Fertility Treatment Commissioning Policy Criteria Based Access Exceptional funding required for any patients that do not meet the criteria specified

Transcription

1 Fertility Treatment Commissioning Policy Criteria Based Access Exceptional funding required for any patients that do not meet the criteria specified Fertility Treatment - Pre Implantation Genetic Diagnosis (PGD) Prior approval required Funding for one cycle of PGD will be considered for couples who meet the following criteria: At least one partner has had a positive predictive test for a lifelimiting condition The female partner is aged between 23 and 40 years* The female partner has a BMI between 19 and 30 for at least 6 months prior to treatment. Women with polycystic ovaries with a BMI of 19 to 33 will be eligible for treatment There are no living unaffected children from the current relationship Both partners are non-smokers The relationship has been stable for 3 years There are no concerns for the welfare of the child or existing children within the relationship

2 Fertility Treatment Criteria Based Access THIS POLICY RELATES TO ALL PATIENTS NHS Bath and North East Somerset Clinical Commissioning Group Policy Statement: IVF Date of Issue: May Age of Woman at time of cycle starting 2 Age of woman at time of referral 3 Age of male partner 4 Number of cycles 5 Previous infertility treatment *The time of the cycle of IVF / ICSI or ICSI starting should be after the woman s 23 rd birthday and before the woman s 40 th birthday. The minimum age at the time of referral is exactly 23 years minus the maximum likely waiting time. This is to ensure that women who have a reduced chance of conceiving receive a service first. This age limit will not normally be lowered in the case of partners who have medical evidence suggesting that IVF / ICSI will be their only chance of conception because of physical causes which have been discovered earlier. The maximum age at the time of referral is exactly 40 years minus the maximum likely waiting time. No upper age limit. (Note: No upper age limit in adoption laws for male partner). One full cycle of IVF /ICSI to include 1 frozen embryo transfer where available will be available on the NHS. Any previous NHS funded IVF / ICSI treatment will be an exclusion criterion. Couples who have already had 3 or more cycles of IVF / ICSI (privately or NHS funded elsewhere) will not be eligible for further NHS funding. Funding will not be available retrospectively for any couples who would have been eligible but self- funded their treatment.

3 6 Same sex couples/ individuals not in a partnership Sub fertility treatment will be funded for same sex couples or individuals not in a partnership if those seeking treatment are demonstrably sub fertile. Cases will be considered by the Primary Care Trust. An assessment of sub fertility will be made on an individual, case by case basis. The Primary Care Trust will aim to apply the same level of stringency in determining sub fertility for all individuals or couples seeking treatment. In the case of same sex couples in which only one partner is sub fertile, clinicians should discuss the possibility of the other partner receiving treatment before proceeding to interventions involving the sub fertile partner. Same sex couples will be assessed if insemination on at least 10 non-stimulated cycles over a period of 2 years has failed to lead to a pregnancy. NHS funding is not available for access to donor insemination facilities for fertile women. All other criteria apply equally. NHS funding will not be available for access to insemination facilities for fertile women who are part of a same sex partnership or those not in a partnership. In circumstances in which those in a same sex partnership or individuals are eligible for sub fertility treatments, the other criteria for eligibility for sub fertility treatments will apply. Same sex couples and individuals should have access to professional experts in reproductive medicine to obtain advice on the options available to them to enable them to proceed along this route if they so wish. 7 Childlessness Treatments for sub fertility will only be funded for couples with no living child from the current relationship, including adopted children. Once accepted for treatment, should a child be adopted or a pregnancy leading to a live birth occur, other than as a result of the treatment funded by the PCT the couple will no longer be eligible for treatment.

4 8 Sterilisation Fertility treatment will not be available if the sub fertility is the result of a sterilisation procedure in either partner. In addition, the surgical reversal of either male or female sterilisation will not be funded except in exceptional circumstances. 9 BMI Women must have a BMI of between 19 and 30 inclusive for a period of 6 months or more before receiving any treatment. Women with polycystic ovaries with a BMI between 19 and 33 will be eligible for treatment. They must be informed of this criterion at the earliest possible opportunity in their progress through infertility investigations in primary care and secondary care. GPs should provide unambiguous and clear information to infertile couples. 10 Smoking Only non-smoking couples will be accepted on the IVF / ICSI treatment waiting list. They must be informed of this criterion at the earliest possible opportunity in their progress through infertility investigations in primary care and secondary care. GPs should provide unambiguous and clear information to infertile couples. 11 IUI / DI Eligible patients may choose to have up to 3 cycles of IUI or 3 cycles of DI OR one cycle of NHS funded IVF treatment assuming all criteria are met. 12 Egg Donation Egg donation will be funded for women who meet the criteria for IVF, where required 13 HFEA Code of Practice Couples not conforming to the HFEA s Code of Practice will be excluded from having access to NHS funded assisted fertility or other treatment. This includes consideration of the welfare of the child which may take into account the pre-existing health status of the parents. 15 Funding Funding will not be available retrospectively for any couples who would have been eligible but have agreed to self fund their treatment, whether payment has been made in full, part or has yet to be taken. 16 Definition of BANES individual NHS funded IVF / ICSI treatment will be available for individuals registered with a GP in Bath and North East Somerset.

5 Note: Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes exceptional circumstances exist, that warrant deviation from the rule of this policy. Individual cases will be reviewed at the CCG Exceptional Funding Panel upon receipt of a completed application form from the patient s GP, Consultant or Clinician. Applications cannot be considered from patients personally. Approved by Operational Leadership Team (committee) Date Approved: May 2014 Produced by (Title); Consultant in Public Health Review Date: May 2015