Disparities in NHS IVF Access Highlighted Across East Midlands

Hannah Newby, 33, has been presented with an opportunity to establish the family she has “always dreamed of” through the NHS. Diagnosed with Turner syndrome in 2023, a genetic condition that had previously led to early menopause during her teenage years and subsequent infertility, Mrs Newby’s access to fertility treatment is geographically determined. Residing in Southwell, Nottinghamshire, she is eligible for only one cycle of IVF under the policy of her local NHS integrated care board (ICB). However, if she lived approximately 20 miles (32km) away in the Bassetlaw district, she would qualify for three cycles. Amid proposed policy revisions by health authorities, Mrs Newby is advocating for the elimination of this “postcode lottery” to ensure a more equitable system. The Nottingham and Nottinghamshire Integrated Care Board (ICB) has initiated a public consultation, inviting residents to provide their perspectives on fertility services policies via an online survey. Currently, Bassetlaw stands as the sole area within the county where residents are granted access to three rounds of NHS IVF. This contrasts with guidance from the National Institute for Health and Care Excellence (NICE), which recommends offering three cycles to women under 40 who meet specific criteria. Mrs Newby expressed her concern, stating, “I think it’s crazy that we could live in the same region but we could have differences.” She added, “I feel it’s a right to have a family.” Eligibility for NHS fertility services is also contingent on various other factors, including health status, age, and whether individuals have children from a previous relationship amongst others. Furthermore, significant variations exist in fertility services policies across the five integrated care boards in the East Midlands, which encompass Derbyshire, Leicestershire and Rutland, Northamptonshire, and Lincolnshire. Mrs Newby described the situation as “a real mess. Why it’s all so separate in regions I don’t understand.” She conveyed the emotional toll, saying, “You do feel upset, angry and all the emotions. It’s such a sensitive subject because you want it so badly. “Just because of where you live, why should someone have a better chance?”” These inconsistencies in policy have prompted “listening exercises” throughout the region, including the one in Nottinghamshire, with the stated aim of establishing a single, fair policy for the East Midlands. Mrs Newby is scheduled to commence treatment in January. While she and her husband, Dave, are endeavoring not to place “too much pressure” on themselves, they have had to consider the implications should the initial cycle prove unsuccessful. “It’s something we’ve already had to start talking about. What do we do if this doesn’t work?” she questioned. “Do you keep going? How far do you go to achieve having the child you’ve always dreamed of?” She also noted, “We hear of people that have completely bankrupted themselves trying to have a family.” Pursuing private treatment could incur costs of up to approximately £9,000 per cycle for the couple, according to Dr James Hopkisson, medical director of TFP Nurture Fertility Clinic, located across the border in Sandiacre, Derbyshire. Dr Hopkisson informed the BBC that “Unfortunately there has been a postcode lottery in terms of IVF funding and fertility funding for some time.” His private clinic holds an NHS contract, with approximately 40% of its cycles being NHS-funded for patients primarily from Nottinghamshire, Derbyshire, Leicestershire, and Lincolnshire. He observed that the differing access criteria across the region were contributing to dissatisfaction. He further stated, “Personally I think any decent civilised society should be looking at helping people to achieve their family.” Dr Hopkisson added, “And in a time where we are seeing national and international birth rates falling, actually it becomes more important that we help people have the families that they so desire.” However, a proposed East Midlands-wide initiative to standardize the policy could result in individuals seeking to start a family being offered only one cycle of IVF on the NHS. Dr Dave Briggs, medical director at Nottingham and Nottinghamshire ICB, indicated that NICE guidance recommending three IVF cycles for women under 40 should be considered “alongside” the priorities of the local area. He explained, “That doesn’t mean to say that we don’t recognise the importance of IVF and fertility services but we also need to ensure that delivers within our financial means and also a lot of other services at the same time.” Dr Briggs further clarified that the “vast majority” of the region currently receives only one cycle. He stated, “This proposal is looking for a single policy across the entire East Midlands to ensure it doesn’t matter if you live in the city centre or out in Bassetlaw or in Newark – you get exactly the same access to this important service, regardless of where you live.” Residents are invited to respond to the proposal by completing an online survey on the ICB website, participating in online public meetings, or providing feedback by phone. The public engagement period is scheduled to conclude on 10 January 2025.