In Vitro Fertilisation (IVF) and Intracytoplasmic Sperm Injection (ICSI) Treatment for patients of East Sussex : Revised April 09

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1 In Vitro Fertilisation (IVF) and Intracytoplasmic Sperm Injection (ICSI) Treatment for patients of East Sussex : Revised April Implementation Date 1.1 This policy replaces all earlier East Sussex IVF/ICSI policies. 1.2 This document becomes effective from 1 st April Introduction 2.1 The IVF/ICSI service for East Sussex is currently provided by the Sussex Downs Fertility Centre BMI Healthcare Ltd at the Esperance Hospital Eastbourne. This centre was chosen following an investigation of the quality, success rates and costs of several centres. The service is delivered in line with NICE Clinical Guideline , and any subsequent revisions. The service provider may change in future and this policy will be amended in line with those changes. 2.2 Access is limited to couples who meet strict eligibility criteria, as described in Template Criteria for NHS Funded Treatments for Sub-fertility for the PCTs within Kent, Surrey and Sussex December These criteria apply to the following forms of assisted conception, intra-uterine insemination (IUI), in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). 2.3 This document sets out the criteria which will identify those couples and describes how they will be referred for treatment. Fertility Policy Brighton and Hove City NHS 20 April

2 2.4 This document does not cover the use of donor gametes, people preparing for cancer treatment, or the use of IVF in preimplantation genetic diagnosis. 3. Criteria for IUI/IVF/ICSI treatment All couples must meet all the following criteria: Criteria for NHS funding of assisted conception treatment applying to Kent, Surrey and Sussex PCTs Scope Clinical criteria These criteria apply the following forms of assisted conception in eligible patients: Intra-uterine insemination (IUI) in vitro fertilisation (IVF) Intracytoplasmic sperm injection (ICSI). The criteria will apply to all three forms of treatment unless otherwise stated. Rationale Duration of sub-fertility IUI, IVF and ICSI will be funded in couples that have been attempting to conceive for at least 36 months unless they have an identifiable cause and unless clinical judgement dictates otherwise. The likelihood of couples conceiving increases with time. In the general population, it is estimated that 84% of women would conceive within one year of regular unprotected sexual intercourse. This rises cumulatively to 92% after two years and 93% after three years. Age of woman Funding is available for couples where the woman is aged at the time of treatment. An exception will be made for women who are aged 39 at the point of referral to an IVF unit but they must be treated within six months of their 40th birthday. For women undergoing full cycles that The likelihood of a live birth following IUI, IVF and ICSI falls with the age of the female partner. The Human Fertilisation and Embryology Authority (HFEA) publish data on the live birth rates following IVF and ICSI. The live birth rate is the number of births achieved for every 100 IVF treatment cycles commenced. It is expressed as a percentage. The most recent data from the HFEA suggests that the live birth rate for IVF Fertility Policy Brighton and Hove City NHS 20 April

3 Previous cycles Body Mass Index include subsequent frozen embryo transfers (if the initial fresh cycle was unsuccessful), then the same age stipulation applies, i.e. that they must commence the final frozen cycle within 6 months of their 40th birthday. Couples will not be funded if they have already had three previous cycles of IVF/ICSI (irrespective of how these were funded). Overall, eligible couples will be funded in the NHS for a maximum of 6 cycles of IUI and four embryo transfers (including no more than two transfers from fresh cycles) Women must have a Body Mass Index (BMI) within the range [inclusive] at the time of referral to the IVF/ICSI provider and at the time of treatment /ICSI amongst women of less than 39 years is 27.3 % whereas for women aged between years this rate is 11.1% decreasing to 4% in women over 44 years. Most live births (82%) following IVF occur within the first two cycles of treatment. The birth rate drops at the third and subsequent attempts. Higher body mass index has been associated with decreased chances of pregnancy following IVF treatment. A weight loss programme has been associated with improvements in ovulation and pregnancy outcomes in obese subfertile women for all forms of fertility treatment. Social and other criteria Previous children Previous sterilisation Neither partner in a couple should have a living child from their relationship or any previous relationship. A child adopted by the couple or adopted in a previous relationship is considered to have the same status as a biological child. Assisted conception will not be provided to couples if their sub-fertility is the result of sterilisation or failed reversal of sterilisation It is recognised nationally that NHS organisations need to focus their budgets on patients who have the most need and can obtain the maximum health gain. Local priority is therefore being given to those who are completely childless. Sterilisation is offered within the NHS as an irreversible method of contraception. Considerable time and expertise are expended in ensuring that Fertility Policy Brighton and Hove City NHS 20 April

4 in either partner. individuals are made aware of this at the time of the procedure. Since the majority of requests arise for non -medical reasons, the Primary Care Trusts consider that it is inappropriate that NHS funds are used in reversing these procedures. In addition for East Sussex residents: 3.1 Couples must be registered with a general practitioner based in Brighton & Hove City NHS, East Sussex Downs & Weald NHS or Hastings & Rother NHS. 3.2 The woman must have FSH of 10 or lower at the time of referral to the IVF/ICSI provider and at the time of treatment. 4. How will the service operate? 4.1General Practitioners will refer sub-fertile couples to the designated NHS gynaecologist with an interest in sub-fertility working within one of the following trusts: Brighton and Sussex University Hospitals NHS Trust (Mr Richard Howell and Mr Onome Ogueh) East Sussex Hospitals NHS Trust (Mr Jamal Zaidi and Mr David Chui) Maidstone and Tunbridge Wells NHS Trusts (Mr Mark Wilcox) NHS referrals will only be accepted through this route. 4.2 The gynaecologist may request that prior investigations be done according to local guidelines. Only a small proportion of couples will require IVF/ICSI treatment and it will be the responsibility of the gynaecologist to ensure that the criteria are satisfied before making a referral. 4.3 The gynaecologist will carry out a full series of investigations prior to referral of appropriate patients to the specialist centre. 4.4 Selection of patients at each stage will be made according to the criteria in this document. Fertility Policy Brighton and Hove City NHS 20 April

5 4.5 Referrals will be made using a standard referral form, available from the lead commissioner 4.6 Couples must take up the offer of IVF/ICSI within six months of being referred to the IVF/ICSI provider. 4.7 The decision whether to undertake conventional IVF or ICSI with an individual case will be made by the IVF/ICSI provider. 4.8 General Practitioners will not be asked to prescribe the drugs necessary for IVF/ICSI treatment as the service agreement with the IVF/ICSI provider includes the cost of drugs. GPs are not permitted to prescribe drugs in the NHS for IVF/ICSI funded privately. 4.9 If a cycle is abandoned for reasons of poor response or failure of fertilisation this still counts as one cycle and embryo transfer If the cycle results in a miscarriage, this still counts as one embryo transfer Women who have attempted IVF/ICSI will not be offered subsequent Intra Uterine Insemination (IUI). 5. Monitoring and review 5.1 The IVF/ICSI provider will provide monthly reports on numbers treated and outcomes, as specified by the lead commissioner, to the lead commissioner and to the referring specialist. 5.2 These guidelines will be reviewed if new guidance is issued by the Human Fertilisation and Embryology Authority, NICE or the Department of Health, or if there are any changes to Template Criteria for NHS Funded Treatments for Sub-fertility for the PCTs within Kent, Surrey and Sussex December Fertility Policy Brighton and Hove City NHS 20 April

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