Availability
IVF is only offered on the NHS if certain criteria are met. If you don't meet these criteria, you may need to pay for private treatment.
NICE recommendations
The National Institute for Health and Care Excellence (NICE) fertility guidelines makes recommendations about who should have access to IVF treatment on the NHS in England and Wales.
But individual Health Boards make the final decision about who can have NHS-funded IVF in their local area. This decision is based on the advice from NICE and that of the Welsh Health Specialised Services Committee (WHSSC). This means that their criteria may be stricter than those recommended by NICE and the WHSSC.
Women under 40
According to NICE, women aged under 40 should be offered 3 cycles of IVF treatment on the NHS if:
- they've been trying to get pregnant through regular unprotected sex for 2 years
- they've not been able to get pregnant after 12 cycles of artificial insemination, with at least 6 of the cycles using a method called intrauterine insemination (IUI)
If you turn 40 during treatment, the current cycle will be completed, but further cycles shouldn't be offered.
If tests show IVF is the only treatment likely to help you get pregnant, you should be referred for IVF straight away.
Women aged 40 to 42
The NICE guidelines also say that women aged 40 to 42 should be offered 1 cycle of IVF on the NHS if all of the following criteria are met:
- they've been trying to get pregnant through regular unprotected sex for 2 years, or haven't been able to get pregnant after 12 cycles of artificial insemination, with at least 6 of the cycles using a method called intrauterine insemination (IUI)
- they've never had IVF treatment before
- they show no evidence of low ovarian reserve (where eggs in your ovaries are low in number or quality)
- they have been informed of the additional implications of IVF and pregnancy at this age
Again, if tests show that IVF is the only treatment likely to help you get pregnant, you should be referred straight away.
IVF on the NHS
NHS trusts across England and Wales are working to provide the same levels of service. But the provision of IVF treatment varies across the country and often depends on local health board policies.
Health Boards may have additional criteria you need to meet before you can have IVF on the NHS, such as:
- not having any children already, from both your current and any previous relationships
- being a healthy weight
- not smoking
- falling into a certain age range (for example, some health boards only fund treatment for women under 35)
Although NICE recommend up to 3 cycles of IVF should be offered on the NHS, some ICBs only offer 1 cycle, or only offer NHS-funded IVF in exceptional circumstances.
Ask your GP or contact your local Health Board to find out what the criteria for NHS-funded IVF treatment are in your area.
Private treatment
If you're not eligible for NHS treatment or you decide to pay for IVF, you can have treatment at a private clinic.
Some clinics can be contacted directly without seeing your GP first, but others may ask for a referral from your GP.
The cost of private treatment can vary, but one cycle of IVF can cost up to £5,000 or more. There may be additional costs for medicines, consultations and tests.
Make sure you find out exactly what's included in the price during your discussions with the clinic.
Some people consider having IVF abroad, but there are a number of issues you need to think about, including your safety and the standard of care you'll receive. Clinics in other countries may not be as regulated as they are in the UK.
Further information
Getting Ready
If you're having problems getting pregnant, see your GP. They will look at your medical history and give you a physical examination.
They may also recommend some lifestyle changes to help increase your chances of getting pregnant.
Unless there are reasons that may put you at high risk of infertility, such as cancer treatment, you'll usually only be considered for infertility investigations and treatment if you've been trying for a baby for at least a year without becoming pregnant.
If appropriate, your GP can refer you to a fertility specialist at an NHS hospital or fertility clinic.
Seeing a fertility specialist
The specialist will ask about your fertility history, and may carry out a physical examination.
Women may have tests to check the levels of hormones in their blood and how well their ovaries are working.
They may also have an ultrasound scan or X-ray to see if there are any blockages or structural problems.
Men may be asked for a semen sample to test sperm quality.
If IVF is the best treatment for you, the specialist will refer you to an assisted conception unit.
At the assisted conception unit
Once you're accepted for treatment at the assisted conception unit, you and your partner will have blood tests for HIV, hepatitis B and hepatitis C.
Your cervical screening tests should also be up to date.
The clinic should also check that you've been offered a screening blood test for sickle cell and thalassaemia if your ancestors come from a country where these condition are more common. Anyone can ask to have this test for free on the NHS from their GP.
If you're planning to use donor eggs, check that these have been screened. All IVF clinics in the UK are required to screen donor eggs and sperm.
The specialist will investigate the number of eggs in your body (your ovarian reserve) to estimate how your ovaries will respond to IVF treatment.
This can be assessed by measuring a substance called anti-mullerian hormone (AMH) in your blood, or by counting the number of egg-containing follicles, known as your antral follicle count (AFC), using a vaginal ultrasound scan.
Your specialist will then discuss your treatment plan with you in detail and talk to you about any support or guidance you may find helpful.
How is it performed?
What happens during IVF may differ slightly from clinic to clinic, but a typical treatment follows the main steps below.
For women
Step 1: suppressing the natural menstrual cycle
You are given a medication that will suppress your natural menstrual cycle. This can make the medicines used in the next stage of treatment more effective.
This medicine is given either as a daily injection (which you'll be taught to give yourself) or as a nasal spray. You continue this for about 2 weeks.
Step 2: helping your ovaries produce more eggs
Once your natural cycle is suppressed, you take a fertility hormone called follicle stimulating hormone (FSH).
FSH increases the number of eggs your ovaries produce. This means more eggs can be collected and fertilised. With more fertilised eggs, the clinic has a greater choice of embryos to use in your treatment.
Step 3: checking progress
The clinic will keep an eye on you throughout the treatment. You will have vaginal ultrasound scans to monitor your ovaries and, in some cases, blood tests.
About 34-38 hours before your eggs are due to be collected, you'll have a final hormone injection that helps your eggs to mature.
Step 4: collecting the eggs
You'll be sedated and your eggs will be collected using a needle that's passed through the vagina and into each ovary under ultrasound guidance.
This is a minor procedure that takes about 15 to 20 minutes.
Some women experience cramps or a small amount of vaginal bleeding after this procedure.
Step 5: fertilising the eggs
The collected eggs are mixed with your partner's or the donor's sperm in a laboratory to fertilise them,
In some cases, each egg may need to be injected individually with a single sperm. This is called intra-cytoplasmic sperm injection or ICSI.
You can read more about ICSI on the Human Fertilisation and Embryology Authority (HFEA) website.
The fertilised eggs (embryos) continue to grow in the laboratory for up to 6 days before being transferred into the womb. The best 1 or 2 embryos will be chosen for transfer.
After egg collection, you will be given hormone medicines to help prepare the lining of the womb to receive the embryo. This is usually given either as a pessary placed inside the vagina, an injection, or a gel.
Step 6: embryo transfer
A few days after the eggs are collected, the embryos are transferred into the womb. This is done using a thin tube called a catheter that's passed into the vagina.
This procedure is simpler than egg collection and similar to having a cervical screening test, so you won't normally need to be sedated.
The number of embryos that will be transferred should be discussed before treatment starts.
It usually depends on your age.
- Women under 37 in their 1st IVF cycle should only have a single embryo transfer. In their 2nd IVF cycle, they should have a single embryo transfer if 1 or more top-quality embryos are available. Doctors should only consider using 2 embryos if no top-quality embryos are available. In the 3rd IVF cycle, no more than 2 embryos should be transferred.
- Women aged 37-39 years in their 1st and 2nd full IVF cycles should also have single embryo transfer if there are 1 or more top-quality embryos. Double embryo transfer should only be considered if there are no top-quality embryos. In the 3rd cycle, no more than 2 embryos should be transferred.
- Women aged 40-42 years may have a double embryo transfer.
If any suitable embryos are left over, they may be frozen for future IVF attempts.
The HFEA has more on decisions to make about your embryos.
For men
Around the time your partner's eggs are collected, you'll be asked to produce a fresh sperm sample.
The sperm are washed and spun at a high speed so the healthiest and most active sperm can be selected.
If you're using donated sperm, it's thawed before being prepared in the same way.
Finding out if you're pregnant
Once the embryos have been transferred into the womb, you'll be advised to wait around 2 weeks before having a pregnancy test, to see if the treatment has worked.
Some clinics may suggest carrying out a normal urine pregnancy test at home and letting them know the result, while others may want you to come into the clinic for a more accurate blood test.
This 2-week wait can be a very difficult period because of the anxiety of not knowing whether the treatment has worked. Some people find it the hardest part of the treatment process.
During this period, you may find it useful to speak to a counsellor through the fertility clinic, or to contact other people in a similar situation to you via the HealthUnlocked IVF community.
If you do become pregnant, ultrasound scans will be carried out during the following weeks to check things are progressing as expected.
You will then be offered the normal antenatal care given to all pregnant women.
Unfortunately, IVF is unsuccessful in many cases and you should try to prepare yourself for this possibility.
You may be able to try again if treatment doesn't work, although you shouldn't rush straight into it.
You may find counselling or fertility support groups helpful during this difficult time.
Risks
Before starting IVF, it's important to be aware of the potential problems you could experience.
Some of the main risks are outlined below.
Medicine side effects
Many women will have some reaction to the medicines used during IVF. Most of the time, the side effects can be mild.
They may include:
- hot flushes
- feeling down or irritable
- headaches
- restlessness
- ovarian hyperstimulation syndrome
Contact the fertility clinic if you experience persistent or worrying side effects during treatment.
Multiple births
If more than 1 embryo is replaced in the womb as part of IVF treatment, there's an increased chance of producing twins or triplets.
Having more than 1 baby may not seem like a bad thing, but it significantly increases the risk of complications for you and your babies.
Problems more commonly associated with multiple births include:
Your babies are also more likely to be born prematurely or with a low birthweight, and are at an increased risk of developing life-threatening complications such as neonatal respiratory distress syndrome (NRDS) or long-term disabilities, such as cerebral palsy.
National Institute for Health and Care Excellence (NICE) guidelines recommend that double embryo transfers should only be considered in women aged 40-42.
Younger women should only be considered for a double embryo transfer if there are no top-quality embryos to choose from.
Read more about the Human Fertilisation and Embryology Authority (HFEA) campaign to reduce multiple births
Ovarian hyperstimulation syndrome
Ovarian hyperstimulation syndrome (OHSS) is a rare complication of IVF.
It occurs in women who are very sensitive to the fertility medication taken to increase egg production. Too many eggs develop in the ovaries, which become very large and painful.
OHSS generally develops in the week after egg collection.
The symptoms can include:
- pain and bloating low down in your tummy
- feeling and being sick
- shortness of breath
- feeling faint
Severe OHSS can be dangerous. Contact your clinic as soon as possible if you have any of these symptoms.
It may be necessary to cancel your current treatment cycle and start again with a lower dose of fertility medicine.
Ectopic pregnancy
If you have IVF, you have a slightly higher risk of an ectopic pregnancy, where the embryo implants in the fallopian tubes rather than in the womb.
This can cause pain in the tummy, followed by vaginal bleeding or dark vaginal discharge.
If you have a positive pregnancy test after IVF, you'll have a scan at 6 weeks to make sure the embryo is growing properly and that your pregnancy is normal.
Tell your doctor if you experience vaginal bleeding or stomach pain after having IVF and a positive pregnancy test.
Risks for older women
IVF treatment becomes less successful with age. In addition, the risk of miscarriage and birth defects increases with the age of the woman having IVF treatment.
Your doctor will discuss the increased risks that come with age, and can answer any questions you may have.