In-Vitro Fertilisation (IVF) and Assisted Conception (existing treatment)

 

In-Vitro Fertilisation (IVF) and Assisted Conception (existing treatment)

Proposal:

In 2015 NHS Basildon and Brentwood CCG undertook a Public Consultation to cease specialist fertility service provision. No decision has yet been made following the consultation. However, if the proposal (as per consultation in 2015) were to be approved by the CCG Board, then services would be decommissioned for those requiring tests or procedures that were deemed specialist.

Therefore, those who haven’t already been seen by or referred to one of the current providers, will no longer be able to be referred for a specialist fertility service.

The CCG would continue to fund those tests or procedures that would diagnose fertility problems and those that can be undertaken in a local hospital to aid fertility.

We are now consulting on proposals for people who have already been referred for specialist fertility treatment, for whom the decision of what the CCG will fund for them was not addressed in the original consultation.

The proposals for people who have already been referred or are receiving treatment for specialist assisted conception services cover the following:

  • In Vitro Fertilisation (IVF) with or without Intracytoplasmic Sperm Injection (ICSI)

  • Frozen Embryo Transfer

  • Embryo/Blastocyst Freezing and Storage

  • Surgical Sperm Recovery (Testicular Epididymal Sperm Aspiration (Testicular Epididymal Sperm Aspiration (TESA)/Percutaneous Sperm Aspiration (PESA) including storage where required)

  • Intrauterine Insemination (IUI) - unstimulated

  • Donor Oocyte Cycle

  • Donor Sperm Insemination

  • Egg Storage for Patients Undergoing Cancer Treatments

  • Sperm Storage for Patients Undergoing Cancer Treatments

For those patients who have already been referred for specialist fertility treatment and are in the process of receiving the above specialist services, the CCG is proposing to introduce the following restrictions:

Procedure

What 

Proposal

In Vitro Fertilisation (IVF) with or without Intracytoplasmic Sperm Injection

(ICSI)

A full cycle of IVF treatment, with or without intracytoplasmic sperm injection (ICSI), should comprise 1 episode of ovarian stimulation and the transfer of any resultant fresh and frozen
embryo(s). This will include the storage of any frozen embryos for 1 year following egg collection. Patients should be advised at the start of treatment that this is the level of service available on the NHS and following this period continued storage will need to be funded by themselves or allowed to perish.

An embryo transfer is from egg retrievalto transfer to the uterus. The fresh embryo transfer would constitute one such transfer and each subsequent transfer to the uterus of frozen embryos would constitute another transfer.

Before a new fresh cycle of IVF can be initiated any previously frozen embryo(s) must be utilised.

Where couples have previously self-funded a cycle then the couples must utilise the previously frozen embryos, rather than undergo ovarian stimulation, egg retrieval and fertilisation again.

For anyone who has progressed to IVF the CCG is proposing that they will fund the current cycle with a cycle being considered as:

• One fresh and up to one frozen transfer

* Where more embryos are frozen than can be used for the proposed cycle/s patients can choose to fund storage themselves.

Frozen Embryo Transfer

 For women less than 37 years of age only one embryo or blastocyst to be transferred in the first cycle of IVF and for subsequent cycles only one embryo/blastocyst to be transferred unless no top quality embryo/blastocyst available then no more than 2 embryos to be transferred.

For women age 37-39 years only one embryo/blastocyst to be transferred unless no top quality embryo/blastocyst available then no more than 2 embryos to be transferred.

For women 40-42 years consider double embryo transfer.

A fresh cycle would be considered completed with the attempt to collect eggs and transfer of a fresh embryo.

For those who have previously had CCG funding and have embryos in storage the CCG is proposing:

  • Funding only where considered as part of the current cycle (as above)

* Where more embryos are frozen than can be used for the proposed cycle/s patients can choose to fund storage themselves.

Embryo/Bloastocyst
Freezing and Storage

 

Where embryos have previously been stored the CCG is proposing:

  • Freezing and storage for up to one year

    * Patients can choose to fund embryo / blastocyst storage themselves beyond the NHS funded period. 

Surgical Sperm Recovery

(Testicular Epididymal Sperm Aspiration

(TESA)/Percutaneous Sperm Aspiration

(PESA) including storage where required)

 

 Where this is part of a current cycle the proposal is that:

  • The CCG will fund this for the current cycle only

  • The CCG will not fund storage beyond the current funded cycle requirement.

 * Patients can choose to fund sperm storage themselves beyond the NHS funded period.

Intrauterine Insemination (IUI) unstimulated

NICE guidelines state that unstimulated intrauterine insemination as a treatment option in the following groups as an alternative to vaginal sexual intercourse:

  • people who are unable to, or would find it very difficult to, have vaginal intercourse because of a clinically diagnosed physical disability or psychosexual problem who are using partner or donor sperm

  • people with conditions that require specific consideration in relation to methods of conception (for example, after sperm washing where the man is HIV positive)

  • people in same-sex relationships

Due to poor clinical evidence, a maximum of 6 cycles of IUI (as a replacement for IVF/ICSI and without donor sperm).

The CCG proposal is that:

  • the patient is able to complete the current cycle of IUI

 Donor Oocyte Cycle

 The patient may be able to provide an egg donor; alternatively the patient can be placed on the waiting list, until an altruistic donor becomes available. If either of the couple exceeds the age criteria prior to a donor egg becoming available, they will no longer be eligible for treatment.

This will be available to women who have undergone premature ovarian failure (amenorrhoea >6 months and a raised FSH >25) due to an identifiable pathological or iatrogenic cause before the age of 40 years or to avoid transmission of inherited disorders to a child where the couple meet the other eligibility criteria.

 The CCG proposal is that:

  • the patient is able to complete the current donor oocyte cycle

  • Up to 2 transfers

* Patients can choose to fund oocyte / embryo / blastocyst storage themselves.

Donor Sperm Insemination

The use of donor insemination is considered effective in managing fertility problems associated with the following conditions:

  • obstructive azoospermia

  • non-obstructive azoospermia

  • severe deficits in semen quality in couples who do not wish to undergo ICSI

  • Infectious disease of the male partner (such as HIV)

  • Severe rhesus isoimmunisation

  • Where there is a high risk of transmitting a genetic disorder to the offspring

Donor insemination is funded up to a maximum of 6 cycles of Intrauterine Insemination (IUI).

 The CCG proposal is that:

• the patient is able to donate sperm for the current cycle of:

• IUI

• IVF

* Patients can choose to fund sperm storage themselves beyond the NHS funded period.

Egg Storage for Patients Undergoing Treatments

Sperm Storage for Patients Undergoing Treatments

When considering and using cryopreservation for people before starting chemotherapy or radiotherapy that is likely to affect their fertility, follow recommendations in ‘The effects of cancer treatment on reproductive functions’ (2007).

When using cryopreservation to preserve fertility in people diagnosed with cancer, use sperm, embryos or oocyctes.

Offer sperm cryopreservation to men and adolescent boys who are preparing for medical treatment for cancer that is likely to make them infertile.

Local protocols should exist to ensure that health professionals are aware of the values of semen cryostorage in these circumstances, so that they deal with the situation sensitively and effectively.

Offer oocyte or embryo cryopreservation as appropriate to women of reproductive age (including adolescent girls) who are preparing for medical treatment for cancer that is likely to make them infertile if:

  • they are well enough to undergo ovarian stimulation and egg collection and

  • this will not worsen their condition and

  • enough time is available before the start of their cancer treatment.

Cryopreserved material may be stored for an initial period of 10 years.

Following cancer treatment, couples seeking fertility treatment must meet the defined eligibility criteria.

 The CCG proposal is that they fund storage of eggs/sperm that have been frozen already for those undergoing treatment for cancer and other medical conditions that affect their reproductive functions.

The CCG will fund the storage until the person reaches the age of 42 or for 10 years (whichever comes first).

If the patient dies whilst their sperm or eggs are in storage the CCG will no longer fund the storage 3 months from the person dying.

* Patients can choose to fund storage themselves beyond the NHS funded period.

Rationale for change:

The CCG feel that this decision supports transparency and equity of approach to the population and reduces the perception that for some people we are funding fully in line with NICE Guidance whilst for others not supporting funding at all.

Impact:

The CCG also considers that withdrawing support for funding for those in the system is unfair without notification of this change in decision or approach.
The efficiencies made by not funding this procedure will go towards bringing the CCG back to its statutory financial balance position which is vital in order for it to be viable organisation and fund future services for the local population.

For further information:

Download the Service Restriction Policy Review document here

Download the Equality Impact Assessment - IVF document   here

See our information on Have your say on the Service Restriction Policy Review

Download our current Service Restriction Policy here

Find more information on existing local services at http://www.nhs.uk/service-search