Unlike the majority of healthcare in the UK, fertility treatment is not routinely ‘free at the point of use’. Just under 70 % of the UK’s IVF clinics are privately owned and almost all of the NHS units offer self-funded treatment. There exists a ‘postcode lottery’, with service provision differing throughout the country, resulting in the majority of patients having to pay for their own treatment. This has led to a specialized niche service industry, with competition between providers and an elastic market, which is not affected by changes in government.
The National Institute for Health and Care Excellence (NICE) guidelines for fertility treatment in the UK recommend that women under the age of 40 should be offered 3 cycles of NHS funded IVF. However, the current trend is for English Clinical Commissioning Groups (CCGs) to reduce the number of IVF cycles they fund. In 2013, 24% of CCGs followed the NICE guidelines; in 2017, it was 12%. Some have cut the service altogether (Fertility Fairness 2018).
Finance packages
Cover offered for IVF under private health insurance in the UK is limited, with some insurers covering investigations but not treatment and they all require that the purchaser be on the plan for 12-24 months before any benefit may be used. Some private fertility clinics offer finance packages with the option of a refund if the treatment is not successful (Access Fertility).
How the UK’s fertility provision compares with other countries
| Country | Policy for reimbursement | Number of IVF cycles performed in the country |
| Austria | 70% of treatment & drug costs | 5,000 |
| Belgium | 75% of FSH stimulation medication | 8,000 |
| Luxembourg | 80% of all medication up to $8000 | 5,500 |
| Denmark | 3 full cycles of IVF but only in public clinics | 8,000 |
| Finland | Patients self-fund medication up to a total of 3,300 FIM/year | 5,500 |
| France | Unlimited number of cycles: patient pays difference between public and private costs. | 45,000 |
| Germany | 4 IVF cycles reimbursed by the statutory health insurance companies | 13,000 |
| Italy | Full reimbursement of FSH drugs, Partial reimbursement of IVF cycles, Public centres only | 35,000 |
| Netherlands | 3 full IVF cycles with drugs | 13,000 |
| Norway | 100% of all IVF cycles in public centres only | 5,000 |
| Portugal | 100% IVF cycles, 40% drugs; public centres only | 3,350 |
| Spain | Unlimited cycles in public centres only | 24,000 |
Please sign the ‘End the postcode lottery’ petition
Emily Scott has created a UK government petition to end the IVF postcode lottery. At the time of writing this blog it has 4,667 signitures. If it gets to 10,000 the government will respond to the petition and at 100,000 the petition will be considered for debate in parliment. The deadline is 8 February 2020.
Please sign the petition at https://petition.parliament.uk/petitions/266747
