Clinical policies directory: Assisted conception procedures
The Assisted Conception policy contains a list of procedures that are either funded by Surrey Heartlands when certain criteria is met, or where they are not routinely funded.
For procedures not routinely funded, your consultant will need to submit an Individual Funding Request (IFR) application if they are able to describe how your clinical presentation can be considered to be exceptional and the procedure will provide you with more clinical benefits compared to others.
These pages provide a web friendly version of the Assisted Conception Policy (CLIN05).
Go to Policies and Processes page (Clinical policies section) of this website to read the full policy.
Patients in transgender relationships, where one partner is female and the other is a trans-female (male to female), will be regarded in the same manner as those in same-sex relationships.
Armed Forces (citizens that are in the army)
Overview
Funding for fertility treatment for the Armed Forces.
Thresholds and eligibility
Funding for Armed Forces personnel diagnosed with fertility problems will be the responsibility of NHS England.
The assessment and treatment pathway for individuals with fertility problems (based on NICE guideline 156) are set out in the NHS England Clinical Commissioning Policy on Assisted Conception.
Resources
Cryopreservation to preserve fertility in people diagnosed with cancer (freezing sperm, embryos or oocytes)
Overview
Embryo freezing (cryopreservation) freezes and stores fertilised sperm or eggs for later use. It’s often used with fertility treatments that create embryos (a fertilised egg), such as in vitro fertilization (IVF). It also can help people preserve fertility and get pregnant in the future.
Thresholds and eligibility
The South East Regional Priorities Committee (SERPC) considered NICE and other national guidance; professional society guidance, the evidence base, baseline position, other integrated care board (ICB) policies, equality and equity issues, and the potential impact of changing policy.
All decisions were made with reference to the South East Region Policy Recommendation Committees’ Ethical Framework. Taking these into account, the SERPC recommends:
- Cryopreservation (freezing) of eggs, embryos or sperm will be funded for eligible patients who are under the care of a specialist clinician who has confirmed one of the following:
- the patient is due to undergo a gonadotoxic treatment (i.e. a treatment or surgery that will damage or destroy ovaries or testes ability to produce eggs or sperm); for clarity this may include patients undergoing interventions for gender affirmation
- the patient does not currently have fertility problems, but they have a medical condition that, in their case, is likely to progress such that it will lead to infertility in the future
- The maximum number of egg collection procedures funded for eligible patients will be two. Subsequent cycles will only be funded when deemed clinically appropriate by the treating clinician. No additional egg collection cycles will be routinely funded, even if previous cycles were unsuccessful.
- Fertility preservation patients who require cryopreservation of eggs or embryos must fulfil both of the following criteria:
- they must be well enough to undergo ovarian stimulation and egg collection, and this will not worsen their condition
- enough time must be available before the start of their gonadotoxic treatment, where applicable
- Fertility preservation will be funded for patients who have started a gonadotoxic treatment (e.g. patients undergoing gender affirmation interventions who have started hormone therapy) only if all treatment is paused until either the patient’s normal menstrual cycle has resumed and testosterone has returned to a normal female range, or sperm production has returned, and sperm parameters have returned to a normal range.
- Storage of sperm, embryos and eggs will be funded for 10 years duration after cryopreservation. NHS funding of storage will end sooner where:
- following gonadotoxic treatment, fertility has been established through tests or Conception, or
- the patient dies, and no written consent has been left permitting posthumous use.
- Patients will have the opportunity to self-fund continued cryopreservation of any unused sperm, embryos or eggs after the NHS funded storage period concludes.
- NHS funding of fertility preservation does not guarantee funding of Assisted Conception treatments using cryopreserved materials (sperm, eggs, or embryos) in the future. To access NHS funded Assisted Conception treatments using cryopreserved materials fertility preservation patients must meet the same eligibility criteria as other patients with fertility problems at the time they wish to undergo this treatment.
Assisted Conception treatments involving surrogates is not funded on the local NHS.
In relation to NHS patients who have used or wish to use private care, ICBs will follow Department of Health and Social Care guidance on NHS patients who wish to pay for additional private care (2009).
Note: SERPC-05 is intended as an interim policy and may be subject to change following the upcoming review of the South East region ICBs Assisted Reproductive Treatment (ART) policies.
Resources
Additional information
If the patient does not meet the criteria for this procedure, the clinician has the option of submitting an Individual Funding Request (IFR) application to the NHS Surrey Heartlands Effective Commissioning Initiative (ECI) Team via the Blueteq database.
Cryopreservation of eggs and sperm for young patients
Overview
Cryopreservation freezes and stores eggs and sperm for later use. It’s often used with fertility treatments that create embryos (a fertilised egg), such as in vitro fertilization (IVF). It also can help people preserve fertility and get pregnant in the future.
Thresholds and eligibility
Cryopreservation of eggs and sperm will be funded for up to two years for young patients (18 and under and who are post pubertal), who are about to or have received treatment likely to affect their fertility. Subsequent assisted conception procedures will be funded in accordance with all eligibility criteria set out in this policy.
Resources
Additional information
If the patient does not meet the criteria for this procedure, the clinician has the option of submitting an Individual Funding Request (IFR) application to the NHS Surrey Heartlands Effective Commissioning Initiative (ECI) Team via the Blueteq database.
Intracytoplasmic Sperm Injection (ICSI) (infertility treatment where live sperm is injected into an egg in a laboratory to create an embryo)
Overview
Intracytoplasmic sperm injection (ICSI) is an infertility treatment. It involves injecting live sperm into a person's eggs in a laboratory. This procedure can create an embryo (fertilized egg). ICSI is a form of in vitro fertilization (IVF) and is most commonly used when male infertility affects a couples ability to conceive.
Thresholds and eligibility
IVF with or without ICSU will be for funded for women who have not conceived after three years of regular unprotected intercourse (which can include no more than 1 year prior to fertility investigations), or a maximum of six cycles of IUI unless clinical judgement dictates otherwise.
Eligibility for IVF in respect of age will be determined at the point of referral to an Assisted Conception Unit (ACU). This allows eligible women who have been referred to have appropriate cycles of treatment before their 40th birthday. Up to two cycles of IVF, with or without ICSI, will be funded in eligible women who are aged not more that 39 years and zero days at the time of referral to the ACU. If the woman reaches the age of 40 during treatment, then the current full cycle will be funded but no further cycles will be funded even if only one has been completed. Where a top-quality blastocyst is available, single embryo transfer should be used.
There is no upper or lower age limit for the male partner (as per adoption laws).
In relation to women in same sex relationships and women not in a relationship but who are eligible for IVF/ICSI; NHS funding will only be made available for sperm donation for use in IUI or IVF where the sperm are donated altruistically free of change or are available via an NHS sperm bank or equivalent. Egg donation will not be funded routinely. Women in same sex relationships and women not in a relationship should have access to professional experts in reproductive medicine to obtain advice on the options available to enable them to proceed along this route if they so wish.
Previous infertility treatment and eligibility for IVF/ICSI; eligibility in respect of age will be determined at the point of referral to an ACU. Eligible individuals under the age of 40 will be funded:
- For up to six cycles of initial IUI, as clinically indicated and at the discretion of the referring gynaecologist.
- For up to two cycles of IVF, with or without ICSI, if no previous cycles have been funded by the NHS.
- For one cycle of IVF, with or without ICSI, if the individuals have already received one cycle funded by the NHS.
Any privately funded cycles previously received will not be taken into account (unless they resulted in the individuals having a living child).
Individuals must take up the offer of treatment within six months of being referred to the ACU provider.
If a cycle is abandoned for reasons of poor response or failure of fertilisation, this will count as one full cycle.
If a cycle results in a miscarriage, this will count as one full cycle.
Women who have attempted IVF, with or without ICSI, will not be offered subsequent IUI.
Individuals cannot have a living child from their relationship or any previous relationships in order to be eligible for IVF. A child adopted by the individuals or adopted in a previous relationship is considered to have the same status as a biological child.
Providers will be expected to undertake appropriate diagnostic investigations to determine suitability for IVF in line with contemporary good practice and should take all reasonable measures to prevent the occurrence of Ovarian Hyperstimulation (OHSS).
Assisted Conception will not be provided to individuals if their subfertility is the result of sterilisation in either partner, unless the patient(s) sterilisation is the direct result of treatment for gender dysphoria.
IVF, with or without ICSI, will only be funded for women who have had a BMI of between 19 and 30 for a period of at least 6 months prior to assessment for treatment. Women who have a BMI of over 30 should be informed that they are likely to take longer to conceive. If they are not ovulating, they should be informed that losing weight is likely to increase their chances of conception.
Women must be informed of this criteria at the earliest possible opportunity as they progress through infertility investigations in primary and secondary care.
GP's are encouraged to provide unambiguous and clear information about BMI criteria to infertile individuals.
IVF, with or without ICSI, will only be funded for individuals where bother partners have been non-smokers for a period of at least 6 months prior to assessment for treatment. Smoking individuals must be referred to NHS smoking cessation services and demonstrate that they are non-smokers for a period of at least six months prior to assessment for treatment.
Alongside BMI and smoking, infertile individuals should be advised that the effectiveness of assisted reproduction procedures, including IVF, is reduced by the consumption of more than one unit of alcohol per day and maternal caffeine consumption.
Individuals not conforming to the HFEA 'Code of Practice' will be excluded from having access to NHS funded assisted reproduction procedures. This includes consideration of the welfare of the child which may be born which may take into account the importance of a stable and supportive environment for children as well as the pre-existing health status of the parents.
Resources
Additional information
If the patient does not meet the criteria for this procedure, the clinician has the option of submitting an Individual Funding Request (IFR) application to the NHS Surrey Heartlands Effective Commissioning Initiative (ECI) Team via the Blueteq database.
Intra-Uterine Insemination (IUI)
Overview
IUI (intrauterine insemination) is a type of artificial insemination. Sperm that have been washed and concentrated are placed directly inside of your uterus during ovulation. This helps healthy sperm get closer to the egg when it’s released by your ovaries. It’s a common fertility treatment for couples or individuals wishing to conceive.
Thresholds and eligibility
Up to six cycles of IUI will be funded for individuals who have not conceived despite evidence of normal ovulation, tubal patency, and semenalysis, if they fall into the following groups:
- 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 of where there is a female with no partner.
- People with social, cultural, or religious objections to IVF.
- Females with no partner requiring donor sperm.
- People with unexplained fertility, mild endometriosis, or mild male factor infertility not falling into the above groups will not be funded for IUI, with our without ovarian stimulation, but will be considered for IVF after trying to conceive for 3 years.
Resources
Additional information
If the patient does not meet the criteria for this procedure, the clinician has the option of submitting an Individual Funding Request (IFR) application to the NHS Surrey Heartlands Effective Commissioning Initiative (ECI) Team via the Blueteq database.
In-Vitro Fertilisation (IVF)
Overview
In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm outside of the body to form embryos. The process involves monitoring and stimulating an individual's ovulatory process, removing an ovum or ova from their ovaries and letting sperm fertilise them, usually in a laboratory.
Thresholds and eligibility
IVF with or without ICSU will be for funded for women who have not conceived after three years of regular unprotected intercourse (which can include no more than 1 year prior to fertility investigations), or a maximum of six cycles of IUI unless clinical judgement dictates otherwise.
Eligibility for IVF in respect of age will be determined at the point of referral to an Assisted Conception Unit (ACU). This allows eligible women who have been referred to have appropriate cycles of treatment before their 40th birthday. Up to two cycles of IVF, with or without ICSI, will be funded in eligible women who are aged not more that 39 years and zero days at the time of referral to the ACU. If the woman reaches the age of 40 during treatment, then the current full cycle will be funded but no further cycles will be funded even if only one has been completed. Where a top-quality blastocyst is available, single embryo transfer should be used.
There is no upper or lower age limit for the male partner (as per adoption laws).
In relation to women in same sex relationships and women not in a relationship but who are eligible for IVF/ICSI; NHS funding will only be made available for sperm donation for use in IUI or IVF where the sperm are donated altruistically free of change or are available via an NHS sperm bank or equivalent. Egg donation will not be funded routinely. Women in same sex relationships and women not in a relationship should have access to professional experts in reproductive medicine to obtain advice on the options available to enable them to proceed along this route if they so wish.
Previous infertility treatment and eligibility for IVF/ICSI; eligibility in respect of age will be determined at the point of referral to an ACU. Eligible individuals under the age of 40 will be funded:
- For up to six cycles of initial IUI, as clinically indicated and at the discretion of the referring gynaecologist.
- For up to two cycles of IVF, with or without ICSI, if no previous cycles have been funded by the NHS. Eligible patients will be funded for a maximum of 4 embryo transfers using fresh or frozen embryos created from a maximum of 2 NHS funded fresh IVF/ICSI cycles’ under IVF/ICSI respectively.
- For one cycle of IVF, with or without ICSI, if the individuals have already received one cycle funded by the NHS.
Any privately funded cycles previously received will not be taken into account (unless they resulted in the individuals having a living child).
Individuals must take up the offer of treatment within six months of being referred to the ACU provider.
If a cycle is abandoned for reasons of poor response or failure of fertilisation, this will count as one full cycle.
If a cycle results in a miscarriage, this will count as one full cycle.
Women who have attempted IVF, with or without ICSI, will not be offered subsequent IUI.
Individuals cannot have a living child from their relationship or any previous relationships in order to be eligible for IVF. A child adopted by the individuals or adopted in a previous relationship is considered to have the same status as a biological child.
Providers will be expected to undertake appropriate diagnostic investigations to determine suitability for IVF in line with contemporary good practice and should take all reasonable measures to prevent the occurrence of Ovarian Hyperstimulation (OHSS).
Assisted Conception will not be provided to individuals if their subfertility is the result of sterilisation in either partner, unless the patient(s) sterilisation is the direct result of treatment for gender dysphoria.
IVF, with or without ICSI, will only be funded for women who have had a BMI of between 19 and 30 for a period of at least 6 months prior to assessment for treatment. Women who have a BMI of over 30 should be informed that they are likely to take longer to conceive. If they are not ovulating, they should be informed that losing weight is likely to increase their chances of conception.
Women must be informed of this criteria at the earliest possible opportunity as they progress through infertility investigations in primary and secondary care.
GP's are encouraged to provide unambiguous and clear information about BMI criteria to infertile individuals.
IVF, with or without ICSI, will only be funded for individuals where bother partners have been non-smokers for a period of at least 6 months prior to assessment for treatment. Smoking individuals must be referred to NHS smoking cessation services and demonstrate that they are non-smokers for a period of at least six months prior to assessment for treatment.
Alongside BMI and smoking, infertile individuals should be advised that the effectiveness of assisted reproduction procedures, including IVF, is reduced by the consumption of more than one unit of alcohol per day and maternal caffeine consumption.
Individuals not conforming to the HFEA 'Code of Practice' will be excluded from having access to NHS funded assisted reproduction procedures. This includes consideration of the welfare of the child which may be born which may take into account the importance of a stable and supportive environment for children as well as the pre-existing health status of the parents.
Resources
Additional information
If the patient does not meet the criteria for this procedure, the clinician has the option of submitting an Individual Funding Request (IFR) application to the NHS Surrey Heartlands Effective Commissioning Initiative (ECI) Team via the Blueteq database.
In-Vitro Maturation (IVM) (technique where eggs are collected and matured outside of the body)
Overview
In vitro maturation is the technique of letting the contents of ovarian follicles and the oocytes inside mature in vitro. It can be offered to women with infertility problems, combined with In-Vitro Fertilization, offering women pregnancy without ovarian stimulation.
Thresholds and eligibility
In-Vitro Maturation (IVM) will not be funded, due to limited evidence of effectiveness.
Resources
Pre-Implantation Genetic Diagnosis - PGD (Genetic profiling of embryos)
Overview
Pre-implantation genetic diagnosis (PGD) is the genetic profiling of embryos prior to implantation, and sometimes of oocytes prior to fertilization.
Thresholds and eligibility
Funding of PGD is separate from infertility treatment and is covered by the London Genetics Panel and South East Coast Specialised Commissioning Group. Referral is made directly by the Consultant to this Panel.
Resources
Additional information
If a patient requires this procedure the clinician is required to submit an Individual Funding Request (IFR) application to the NHS Surrey Heartlands Effective Commissioning Initiative Team via the Blueteq database.
Oocyte (Egg) Donation
Overview
Egg donation is the process by which a woman donates eggs to enable another woman to conceive as part of an assisted reproduction treatment.
Thresholds and eligibility
Oocyte donation will not be funded routinely.
Resources
Additional information
If the patient does not meet the criteria for this procedure, the clinician has the option of submitting an Individual Funding Request (IFR) application to the NHS Surrey Heartlands Effective Commissioning Initiative (ECI) Team via the Blueteq database.
Sperm Donation
Overview
Sperm donation is the provision by a man of his sperm with the intention that it be used in the artificial insemination or other fertility treatment of one or more women who are not his sexual partners in order to become pregnant.
Thresholds and eligibility
Sperm donation will be funded only where the sperm are altruistically donated without charge or can be accessed from an NHS sperm bank or equivalent.
Resources
Additional information
If the patient does not meet the criteria for this procedure, the clinician has the option of submitting an Individual Funding Request (IFR) application to the NHS Surrey Heartlands Effective Commissioning Initiative (ECI) Team via the Blueteq database.
Sperm Washing
Overview
Sperm washing is the process in which individual sperms are separated from the semen. Washed sperm is used in artificial insemination using the intrauterine insemination (IUI) technique and in in vitro fertilization (IVF).
Thresholds and eligibility
Sperm washing will be funded if the man is HIV positive and either he is not compliant with HAART or his plasma viral load is 50 copies/ml or greater, as it reduces but does not eliminate the risk of HIV transmission.
Sperm washing will not be funded for men with Hepatitis B or Hepatitis C, as the current evidence does not support this.
Resources
Additional information
If the patient does not meet the criteria for this procedure, the clinician has the option of submitting an Individual Funding Request (IFR) application to the NHS Surrey Heartlands Effective Commissioning Initiative (ECI) Team via the Blueteq database.
Surgical Sperm Retrieval (retrieving sperm surgically)
Overview
Surgical sperm retrieval is the retrieval of sperm for fertilisation from the epididymis or testicles to assist conception for couples where the male partner suffers from azoospermia.
Thresholds and eligibility
Surgical sperm retrieval will be funded in appropriately selected patients, provided that the azoospermia is not the result of a sterilisation procedure or the absence of sperm production, and providing the individuals meet all other criteria.
Resources
Additional information
If the patient does not meet the criteria for this procedure, the clinician has the option of submitting an Individual Funding Request (IFR) application to the NHS Surrey Heartlands Effective Commissioning Initiative (ECI) Team via the Blueteq database.
Surrogacy (carrying a baby for someone else)
Overview
Surrogacy is an arrangement whereby a woman agrees to carry a baby for another person or people, who will become the child's parent after birth.
Thresholds and eligibility
No elements of Surrogacy procedures will be funded. Therefore, NHS Surrey Heartlands will:
- Not be involved in the recruitment of surrogate mothers.
- Not fund any element of treatment which relates specifically to addressing fertility treatments directly associated with surrogacy arrangements.
- Not fund any payments to a surrogate mother (to cover expenses, legal costs, treatments abroad or transport costs).
Resources