Cambridgeshire: Decision due today on whether or not routine IVF will be available on the NHS
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Whether or not routine IVF will be available on the NHS in Cambridgeshire will be decided today (Tuesday).
The decision to extend a suspension into a longer-term withdrawal of the service looked set to go ahead earlier this year, with multiple delays raising the prospect of a change.
But despite "new information from the Department of Health," the recommendation being put to the county's NHS bosses tomorrow is still to extend the suspension, with no specified end-date.
Routine treatment for women under 40 is available almost everywhere else in England.
Official guidelines state it should be available, but each Clinical Commissioning Group (CCG) makes the final decision in their area.
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Cambridgeshire and Peterborough is one of just five CCGs that does not offer routine IVF according to Fertility Fairness, out of the 196 the campaign group claims to have data for.
It was suspended in Cambridgeshire in 2017, with the CCG citing a negative financial situation - it claims to be the third lowest funded CCG in England.
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That suspension was due to be reviewed already in April, and then June, then July - but the decisions were delayed.
The recommendation put to the Governance Board for its meeting tomorrow is to continue its suspension, now until the CCG "returns to a sustainable financial surplus".
The full recommendation reads: "The Governing Body is asked to approve the recommendation from the Integrated Performance and Assurance Committee to continue not to fund the provision of specialist fertility services until such point that the CCG returns to a sustainable financial surplus or is instructed otherwise by our Regulators."
But the financial situation has been getting worse since the initial suspension in 2017. The CCG had a £21.6m deficit then, which has risen to a forecast £75m this year.
The IVF decision is one of many the CCG has made and is looking to make to reduce its deficit and return to surplus - but it has not said when that will be.
IVF - in vitro fertilisation - is a medical procedure where an egg removed from a woman's ovaries is fertilised with sperm in a laboratory, and can help couples with fertility problems to conceive.
The technique is used across the world but was first successfully carried out in Cambridgeshire.
IVF will still be available at private practices.
How much does it cost the CCG and how many people use it?
The CCG says its average cost per patient is close to £5,000 per cycle of IVF.
The original suspension was expected to save £700k per year.
The latest CCG report shows that between September 2017 and March 2019 it saved £730k.
The CCG estimates that 159 patients have been impacted by the suspension between September 2017 and June 2019.
If the suspension continues then the CCG estimates that a total of 148 patients will be affected in 2019/20 and a further 154 patients in 2020/21.
Where can you get free IVF, and what do the guidelines say?
According to the national guidance provided by the National Institute for Health and Care Excellence (NICE), IVF should be made available on the NHS in a greater capacity than in Cambridgeshire and Peterborough. Although the NICE guidelines to state that each CCG makes the final decision.
Campaign group Fertility Fairness says four other CCGs do not currently offer routine IVF: Croydon, Mid Essex, North East Essex, and Basildon and Brentwood.
It means four of the five are in the east, and even share a boundary.
Contrast that with the rest of the country - Fertility Fairness claims 127 CCGs offer one cycle of IVF, 40 offer two cycles, and 24 offer three cycles.
According to NICE, women aged under 40 should be offered three cycles of IVF treatment on the NHS if:
- they've been trying to get pregnant through regular unprotected sex for two years
- they've not been able to get pregnant after 12 cycles of artificial insemination
- tests indicate it is the only treatment
The NICE guidelines also say women aged 40 to 42 should be offered one 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
- 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've been informed of the additional implications of IVF and pregnancy at this age
- if tests indicate it is the only treatment
Exceptions to the current suspension of specialist fertility services
The CCG says there are two exceptions to the suspension: egg/sperm/embryo storage for cancer patients; and sperm washing provided to men who have a chronic viral infection, whose female partner does not, and where intrauterine insemination is being considered.