A rising number of women are seeking private IVF treatments in England as the National Health Service rolls back funding for fertility services.
Only 24 per cent of IVF cycles in England were funded by the NHS in 2022, compared with 32 per cent in 2019, according to the Human Fertilisation and Embryology Authority, an independent regulator.
With birth rates falling, academics and charities are calling for a national policy for providing fertility treatment across the NHS.
The National Institute for Health and Care Excellence, the public health body, recommends that women under 40 who have been unable to conceive for two years should be offered three full cycles on the NHS.
Women aged between 40 and 42 should be offered one cycle, according to the guidelines.
However, integrated care boards (ICBs), which allocate NHS resources to local health services, are not legally required to offer this to couples.
Experts have warned this has resulted in a “postcode lottery”, with NHS funding for IVF cycles varying enormously in different parts of the UK.
Just three of the 42 ICBs in England have policies consistent with Nice guidelines, according to a Financial Times analysis of data collected by the Progress Educational Trust (PET), a fertility charity.
Half of ICBs do not offer any treatment to women aged 40 and over, although some are in the process of reviewing their offering.
“The fundamental problem is that NHS funding isn’t consistent across England — it’s shockingly bad that it can vary in a matter of miles,” said Claire Heuclin, operations manager at the Fertility Network UK. “We believe that every ICB should meet Nice guidelines.”
Only 16,200 of the estimated 67,000 IVF cycles in England in 2022 were funded by the NHS, according to the HFEA. This is a decline of 17 per cent since 2019, when the NHS funded 19,600 of the total 60,400 cycles.
Other parts of the UK have also seen a decline in NHS IVF treatment, although they are less reliant on private clinics. Between 2019 and 2022 the proportion of NHS-funded cycles fell from 62 per cent to 53 per cent in Scotland and 39 per cent to 34 per cent in Wales.
Sarah Norcross, director of PET, believes NHS provision is declining because “there is no pressure or impetus on local commissioners in England to fund this properly”.
Fertility rates in England and Wales have continued to fall since 2010, reaching a record low of 1.5 in 2022. This is well below the “replacement level” of 2.1 children per woman at which a country’s population is considered to be stable without immigration.
No local areas have fertility rates above the replacement rate, down from almost a third in 2012, according to the Office for National Statistics.
The average age of first-time IVF patients increased to just over 35 in 2022, the highest since data collection began in 1991. By comparison, the average age of a first-time mother in England and Wales was 29, according to the ONS.
Experts say many women are choosing not to have children because of the increasing cost of living and the impact parenthood may have on their careers.
“We are looking at such a downward trend that anything that can be done to support those women who want children to have them is a good thing,” said Sarah Harper, a professor of gerontology at the University of Oxford. “We really should be pulling every lever available to us, including more support for fertility treatments.”
The NHS estimates that about one in seven couples may have difficulty becoming pregnant. One cycle of IVF can “cost up to £5,000 or more” if accessed privately.
Falling birth rates in recent years have been driven by women in their 30s, who account for the majority of babies. There has been a rapid rise in births to mothers in their 40s over the past few decades, but this group still only accounts for one in 20 live births.
“Fertility treatment is no longer a healthcare niche,” said Kayleigh Hartigan, founder of Fertility Mapper, an advice and review platform of fertility services. “It is how the majority will create families in the future.”
“Whilst at a national level we are all scratching our heads on how to tackle the issue of the national birth rate decline, we have no national policy for providing fertility treatment,” added Hartigan.
One reason for the decline in NHS funding is that changing demographics mean women are not qualifying for the different criteria set by ICBs. The criteria includes weight, age and personal circumstances, including how long you have been with a partner.
A total of 74 per cent of ICBs stipulate that you cannot already have any children, from either your current or previous relationships, according to Hartigan.
Professor Geeta Nargund, medical director of Create Fertility, a clinic based in the City of London, added: “Falling levels of NHS funding for IVF treatment are a depressing reflection of the state of fertility treatment accessibility in the UK, and should be a particular cause for concern for an ageing society on the brink of a fertility rates crisis.”
An NHS spokesperson said: “While these decisions are legally for local health commissioners who have to balance the various competing demands on the NHS locally, it is absolutely right that they provide equal access to services according to the needs of people within their areas.”
A Department of Health and Social Care spokesperson added: “Everyone should have access to the fertility services they need, regardless of where they live.
“There are clear clinical guidelines making sure there is equal access across the country, and we fully expect these to be followed.”