2. What is the average cost of a cycle of an IVF cycle funded by the CCG and what does that include?

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1 Communications & Engagement Team 1st Floor North Point Cardinal Square 10 Nottingham Road Derby DE1 3QT Tel: Fax: Our ref: 91/15 Monday 20 July 2015 Re: Freedom of Information Act Request Thank you for your dated 22 June 2015 requesting information from NHS Southern Derbyshire Clinical Commissioning Group. I can confirm we do hold the information you require. You asked us to provide the following information: 1. According to your current IVF treatment policy: a. How many cycles of IVF do you offer to eligible patients? b. Do you fund a full cycle of IVF, as defined by NICE, which includes replacement of all frozen embryos? If not how many frozen embryo transfers do you fund? c. What is your upper and lower age limit that female patients must meet in order to qualify for treatment? d. Do you fund one full cycle of IVF for women aged in line with the NICE guidance? e. Do you have an age criteria that male patients must meet in order to qualify for treatment? If so, please state what the criteria is. f. What must the smoking status of patients be? g. What weight requirement exists (i.e. BMI)? h. How long do couples need to be trying to conceive before becoming eligible for treatment? i. Is there a minimum period that the couple need to have been in a relationship before becoming eligible for treatment? j. What eligibility criteria do you apply in relation to existing children that either one or both partners may have? k. What policy is in place (if any) for the use of Single Embryo Transfer? l. Do you fund fertility treatment for same sex couples, and if so what eligibility criteria do they have to fulfil? m. Do you fund fertility preservation for cancer patients and if so what budget is the funding taken from? 2. What is the average cost of a cycle of an IVF cycle funded by the CCG and what does that include?

2 3. What providers does the CCG contract with to provide IVF services? 4. When was the current assisted conception policy developed? And who was consulted? 5. When will the CCG review its assisted conception policy? 6. Is the assisted conception policy available on the CCG s website? If so please provide a link to the policy. 7. Please could you provide me with a copy of your assisted conception policy? 8. Which MPs cover the boundaries of the CCG? 9. Has the CCG conducted any financial modelling on the cost implications of funding three full cycles of IVF? 10. If the CCG does not follow the NICE guideline, have they published the reasons why they do not follow the guideline? If so, what are the reasons for not complying with the NICE guideline? 11. In the last 12 months, or at the time of the last consultation on the IVF policy, has the CCG considered collaborating with other CCGs on the fertility policy? 12. In the last 12 months, how many patients have applied for fertility funding (both successfully and unsuccessfully) through an Individual Funding Request? 13. In the last 12 months, how many women aged between has the CCG funded IVF treatment for? What does the CCG estimate this to have cost? 14. I would also like to request permission to re-publish the data provided in a publically accessible document/web-format. I can provide the following information: a. How many cycles of IVF do you offer to eligible patients? NHS Southern Derbyshire Clinical Commissioning Group currently fund one cycle of In Vitro Fertilisation (IVF) or Intra-Cytoplasmic Sperm Injection (ICSI) treatment in accordance with its policy for IVF/ICSI. b. Do you fund a full cycle of IVF, as defined by NICE, which includes replacement of all frozen embryos? If not how many frozen embryo transfers do you fund? Funding for one cycle of IVF treatment includes ovarian stimulation and is deemed to be complete when all viable fresh and frozen embryos resulting from that stimulation have been transferred. c. What is your upper and lower age limit that female patients must meet in order to qualify for treatment? covers the following: - There is lower no age limit for female patients - For women up to 40 years of age, funding for one cycle of IVF/ICSI is provided - For women aged years, funding for one cycle of IVF/ICSI is available provided the below criteria is met: o The patient has never previously received IVF/ICSI treatment o There is no evidence of low ovarian reserve

3 o The implications of IVF and pregnancy at this age have been discussed with the patient. d. Do you fund one full cycle of IVF for women aged in line with the NICE guidance? NHS Southern Derbyshire Clinical Commissioning Group funds one cycle of IVF/ICSI for women aged years in line with the NICE guidance provided the below criteria is met: - The patient has never previously received IVF/ICSI treatment - There is no evidence of low ovarian reserve - The implications of IVF and pregnancy at this age have been discussed with the patient. e. Do you have an age criteria that male patients must meet in order to qualify for treatment? If so, please state what the criteria is. No, there is not age criteria for male patients. f. What must the smoking status of patients be? states both partners must be non-smoking for at least 28 days prior to treatment commences and must continue to be non-smoking throughout treatment. g. What weight requirement exists (i.e. BMI)? Couples should be advised that having a BMI of 30 or above, in either or both partners, is associated with a reduction in fertility and chances of conceiving which may be reversed with weight loss. Women being considered for IVF must have a stable BMI below 30 at the commencement of treatment. h. How long do couples need to be trying to conceive before becoming eligible for treatment? states where a woman is of reproductive age and having regular unprotected vaginal intercourse two or three times a week, failure to conceive within 12 months should be taken as an indication for further assessment and possible treatment. If the woman is aged 36 years or over, such assessment should be considered after 6 months of unprotected regular intercourse. For women aged over 42 years who have not conceived after 2 years of regular intercourse or a course of artificial insemination, this should be taken as an indication for consideration of IVF treatment. i. Is there a minimum period that the couple need to have been in a relationship before becoming eligible for treatment? Treatment is available when a couple has a medical reason for being unable to conceive a child. Couples who are able to demonstrate this and fulfil the criteria will be eligible for infertility treatments; therefore there is no minimum period of time couples need to have been in a relationship before becoming eligible. j. What eligibility criteria do you apply in relation to existing children that either one or both partners may have? states funding will be available to couples who do not have a living child from their current relationship, nor any previous relationship. A child adopted by a couple is considered to have the same status as a biological child. This does not include foster children. k. What policy is in place (if any) for the use of Single Embryo Transfer? In keeping with the Human Fertilisation and Embryology Authority s (HFEA) multiple birth reduction strategy couples will be counselled about the risks associated with multiple pregnancies and advised that they will receive a single embryo transfer (whether fresh or frozen) in line with NICE guidance unless there is a clear clinical justification for not doing so

4 (e.g. a single top quality embryo is not available or in older women). In any event a maximum of 2 embryos will be transferred per procedure (either fresh or frozen). Women with a good prognosis should be advised that a single embryo transfer, for both the fresh and any subsequent frozen embryo transfers, can almost remove the risk of a multiple pregnancy while maintaining a live birth rate which is similar to that achieved by transferring two fresh or frozen embryos. For women aged between years double embryo transfer can be considered if no top quality embryo is available. For women aged between years, double embryo transfer may be considered. l. Do you fund fertility treatment for same sex couples, and if so what eligibility criteria do they have to fulfil? is intended, as per NICE Clinical Guidelines, for people who have regular sexual intercourse who have failed to conceive due to a specific identified pathological problem or who have experienced infertility. NHS Southern Derbyshire Clinical Commissioning Group will fund IVF treatment for same sex couples provided there is evidence of subfertility, defined as no live birth following artificial insemination (AI) as per policy or proven by clinical investigation as per NICE guidelines. AI should be undertaken in a licensed clinical setting with an initial clinical assessment. m. Do you fund fertility preservation for cancer patients and if so what budget is the funding taken from? NHS Southern Derbyshire Clinical Commissioning Group funds fertility preservation for cancer patients. This funding does not come from the IVF budget. Funding for this is taken from our routine budget for the treatment of cancer patients. 2. What is the average cost of a cycle of an IVF cycle funded by the CCG and what does that include? The average cost of a cycle of an IVF cycle funded by NHS Southern Derbyshire Clinical Commissioning Group is 2,600. This cost includes one course of IVF and/or ICSI, ovarian stimulation, egg collection, embryo transfer, drug therapy, follow up appointments, frozen embryo storage and frozen embryo replacement. 3. What providers does the CCG contract with to provide IVF services? NHS Southern Derbyshire Clinical Commissioning Group contracts with a number of providers collaboratively across the East Midlands through Arden and GEM Commissioning Support Unit. The providers included within this contract are listed below: CARE Fertility, Sheffield CARE Fertility, Nottingham CARE Fertility, Northampton NURTURE Burton Fertility Unit 4. When was the current assisted conception policy developed? And who was consulted? was developed in April The details of who was consulted during this process are outlined within the policy, attached. 5. When will the CCG review its assisted conception policy? will be reviewed in April 2017.

5 6. Is the assisted conception policy available on the CCG s website? If so please provide a link to the policy. The policy for IVF/ICSI is available on our website and can be found here: 7. Please could you provide me with a copy of your assisted conception policy? Please find attached policy for IVF/ICSI. 8. Which MPs cover the boundaries of the CCG? This information is publically available via the below website: 9. Has the CCG conducted any financial modelling on the cost implications of funding three full cycles of IVF? Financial modelling on the cost implications of funding three full cycles of IVF was undertaken as part of the review of the IVF Policy during If the CCG does not follow the NICE guideline, have they published the reasons why they do not follow the guideline? If so, what are the reasons for not complying with the NICE guideline? NICE Guideline 156 recommends Clinical Commissioning Groups to fund three cycles of IVF, however the guideline does not place a statutory duty onto the organisations to implement this recommendation. The guideline, under recommendation 121, also states the organisations should inform people that the overall chance of a live birth following IVF treatment falls as the number of unsuccessful cycles increases. The recommendation was considered as part of the clinical and cost effectiveness of funding more than one cycle of IVF. NHS Southern Derbyshire Clinical Commissioning Group has a responsibility to take account of priorities for funding all treatments, and on the grounds of cost and clinical effectiveness it was agreed to fund one cycle of IVF. 11. In the last 12 months, or at the time of the last consultation on the IVF policy, has the CCG considered collaborating with other CCGs on the fertility policy? NHS Southern Derbyshire Clinical Commissioning Group has adopted the East Midlands Commissioning Policy for IVF/ICSI along with all Clinical Commissioning Groups in the East Midlands. 12. In the last 12 months, how many patients have applied for fertility funding (both successfully and unsuccessfully) through an Individual Funding Request? Two patients in the last 12 months have applied for fertility funding through an Individual Funding Request. 13. In the last 12 months, how many women aged between has the CCG funded IVF treatment for? What does the CCG estimate this to have cost? NHS Southern Derbyshire Clinical Commissioning Group can confirm eight (8) women aged between have received funding for IVF treatment in the last 12 months. The cost of this is 13, I would also like to request permission to re-publish the data provided in a publically accessible document/web-format. NHS Southern Derbyshire Clinical Commissioning Group grants permission for this data to be republished in a publically accessible document/web format.

6 I hope that the information meets your requirements. Should you have any further enquiries or queries about this response please do not hesitate to contact me. However, if you are unhappy with the way in which your request has been handled, you can raise any concerns you might have by contacting Helen Dillistone, Director of Corporate Development, at the following address: 1 st Floor North Point, Cardinal Square, 10 Nottingham Road, Derby, DE1 3QT. Telephone: If you remain dissatisfied, you can apply to the Information Commissioner, who will consider whether NHS Southern Derbyshire Clinical Commissioning Group has complied with its obligations under the Act, and can require NHS Southern Derbyshire Clinical Commissioning Group to remedy any problems. You can find out more about how to do this, and about the Act in general, on the Information Commissioner s website at: Complaints to the Information Commissioner should be sent to: FOI/EIR Complaints Resolution, Information Commissioner s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF.