guidelines, and they are not currently using recreational drugs.

Number of intrauterine insemination (IUI) cycles of treatment

We will fund up to 12 NHS-funded unstimulated IUI cycles for eligible patients.

IUI for single women and same-sex couples is not routinely funded unless the criteria set out within the policy are met.

Number of in vitro fertilisation (IVF) or intra-cytoplasmic sperm injection (ICSI) cycles of treatment

We will fund one NHS-funded full IVF/ICSI cycle for eligible patients.

Patients who have previously had NHS-funded IVF/ICSI or patients who have had more than two full cycles of IVF/ICSI (if aged under 40) and more than one cycle (if over 40), whether privately or NHS-funded will not receive any further NHS-funded IVF/ICSI.  

For women aged 40 to 42 who have been trying for 2 years or longer, or have had 12 cycles of IUI, we will fund 1 full cycle of IVF if the following apply:

  • they have never had IVF before
  • they have discussed the risks of IVF and becoming pregnant at this age with their doctor

Exceptional circumstances

Where the eligibility criteria are not met but your clinician feels there are exceptional clinical reasons, cases can be referred to our Individual Funding Requests (IFR) panel for consideration.

Read our evidence based interventions policy to find out more about eligibility.

Fertility preservation

Fertility preservation usually involves the harvesting and freezing of eggs or sperm that may be thawed for use in future assisted conception treatment.

It can also involve the creation of embryos for freezing that may be implanted in the womb later.

Am I eligible for fertility preservation?

Fertility preservation is only available on the NHS to patients whose ongoing medical condition or treatment is causing, or is likely to cause, permanent harmful effects on sperm or egg production.

Read our evidence based interventions policy to find out more about eligibility.

Frequently asked questions

How do I start my IVF journey?

If you have concerns about your fertility, you should visit you GP in the first instance and they can advise what investigations you may need.

Around 1 in 7 heterosexual couples may have difficulty conceiving.

84% of women in the general population will conceive within 1 year if the woman is aged under 40 years and they do not use contraception and have regular sexual intercourse (every 2 – 3 days). This increases to 92% after 2 years and 93% after 3 years.

Who is eligible for assisted conception on the NHS?

Read our evidence based interventions policy to find out more about eligibility.

Why don’t you fund three cycles of IVF as recommended by NICE?

NICE recommends three cycles of IVF.  However, in South West London we fund 1 cycle.

The reason for this is that, within currently available resources, we want more people to have access to IVF treatments rather than restrict access to a smaller number of people who are offered 3 cycles of NHS-funded IVF.

Why do I have to wait two years before I can get IVF treatment?

Around one in seven couples may have difficulty conceiving.

84% of women in the general population will conceive within one year if the woman is aged under 40 years and they do not use contraception and have regular sexual intercourse (every 2 to 3 days). This increases to 92% after two years and 93% after three years.

What if I do not meet the eligibility criteria in full?

If you do not meet the eligibility criteria in full, we will not be able to fund your IVF treatment.

Where the eligibility criteria are not met but your clinician feels there are exceptional clinical reasons, your case can be referred to our Individual Funding Requests (IFR) panel for consideration.

Can single women or same-sex female couples have IVF on the NHS?

Yes, if the prospective mother has an identified cause of sub-fertility/infertility or has had 12 cycles of unstimulated intrauterine insemination (IUI) over at least 12 months.

Can single men or same-sex male couples have IVF on the NHS?

No, they cannot as IVF would require a surrogate mother and surrogacy is not funded in England due to legal reasons. However, they are eligible for fertility investigations should this be required.

Why is surrogacy not funded by the NHS?

Surrogacy is legal in the UK but the Surrogacy Arrangements Act 1985 makes commercial surrogacy illegal.

The legal parentage remains with the mother carrying the child – regardless of whether the child is genetically related or not. If the host mother wishes to keep the child she has been carrying, it is her right to do so.

Therefore, the funding of surrogacy arrangements and associated conception treatments raises numerous legal and ethical issues.

What is the success rate of IVF?

The success rate of IVF depends on the age of the woman undergoing treatment, as well as the cause of the infertility (if it’s known).

Younger women are more likely to have a successful pregnancy. IVF isn’t usually recommended for women over the age of 42 because the chances of a successful pregnancy are thought to be too low.

Can I claim back money from the NHS if I had IVF privately?

No, you cannot claim back money for privately funded IVF treatments. However, if you meet the full eligibility criteria then you will be eligible for NHS funded IVF.

Can I claim parts of my treatment on the NHS and fund others privately?

No, you cannot mix private and NHS-funded treatments.

If you are eligible for NHS funded IVF then all aspects will be paid for by the NHS. However, if you need a donor egg or sperm the costs associated with the procurement and transportation will have to be paid by you.

Can I get some tests or drugs from my GP if I am undergoing IVF privately?

When investigating your fertility, GPs can only carry out the tests described in section 18.7 of our evidence based interventions policy.

You may receive other tests and prescriptions from your chosen secondary care provider. These are outlined within sections 18.8 to 18.12 of the policy.  Section 18.11 describes the circumstances under which a referral may also be considered for specialist tests, for example hepatitis B or HIV. 

None of these additional tests should be undertaken by your GP.  Please note that this also includes requests from private providers, whether the treatment is NHS or privately funded.

I am a British citizen, but my wife has to pay charges to overseas visitors? Can we get IVF?

Where two people are seeking assisted conception services with NHS funding, and one of the two people is covered by health surcharge arrangements and the other is ordinarily resident in the UK and therefore not subject to charge, the services required by the health surcharge payer will be chargeable. 

Any services required by the ordinarily resident person will continue to be freely available, subject to the established local or national funding arrangements. This applies to both diagnosis and treatment.

Which hospitals can I go to for my IVF?

There are several NHS providers in London you can go to for your IVF. You should speak to your doctor about which services to use or check the government regulator for services.

Before you can start treatment, we must give authorisation to your provider.