EALING PCT INFERTILITY TREATMENT POLICY
Clinical / Corporate / Public Health / HR & Employment Law Document Number | |
Policy Author | Cyprian Okoro, Consultant in Public Health Medicine |
Approved and Authorised By | Jackie Chin & Ruth Barnes, Joint Director of Public Health |
Date Signed | |
Ratifying Committee | Board |
Date Ratified | |
Review Date | Three yearly, or as indicated by clinical or NICE developments |
Document Application | Trust-wide |
Related Documents | |
Distributed To | All GPs, Gynaecologists at local acute Trusts, service managers, assisted conception provider units and PCT intranet. |
Data Protection Act 1998
Data Protection issues have been considered with regard to this policy. Adherence to this policy will therefore ensure compliance with the Data Protection Act 1998 and internal Data Protection Policies.
Freedom of Information Act 2000
Freedom of Information issues have been considered with regard to this policy. Adherence with this policy will therefore ensure compliance with the Freedom of Information Act 2000 and internal Freedom of Information Policies.
Health and Safety Act 1974
Health and Safety issues have been considered with regard to this policy. Adherence with this policy will therefore ensure compliance with Health and Safety legislation and internal Health and Safety policies.
Mental Capacity Act 2005
The Mental Capacity Act 2005 provides a statutory framework to empower and protect vulnerable people who are not able to make their own decisions. It makes it clear who can take decisions, in which situations, and how they should go about this. It enables people to plan ahead for a time when they may lose capacity. Guidance set out in the Act should be considered when implementing this policy.
Human Rights Act 1998
The Human Rights Act 1998 has been considered with regard to this policy. Proportionality has been identified as the key to Human Rights compliance. This means striking a fair balance between the rights of the individual and those of the rest of the community. There must be a reasonable relationship between the aim to be achieved and the means used.
Race Relations Amendment Act 2000
The Race Relations Amendment Act 2000 has been considered with regards to this policy. Adherence to this policy means that the Trust will eliminate discrimination on the grounds of race and will promote race equality and good race relations.
Diversity Policies
Equality issues have been considered with regard to this policy. Adherence with this policy will therefore ensure compliance with Equal Opportunity legislation and internal Equal Opportunity policies.
1.0 INTRODUCTION
1.1 This policy sets out revised criteria for NHS funded treatment for infertility using assisted conception techniques such as in vitro fertilisation (IVF) for Ealing Primary Care Trust’s registered population.
1.2 IVF is now an established treatment option for infertility and the specialty is characterised by rapidly changing, albeit expensive health technologies. Demand for IVF services has also been increasing nationally.
1.3 The NICE 2004 Guideline recommended that eligible couple should have 3 cycles of IVF treatment but only few PCTs have been able to fully implement this. About 20% of PCTs fund 2 cycles of treatment but the Department of Health has recently urged PCTs to increase access to IVF services and to take necessary actions towards the full implementation of the guidelines.
1.4 This policy update is a response to the drivers identified above and the recommendations below are based on the best available evidence. The policy has undergone extensive consultation and the views of service users, lay public, local GPs, specialists, service managers and PCT senior management are all reflected in the recommendations.
1.5 The issue of offering IVF treatment within the 18 week environment was discussed during consultations. With necessary service changes, it is possible to achieve the 18 weeks target in this context. This policy will therefore apply to all patients referred under the 18 week rules.
1.6 The cost of increasing IVF provision from 1 funded cycle to 2 cycles has been analysed and is included in the appendix to this policy document. A policy shift to 2 funded cycles will not necessarily equate to a doubling of the cost of the current service. This is because given the current service outcomes, we can expect a third of couples to achieve a live birth following the first attempt. The cost will be even lower at units with higher success rates.
1.7 Patients / Public, Stakeholders & Staff Involved in the Document
We widely consulted on the policy options paper and held a Policy Options Workshop in November 2007. Stakeholders at the workshop included service users, lay public, local GPs, service managers, PCT senior management, gynaecologist from EHT, and assisted conception specialists from Hammersmith Hospital , Chelsea & Westminster Hospital and University College , London
1.8 Review Date
This policy should be reviewed within 3 years or to respond to a specific purpose, such as new guidance etc.
1.9 Related Procedural Documents
Ealing PCT Individual Treatment Panel (ITP) Policy
2.0 DUTIES
The following sets out the duties and responsibilities of staff with respect to each of the types of procedural documentation developed by the PCT.
2.1 Duties within the Organisation
· Jackie Chin, Joint Director of Public Health, is responsible for the implementation of this policy
· Carol Hall, Assistant Director of Commissioning, will be responsible for issues relating to commissioning in this policy.
· Dympna Tansinda, Clinical Risk Manager, is responsible for issues relating to clinical risks and patient satisfaction in this policy.
· Cyprian Okoro, Consultant in Public Health Medicine, is responsible for dealing with the technical aspects and review of this policy.
3.0 POLICY PROCESS
3.1 Improving access and patient choice in IVF provider units
The PCT will increase access to IVF treatments and encourage patient choice by commissioning IVF and other assisted conception services with 3 London specialist centers namely; The Imperial College Hospitals Trust (formerly Hammersmith Hospitals Trust), Chelsea & Westminster Hospital and the University College Hospital, London, in the first year. Each year we shall evaluate the success rates, in age bands across London providers and offer couples a choice from the three best providers in London
3.2 Definition of a treatment cycle
This policy adopts the Human Fertilisation and Embryology Authority definitions of a ‘cycle’: Under this guidance, a fresh IVF treatment cycle starts when drugs are administered for ovarian stimulation or, if no drugs are used, when an attempt is made to collect eggs. A frozen cycle is one which starts when a cryopreserved embryo is removed from storage in order to be thawed and then transferred.
3.3 Number of cycles to be funded
Ealing PCT will fund 2 fresh cycles of IVF with or without ICSI at the designated provider units. One treatment cycle will ideally be followed by the other, but a successful first cycle (in terms of a live birth ) would make the couple ineligible for a second cycle. Similarly a spontaneous conception while on the waiting list will make the couple ineligible for further IVF treatment. Where a woman has previously privately funded one or two cycles the PCT will still fund two cycles, until a maximum of three cycles has been completed, after which the chance of success decreases substantially.
3.4 What constitutes assisted conception treatment
The PCT will fund the assisted conception techniques listed below. These techniques are continuously being developed and not every centre is able to offer all the techniques. The list is therefore not exhaustive but they represent the proven and available treatments in current clinical practice.
· In-vitro Fertilisation (IVF)
· Intra-cytoplasmic sperm injection (ICSI)
· Stimulated or unstimulated intra uterine insemination (IUI).
· Micro-epididymal sperm aspiration (surgical sperm retrieval)
· Testicular sperm aspiration
· Blastocyst transfer
· Sperm washing when male partner is HIV positive
· Egg donation
3.5 Referral and treatment pathways for infertility
Majority of the investigations for sub-fertility will be undertaken in primary care by the patient’s own GP. The list of investigations in primary care recommended by NICE is given in appendix 1. The PCT will expect GPs to have organised these investigations before referring patients to secondary care.
Smoking and weight loss advice, and relevant vaccination should occur before referral – where age factors indicate that referral is a priority then referral to dietetics and infertility could be instigated at the same time, but normally weight loss towards BMIs with greater chance of success should occur before referral.
Where tests indicate a sub-fertility problem, the GP will refer the patient to the PCT’s acute hospitals for further investigation and any sub-fertility treatment required. The referral will go via CAS (or FP Service) to ensure all necessary tests have been completed and infomation included in the referral. Where no cause has been identified in the initial tests the CAS doctors will refer to Imperial for a hysterosalpingogram. The results will be reviewed by the Primary Care Infertility Service (PCIS) If tubal occlusion is found then the patient should be reviewed and referral to a infertility centre for consideration of laparoscopy and tubal surgery should be initiated at a suitable specialist unit.
Where no cause for infertility has been identified, following HSG, the PCIS will refer to Ealing PCT’s local acute hospitals - for these purposes - Ealing Hospitals Trust, West Middlesex University Hospital Trust, or Queen Charlottes at Imperial..
Sub-fertility treatment at the local acute trust will usually not include assisted conception, although intrauterine insemination (IUI) could be tried for cases of unexplained infertility if the acute hospital is licensed for this treatment. Up to six cycles of IUI can be tried at this setting as part of the pathway before referral to an assisted conception unit. Although NICE recommended unstimulated IUI, the PCT will fund clomid stimulated IUI at licensed centres with facilities for ovarian monitoring where necessary because this improves pregnancy outcomes.
If initial treatments for sub-fertility are unsuccessful, and the patient is considered appropriate for IVF or ICSI, the gynaecologist at the local acute trust must refer/discharge the patient to the PCT’s Primary Care Infertility Service (PCIS) with a summary of all the investigations and treatments. The PCIS will review this information and discuss referral options with the couple. They will provide patients with all necessary information such as success rates at the provider units, including the option of visiting units before making up their mind in order to encourage informed choice. A list of information sources couples might need is provided in the appendix. Including the PCT’s PCIS in this pathway is a sound management strategy that will ensure couples have real informed choice of providers with no adverse impacts on the 18 week rules.
Once a referral has been made to an assisted conception unit, all drug costs will be met by the chosen unit, and the patient’s GP must not be required to prescribe any ovulation induction drugs.
4.0 Eligibility criteria
The four principles that underpin the recommendations for eligibility for assisted conception within the provisions of this policy are:
· The welfare of the child
· Evidence in support of improved treatment outcome (higher chances of success)
· Equity of access to services for those meeting the criteria
· Constraints on PCT resources. Section 97(A) and 97(D) of the NHS Act of 1977 makes it statutorily incumbent on the NHS to balance its budget at the end of each financial year.
4.1 Referral criteria
All couples or at least the female must be registered with a GP within Ealing PCT boundary and be eligible for NHS treatment. All such patients are eligible for consultation, investigation, advice and treatment in primary and secondary care in line with NICE guidelines (appendix1).
Couples will only be referred for assisted conception if they meet the eligibility criteria below and when all appropriate tests and investigations have been successfully completed in primary and secondary care in line with NICE guidelines.
4.2 Compliance criteria
The referring clinician must ensure that patients are aware of the implications of IVF treatment and the commitments required before making a referral for assisted conception. Those where compliance is deemed to be a problem must be referred for counselling in the first instance.
4.3 Duration and cause of infertility
Couples who have not conceived after one year of unprotected sexual intercourse will be offered investigations in primary and secondary care as appropriate and referred for AC if they meet other criteria. Investigation after 6 months may be indicated if maternal age is approaching the maternal age referral criterion.
Couples with diagnosed or known cause of infertility that precludes natural conception must not wait before referral for AC. This includes couples who cannot achieve full sexual intercourse due to disability.
Couples in whom one or both partner have been voluntarily sterilised will not be eligible for IVF treatment under this policy.
4.4 Social access criteria
Where either of the potential parents has not had had an opportunity to experience parenthood ( defined as a direct role in caring for a child up to the age of 5 years) the couple will be eligible for NHS funded IVF treatment. Couples who have adopted a child together will not be eligible for assisted conception under this policy.
4.5 Welfare of the child
Treatment will not be funded in any circumstance where there are known adverse factors that might affect the welfare of the child who might be born, including any child who might be affected by the birth. This will include substance and alcohol misuse.
4.6 Age of couple (see Appx 4b)
The PCT will fund IVF treatment for women aged 23-39 years by the time of referral for assisted conception in line with NICE guidelines. No female patient will be placed on the waiting list within 18 weeks of their 40th birthday. There will be no limits on the age of the male partner under this policy.
4.7 Life style factors
The woman must have a body mass index (BMI) of between 19 and 30 at the time commencement of treatment. Women who are overweight or underweight will be offered referral to dieticians in order to improve their BMI before referral to AC. Women with a BMI less than 19 and greater than 30 will not be funded.
Women who smoke must be referred to our smoking cessation service to support their efforts in stopping smoking. The PCT will not fund IVF treatment until women have stopped smoking. Referral for smoking cessation will be the responsibility of the GP/hospital consultant and confirmation of compliance with this criterion will be included in the referral letter to the tertiary provider. We recommend that households are encouraged to be smoke free.
4.8 Frozen cycles
The PCT will normally only fund fresh IVF cycles because of the higher chances of success. The PCT will fund frozen cycles when it is the only option (such as for patients undergoing chemotherapy or other treatment for cancer).
4.9 Gamete & Embryo storage
The PCTs will fund sperm banking for post-pubertal males who have not yet completed their family, and are about to undergo treatment which is likely to result in long-term sub-fertility.
Ovarian stimulation and embryo cryopreservation will be made available to women who are about to undergo treatment likely to cause infertility, provided they are in a stable relationship and wish to pursue this option.
4.10 Number of embryo transfers
The PCT will support the transfer of up to 2 embryos during an IVF treatment cycle as an interim measure pending further national guidance from the Human Fertilisation and Embryo Authority (HFEA).
4.11 Intra Uterine Insemination (IUI)
Intra Uterine Insemination (IUI) for unexplained infertility is part of the care pathway leading to IVF/ICSI. Therefore previous treatment with IUI will not preclude access to PCT funded IVF treatment. Ealing PCT will fund up to 6 IUI cycles as a treatment option for couples who wish to avoid the invasive procedures associated with IVF. Clomid stimulated IUI cycles will be funded at licensed centres with facilities for ovarian monitoring when indicated. In order to be eligible for IUI, couples must meet the eligibility criteria in this IVF policy.
4.12 Egg donation
Ealing PCT will commission IVF using donated eggs from UK clinics licensed by the HFEA (but not from clinics abroad) for women with premature ovarian failure due to an identifiable pathological or iatrogenic cause or in order to avoid the transmission of inherited disorders to a child where the couple meet the relevant eligibility criteria.
4.13 HIV and sperm washing
Ealing PCT will commission sperm washing for IUI/IVF/ICSI in couples where the male partner is HIV positive and the female partner is HIV negative.
4.14 Surgical sperm retrieval
Surgical sperm retrieval will be commissioned by the PCT in appropriately selected patients, provided that the azoospermia is not the result of a sterilisation procedure.
4.15 Preimplantation Genetic Diagnosis (PGD)
This Policy excludes PGD treatment. Although PGD is delivered through assisted conception techniques, patients that require PGD treatment have different clinical circumstances. A clinical group has been formed as a sub group to the Genetics Consortium to consider Individual cases for Pre-implantation Genetic Diagnosis treatment across London
4.16 Surrogacy
IVF using a surrogate mother will not be funded by Ealing PCT.
4.17 The role of the PCT’s ITP in assisted conception
In rare or exceptional circumstances where a clinician feels that a couple represent a special case and do not meet the criteria set out, an application can be made in writing to the PCT’s Individual Treatment Panel (ITP).
5.0 Provider Unit responsibilities
The designated assisted conception provider units must:
· Confirm that any referred patient is registered with an Ealing PCT GP
· Check that the couple meets the eligibility criteria stated in this policy
· Have up to date patient information leaflets including information on treatment outcomes for patients
· Develop their own clinical criteria for success and discuss implications with patients before starting treatment. For example a woman with an FSH level > 12 have a significantly reduced chance of success using her own eggs, and such patients should be counselled on the option of donor eggs in order to maximise their outcomes.
· Check that BMI and smoking status comply with PCT policy, in addition to excluding problem drinking or alcoholic addiction through usual enquiries with the patient’s GP.
· Provide the PCT with timely monitoring and audit data as listed below.
· Ensure all information exchanges with the PCT comply with Caldecott standards for confidentiality and the requirements of the HFEA Act.
5.1 Monitoring and audit
The PCT will require assisted conception units to provide six-monthly returns on their activity levels with emphasis on the following:
· The number of couples treated
· Age profile of patients treated
· The conception rate per cycle
· Live birth rate per cycle
· Multiple birth rate per cycle
· Waiting times for routine IVF treatment.
· Numbers of abandoned treatments with reasons for abandonment.
· The number of couples receiving treatment where the cause of infertility has been explained (& the causes identified).
· The number of couples receiving treatment where the cause of infertility has not been explained.
· Number of women undergoing laproscopic salpingectomy prior to IVF treatment in women with hydrosalpinges.
5.2 Indicators of service quality for audit purposes
The PCT will use the following national norms as indicators of a good assistance conception service for audit purposes.
· Pregnancy rate around 42% per cycle
· Live birth rate around 35%
· Multiple birth rate less than 25%
· Proportion of abandoned cycles
6 Key PCT Contacts
For service related queries, contact Carol Hall, Assistant Director of Commissioning, on 020 3313 9185 or Carol.Hall@ealingpct.nhs.uk
For issues relating to clinical risks and patient satisfaction, contact Dympna Tansinda, Clinical Risk Manager, on 020 3313 9312.
For technical queries, contact Cyprian Okoro, Consultant in Public Health Medicine on 020 3313 9180, and Fax 020 3313 9618 or Cyprian.okoro@nhs.net
7 Dissemination and implementation
The Ealing Matters newsletter will be used to create awareness of this policy within primary care and PCT management.
This policy document will be sent to all Ealing GP practices, local acute trusts and the PCT’s designated providers of assisted conception services.
8 Policy review date: December 2011
9 List of abbreviations
AC Assisted conception
BMI Body Mass Index
CAS Clinical Assessment Service
DI Donor insemination
ET Embryo transfer
GIFT Gamete intrafallopian transfer
HFEA Human Fertilisation and Embryology Authority
ICSI Intracytoplasmic sperm injection
IVF In Vitro Fertilisation
IVM In vitro maturation
IUI Intrauterine insemination (IUI)
NICE National Institute of health and Clinical Excellence
PCIS Primary Care Infertility Service
PCT Primary Care Trust
PGD Pre implantation genetic diagnosis
ZIFT zygote intrafallopian transfer
10 Appendices
Appendix 1 Investigations to be done in primary care
1. When to refer
Couples who have not conceived after 1 year of regular unprotected sexual intercourse must be offered further clinical investigation including semen analysis and assessment of ovulation. Where there is a history of predisposing factors, (such as amenorrhoea, oligomenorrhea, pelvic inflammatory disease or undescended testes), or where a women is aged 35 years or over, earlier investigation should be offered.
Where there is a known reason for infertility (such as prior treatment for cancer), early specialist referral should be offered.
2. History
It is essential to obtain good clinical history from both partners to determine presence of obvious cause or associated disease, and plan appropriate investigations and treatment.
3. Body Mass Index
This is the patient's weight in kilograms divided by the square of their height in metres.
BMI = kg / m2
There is a definite correlation between body mass and fertility. Body mass for optimum fertility is 19 - 25. Ability to conceive decreases and miscarriage rate rises if BMI is over 27. Patients with a BMI >27 should be strongly advised to lose weight prior to treatment. BMI >30 may exclude them from investigations or treatment, as the risks associated with ovulation induction and pregnancy increase with BMI.
4. Rubella status
Rubella status of all female patients should be checked. Any woman without rubella immunity should be offered vaccination. ? Hep B screening (otherwise needs doing in secondary care)
5. Chlamydia screening
Before undergoing uterine instrumentation women must be offered screening for Chlamydia trachomatis by the GP, family planning service or at a secondary care provider. ? Also ensure Cervical Smear within 3 years ?
6. Female ovulation
Regular cycle:
Women under 39 years of age, with a regular menstrual cycle of 26 - 32 days duration, have a 90% chance of ovulating.
The only blood test to ensure ovulation is occurring would be a mid-luteal phase progesterone level, which must be performed 7 days before the onset of the period. eg. Day 21 for a 28 day cycle.
Irregular cycle:
If the patient has an irregular cycle, then mid-follicular gonadotrophin levels, LH/FSH must be performed between days 2-7 of an average cycle. Prolactin levels must also be performed for these patients. Only one prolactin level needs to be done by the General Practitioner, if it is markedly raised it will be repeated by the secondary care provider. If elevated referral to endocrinology rather than infertility is indicated. Discussion may need to occur with the chosen specialist unit where there is only mild elevation.and maternal age indicates a need to progress infertility treatment – high levels would however preclude IVF until treated.
7. Semen Analysis
Semen analysis will be performed by the General Practitioner.
8. Hysterosalpingogram as organised by the Primary Care Infertility Service. The digital images should be made available to the treating clinicians.
9. Recording of Laparoscopic Findings undertaken in secondary care
Where extensive investigations e.g. laparoscopy have been conducted prior to a GP making a referral for assessment and treatment of sub-fertility / infertility then the findings of previous investigations must be shared with the provider of secondary or tertiary care. In the case of laparoscopic findings:
Either:
Video
This is the preferred option whereby laparoscopic findings are recorded on a video at the time of the procedure and the video forwarded to the tertiary centre.
Or
Film/ electronic recording
Good quality images of laparoscopic findings are recorded on film or electronically and forwarded to the tertiary centre.
Or
Comprehensive diagram
Of the findings with particular attention to each portion of the tube, starting from the cornua, isthmic, ampullary isthmic junction and ampulla and fimbria.
It must also be noted whether there are any peritubular adhesions, however filmy, on any portion of the tube and whether there is any delay or problems injecting the dye.
Any endometriosis must be clearly marked on the diagram and if there are any other abnormalities, these must be marked. The upper abdomen must also be examined for signs of previous infection.
10. Tubal surgery
Laparoscopic findings may indicate the need for tubal surgery. This is to be done at the tertiary provider unit if considered appropriate by the clinician there. There may be occasions when the tertiary centre will consider tubal surgery appropriate on examination of the findings and on these rare occasions, the patient will receive the micro-surgery at the tertiary centre.
11. Urgent referrals
Urgent referrals such as requests for embryo freezing prior to chemotherapy treatment must be sent to Carol Hall on Telephone 020 3313 9185 or email Carol.Hall@ealingpct.nhs.uk giving clinical details and contact telephone numbers for the patient.
Appendix 2 Information resources for patients and PCIS
1 Provider unit web sites and service/business manager contact details
Imperial College Hospital Trust (formerly HHT)
Telephone 020 8383 4908
Fax 020 8383 8534
Email Debbie.Clarke@imperial.nhs.uk
Website www.ivfhammersmith.com
Telephone 020 8746 8585
Fax 020 746 8921
Email Jason.leane@chelwest.nhs.uk
Website www.londonfertility.co.uk
Telephone 020 7837 2905
Fax 020 7278 5152
Email brett.rowland@uclh.nhs.uk
Website www.conception-acu.com
2 HFEA website http://www.hfea.gov.uk/guide
3 Up to date information on birth rate per cycle for each provider unit – usually available from ACU provider and HFEA websites
4 Patient information leaflets from provider units
5 PCT smoking cessation service contact number – 0845 111 0155
6 Information on local weight management and physical activity programmes
Appendix 3 Analysis of the cost of implementing a 2-cycle IVF policy
Useful planning information
Number of new referrals we can expect per year ~ 100
Trends in demand increasing
Cost (at 2006/2007 prices with current provider) £3,010 per cycle (IVF & ICSI)
Success rate (live birth rate for all ages)
with current provider 31%
SCENERIO 1: Continue with funding for 1 Fresh Cycle of IVF & ICSI
100 cycles will cost (100 x £3010) = ~ £300,000
About 31 of these cycles will lead to a live birth.
Cost of 31 IVF live births = ~ £ 300,000
Approximate cost per live birth = £9,709.7
SCENERIO 2 Increase funding to 2 cycles of Fresh IVF & ICSI
Using the information on success rate as above, after the first cycle, 31 out of 100 women will have a baby, leaving 69 women who will need a second cycle. A second cycle of treatment in these 69 women will result a further 21 live births, leaving 48 women who would have completed 2 cycles of treatment but no live birth.
Therefore, cost of funding 2 cycles for 100 couples = (169 cycles x £3010) = £508, 690
The 2 cycles of IVF in 100 women will lead to 52 live births
Cost per live birth if 2 cycles = £9,782.5
What is the marginal benefit of shifting to 2 cycles per couple?
21 extra live births at the cost of extra £208, 690 per yearAppendix 4 Other cost considerations
4a The Opportunity Costs of funding 2 IVF cycles
Procedure/intervention | Cost (£)/annum | Comments |
2 cycles of IVF/ICSI at £3,010/cycle for 100 couples per year). | 508, 000 | Will involve expansion of service to reflect growing need/demand, address waiting time issues and a shift towards full implementation of NICE guidelines. |
1 cycle of IVF & ICSI for about 100 couples per year | 300, 000 | Maintains recent increase in funding to clear waiting list. But will not signal any shift towards full implementation of NICE guidelines and waiting list is likely to remain at least 1 year. |
Orthopaedics
| 505,000 | 78 additional elderly people will benefit and have improved quality of life. |
Neonatal care
| 505, 000 | Increase in neonatal costs could result from an expansion in IVF provision but the awaited national (HFEA) guidance on number of embryos to be transferred during IVF treatment could mitigate against this. |
Adult Intensive care services
| 505, 000 | |
Primary prevention of cardiovascular disease
| 500,000 | Cardiovascular diseases are responsible for a third of all deaths in the population. |
Appendix 4b
Women should be informed that the chance of a live birth following in vitro fertilisation treatment varies with female age and that the optimal female age range for in vitro fertilisation treatment is 23–39 years. Chances of a live birth per treatment cycle are: (NICE clinical guideline 2004,pg 85)
It is a judgment of cost benefit and outcomes where in this graph a maternal age criterion is chosen. Success begins declining at 32 years.
At 40 years there is over 90% failure rate, at 37 the success rates are 50% higher than at 40 (i.e 15% success).
Current Guidelines from NICE recommend treatment before the age of 40. .
Appendix 4c Effect of maternal age on cost per live birth: IVF births cost more with increasing maternal age.
Maternal age (years) | Cost per live birth |
24 | £11, 917 |
35 | £12,931 |
39 | £20,056 |
Appendix 5 IVF funding policies of selected PCTs
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