Funding fertility treatment and choosing a clinic

Here we discuss what people told us about how their care was funded and how they went about choosing a clinic. We spoke to people who had only had NHS care, some who had only private treatment and others who had used a mixture of private and NHS care.
Eligibility for NHS funding in England has, in recent years, been determined by the local clinical commissioning group (CCG), previously known as the local Primary Care Trust (PCT). NHS funding in Scotland, Wales and Northern Ireland is set by central government. NHS funding can cover the costs of IVF or ICSI, but eligibility (including age limits) and the number of cycles that the NHS will fund varies across the UK. NHS treatment should follow the NICE guidance, but this is not always the case as the guidance is not mandatory published in 2004 (for more information see Human Fertilisation Embryology Authority website). Due to NHS funding cuts in recent years some CCG’s are choosing not to follow NICE guidance and not to fund any cycles of IVF or ICSI and people are increasingly paying for their own treatment through private clinics.
The Human Fertilisation Embryology Authority (HFEA) licenses private clinics to practice in the UK, but does not regulate the cost of treatment set by private fertility clinics. Prices vary from clinic to clinic and the final cost will depend on a number of factors. The HFEA states:
“…the same treatment could be two or even three times more expensive depending on which clinic you choose. We strongly recommend you shop around before committing to a clinic and consider a wide range of factors when making your final decision.” (taken from HFEA website July 2017)
Fiona and her husband felt that they could have saved up money for expensive treatment but decided that they would not, given the odds of treatment being successful for them. “I think we were quite sensible about thinking well we are not going to spend thousands and thousands of pounds on something that is actually pretty horrible to go through”.
Liz and her husband couldn’t afford private treatment and one clinic refused to treat her because she was over-weight. They had a long battle with their then local Primary Care Trust to get ICSI treatment (Intra-cytoplasmic sperm injection). 
Some couples had tried to maximise their chances of success by having treatment both on the NHS and privately. Marine had a good experience of this in London, but elsewhere in the country people struggled to obtain NHS treatment if they had already funded treatment themselves. James thought they would try private treatment during the six months they had to wait to qualify for their NHS treatment; they were delighted to be successful and it was only afterwards that, ‘It dawned on them’ that they could have lost their opportunity for NHS funded treatment (see Infertility Network UK).
In some clinics it is possible to get help with the costs of private treatment by taking part in an egg-sharing scheme. We spoke to one couple who had tried this, who unfortunately had a negative experience.
Saskia and her lesbian partner were looking for a clinic to give them treatment with a sperm donor. Her GP advised her that although some Trusts funded treatment for lesbian couples on the NHS her local one didn’t. NICE guidance (2013) published since these interviews were collected states that same sex couples should be offered NHS fertility treatment.
We also spoke to some couples who had been able to afford to pay for all their treatment privately, although it was often not easy to find the money. Lulu was grateful that her mother lent them the money to pay for her treatment, but she felt it was “quite a pressure”. Although Tim felt he had numbed himself to their negative results, he said the worst thing is they’ve spent so much with nothing to show for it. “So when it does actually come out as a negative it is almost to say well I am already expecting it. Again whether I intentionally suppress the feelings or whether it is just I am numb to it now. I don’t know. But as I say, the worst thing for me really is that we have spent this much money and again we have got nothing to show for it”.

Older couples were often acutely conscious that the ability to start treatment now rather than wait for a NHS referral could make all the difference to them. The high costs involved raised the stakes; some were happy to forgo holidays and new cars to maximise their chance of a baby. Most people felt it was impossible to equate the possibility of having a baby with a monetary value. 
Choosing a clinic
The HFEA recommends that people take into account the location, appearance, success rates and the embryo transfer policy when they are choosing a clinic. Success rates were certainly important in deciding where to have treatment. Many of the couples we talked to had done a lot of research on the Internet before they chose a clinic (see ‘Information and support’). Janine explained that they looked at league tables and statistics but were “dubious about some of the fairly unsophisticated results” and decided to go for their local centre. Some, like Naomi and Martin, chose to travel abroad for their treatment (see ‘Travelling abroad for treatment’). They used the Internet to find out about clinics in Spain and the experiences of others who had been treated there. 
The people we spoke to also stressed the importance of the ‘feel’ of the clinic and their relationship with the clinicians. Frances followed her gynaecologist’s recommendation to see a doctor who had, “’Very good results and is absolutely super and this is the person you want to see’ so without a second thought, without a second opinion, without anything I toddled off and that is what I did”.
Karen and her husband had had a bad experience at one clinic, where they did not feel they were given enough information; at the next clinic she prioritised their success rates and how open they were to her questions. Janine and her husband chose a clinic that did not have the best results, but which meant they didn’t have far to travel – “So we decided that (it) might not be the best but its good enough and it’ll keep our stress levels down”. Others, like Martha, did not have the option of a local clinic because of her address. There wasn’t one near and so she had a long journey to get to the fertility clinic.
The overall feel of the clinic was key for several of the people we talked to. Lulu had been to visit a very famous clinic but felt it was too impersonal. She chose one closer to home that was smaller but much more friendly. Naomi also rejected clinics that felt like a production line and went for one that seemed friendlier. For Bev, her personal relationship with the consultant was very important. “I think it’s important to have a good relationship with your consultant. For them to be able to understand where you’re coming from, what your anxieties are, what your concerns are. And for you to be able to communicate how you feel with your consultant”.

Last reviewed July 2017.
​Last updated July 2017.


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