SMOKERS, drinkers and the obese will be denied access to IVF until they improve their lifestyles, under strict new guidance for the NHS in Scotland.
The new criteria, designed to make access to fertility treatment fairer across the country, states that women under 40 can have two cycles of IVF funded by the NHS.
But treatment is limited to patients who are not obese, where neither partner smokes and neither drinks alcohol before or during treatment.
The new guidance from the National Infertility Group also states that the couple should be in a stable, co-habiting relationship for at least two years before starting treatment. However, those behind the guidelines admitted this could be difficult to police.
The guidelines will also lead to a drop in cycles offered to patients in some areas which currently provide three cycles.
But the report said, following a review of progress and waiting times in 2015, they would like to see the number of cycles increased to three.
Opposition politicians welcomed moves to make access more equal, but questioned the drop in provision.
The public health minister, Michael Matheson, said the guidance would help to provide fair, reliable and faster access to IVF treatment, following previous concerns about a postcode lottery of services.
The report reveals wide differences between boards in terms of waiting times. At the end of last year, these ranged from no wait in NHS Borders, to three to six months in NHS Orkney, Shetland and Western Isles, to a high of three years and eight months in Grampian.
Boards also often have different criteria on who is eligible for treatment. The guidance gives women a guaranteed maximum of two fresh cycles of IVF up to the age of 40, including unlimited transfer of any frozen embryos created at the same time.
The guidelines also guarantee women aged 40 to 42 one full cycle of IVF if they meet extra criteria, which mean they would have a reasonable chance of becoming pregnant. From 31 March, 2015, all couples will start treatment within 12 months of being accepted for IVF.
But the guidance sets strict new criteria on who will be eligible in efforts to address differing guidelines used around Scotland.
Women must have a body mass index (BMI) of below 30 and above 18.5 before they are referred for treatment. An ideal BMI – a figure derived from measuring weight against height – is between 21 and 22.
The report says this is due to the reduced chances of successful IVF in obese women, as well as the risks to mother and child during pregnancy.
Both partners must also be non-smokers for at least three months before treatment and continue during treatment. Alcohol should be avoided during the treatment, as should illegal substances.
Mr Matheson said: “Currently, the service and criteria offered to women vary across the country. This is not acceptable. For the first time, NHS provision of IVF will not vary, regardless of where you live.
“All patients in Scotland will have access to a more generous and fairer service than elsewhere in the UK.”
Half of health boards say they offer three cycles of IVF treatment, meaning the new criteria will reduce the number of treatments available to some couples.
But Ian Crichton, chair of the National Infertility Group, said in reality many boards were not able to give couples three cycles due to long waiting times.
“Some of the boards that have three cycles down as what they would provide were boards which had long waiting time, so if you think what age you’d be by the time you get to cycle number three, you would fail another criterion,” he said.
“I can’t promise it is like snake oil and everyone is better off, but overall what I can say is by March 2015 we should be in a position where everyone has the same entitlement and is waiting roughly the same length of time.”
NHS IVF services are provided in centres in Aberdeen, Dundee, Edinburgh and Glasgow. The access recommendations for all couples from 1 July, 2013, are:
• Eligible patients up to the age of 40 may be offered up to two cycles of IVF where there is a reasonable expectation of a live birth.
• Both partners must be non-smoking for at least three months before treatment and continue to be non-smoking during treatment.
• Both partners must abstain from illegal and abusive substances.
• Both partners must be methadone-free for at least one year prior to treatment.
• Neither partner should drink alcohol prior to or during the period of treatment.
• Body mass index (BMI) of female partner must be above 18.5 and below 30.
• Neither partner to have undergone voluntary sterilisation, even if sterilisation reversal has been self-funded.
• NHS funding will not be provided to couples where either partner has already received the number of NHS-funded IVF treatment cycles supported by NHS Scotland, regardless of where in the UK they received treatment.
• No individual (male or female) can access more than the number of NHS-funded IVF treatment cycles supported by NHS Scotland under any circumstances, even if they are in a new relationship.
• Fresh cycles of treatment must be initiated by the date of the female partner’s 40th birthday, and all subsequent frozen transfers must be complete before the woman’s 41st birthday.
• Couples must have been co-habiting in a stable relationship for a minimum of two years.
• NHS funding may be given to those patients who have previously paid for IVF treatment, if in the treating clinician’s view the individual clinical circumstances warrant further treatment.
• Patients should not be placed at the end of the waiting list following an unsuccessful treatment cycle.
For couples where the woman is aged from the day after her 40th birthday to 42, one full cycle will be offered if:
• They have never previously had IVF treatment.
• There is no evidence of poor ovarian reserve and if, in the treating clinician’s view, it is in the patients’ interest.
• There has been a discussion of the additional implications of IVF and pregnancy at this age.