Assisted Fertility Review

The review includes:

• Addressing options for treatment regimes, taking account of all arrangements and NICE guidelines;
• Producing an evidence base of analysis at ICB, and East Midlands level
• Considering any inequalities and the risks and benefits of mitigation;
• Developing an option appraisal and associated modelling, to deliver the best population health outcomes and appraising financial and activity analysis projections;
• Providing a set of recommendations for the East Midlands ICBs to consider.

Based on a series of agreed research questions on clinical effectiveness and safety, the scope of the review will cover: 

• Definitions of infertility;
• The number of IVF cycles commissioned and available to people;
• Immigration status;
• Use of frozen embryos;
• Abandoned or cancelled cycles;
• IUI/DI cycles and IUI for people with unexplained infertility;
• Mild endometriosis;
• Gamete and embryo storage as part of treatment;
• Single embryo transfer;
• Access to treatment for people with children, for same sex couples and single women;
• Female age;
• Smoking;
• Sterilisation and reversal of sterilisation;
• People with a physical disability;
• Male age and male BMI;
• Ethical considerations where evidence is unlikely to be available.

There are currently differences between Fertility Policies in the East Midlands, in terms of access to treatment, in relation to age, BMI and number of cycles available. Moreover, there are also inequalities inherent in the policies in that they exclude or limit access to same sex couples, couples with children from former relationships and single people.

This case for change sets out proposed criteria for access to Specialist Fertility Services for the population of the East Midlands, aimed at supporting a more collaborative approach to ICB Policy that will result in one policy to address fertility treatment across the whole of the East Midlands region.

The review aims to address inequalities to improve access to fertility treatment whilst prioritising treatment for people with proven fertility issues. The proposals outlined on pages 8,9 and 10 maintain elements of existing policy, and update others, giving the rationale or evidence base for each proposal.

It is felt that this case for change proposes commissioning arrangements for fertility services in a manner that is clear, fair, and transparent, and the proposed criteria has been developed in line with clinical evidence taking in to account the success rates of fertility treatments and the impact that different factors have on this.

However, at this stage in the review the proposals put forward are recommendations only and following agreement by decision making forums within each ICB to endorse the direction of travel, a period of engagement will then follow to determine the impact of these proposals on our populations in the East Midlands and gather feedback and thoughts on the proposals to be considered and fed into the final policy.

Read the full  Assisted Fertility Review - full case for change [pdf] 211KB

Read the overview Assisted Fertility Review - Case for change overview.pdf [pdf] 176KB