If you are having, or hoping to have, NHS-funded treatment, the decisions about eligibility are made by your local CCG or Clinical Commissioning Group in England. They have guidance from NICE, the National Institute for Health and Care Excellence, but they don’t have to follow this and many prefer to set their own rules. In practice, this means that whether or not you can access NHS-funded treatment depends entirely on where you live. The CCG will have a contract with one or more clinics who provide fertility treatment and you may be given a choice between these clinics as to where you go. Some of these clinics may be in NHS hospitals but others may be private providers.
In Wales, Northern Ireland and Scotland, decisions about how much treatment people can access are made nationally, which means there are not the same variations where those who live just a few miles apart are eligible for totally different levels of help and support.
In England, an individual clinic may have a number of different contracts, so some of their patients may be having the three full cycles of NHS treatment recommended by NICE but others may only have one cycle. It is important to be clear that the funding doesn’t come depending on the clinic you are going to, but depends instead on your local CCG.
The CCG may set rules for eligibility and these often include things like not offering treatment to women who are very overweight, to those who smoke or to those who are already parents, even if the child is from a previous relationship.
If you are paying for your own treatment, decisions about whether or not to treat patients lie with the clinic itself. In many areas, there are many different clinics to choose from and you will want to look at price and location and the types of treatment offered as well as the success rates before making your decision. You should also look at the multiple birth rates as multiple birth is the biggest risk from fertility treatment and a really good fertility clinic will be able to combine good success rates with a low multiple rate. You can pay for treatment at a private clinic, but many NHS units also take fee-paying patients who will cover the cost of their own IVF.
There are generally far fewer criteria for access to treatment if you are paying for private treatment although most clinics will have a set upper age limit for treatment, and may want you to have a reasonably good ovarian reserve (stock of potential eggs in your ovaries) unless you want to use an egg donor. There may also be rules about smoking and weight, but these can be more flexible in the private sector. If you are having private treatment, you will not face the sort of social criteria that CCGs to about not offering treatment to people who are parents already.
If you want help choosing a clinic, the best place to start is the HFEA’s Choose a Fertility Clinic as this will allow you to find a list of all the licensed clinics in your area, to see what they offer and to find out about their success rates and multiple rates.