How to Access Treatment on the NHS
We know it can be upsetting when you’re trying for a baby and you’re not getting pregnant as quickly as you may have hoped. The NHS explain that around 84% of heterosexual couples will conceive within a year if they have regular, unprotected intercourse1. This means that some couples may conceive quickly, but for others it may take longer, and some may require fertility treatments such as IVF to help them conceive. To help make things easy for you during this time, we want to provide a guide to help you better understand how to access NHS fertility treatment services, such as IVF or IUI. Here we’ll explain when you should seek medical advice, what you can expect from your GP and what your next steps may be.
When should you see a GP about your fertility?
The National Institute for Health and Care Excellence (NICE) guidelines state you should visit your GP if:
- You’re under the age of 35 and you’ve been trying to conceive for 1 year.
- If you’re over the age of 35 you should get in touch with your GP sooner as you may be able to access investigations earlier2.
You should also visit your doctor soon if you or your partner have a condition that is known to affect fertility as you should be offered investigations sooner3.
What will you discuss with your GP?
Your GP will perform an assessment and determine if you’re eligible to NHS fertility treatment and tests in order to see if there are any underlying causes of the fertility problems you may be experiencing. They will ask specific questions relating to your reproductive health and sexual intercourse. This may feel uncomfortable to talk about, but it’s important to be as open as you can, as your GP is there to help you.
In order to help you prepare for that visit with your GP, here are some questions you may be asked:
- Contraception. If you’ve taken any type of contraception, your doctor will want to know what type and when you stopped using it. They may ask if you experienced any side effects while taking/coming off of contraception.
- Your menstrual period. You may be asked when your last menstrual period was, how long your menstrual cycles are and if they are regular. This can help determine if there’s any irregularity to your ovulation.
- Sexual intercourse. You’re more likely to get pregnant around the time of ovulation, so your GP may ask you questions about when and how frequently you have intercourse.
- Known medical conditions or medication. Some long term medical conditions and some medications can have an impact on your ability to conceive. It’s important to discuss these with your GP to get the best medical advice when moving forward.
- Lifestyle factors. Smoking and passive smoking can reduce a woman’s chances of getting pregnant and can reduce semen quality in men4. Your GP may be able to help you with smoking cessation programs which could help increase your chances of conceiving naturally. You may be asked about your alcohol consumption as excessive drinking can also have a negative impact on semen quality5. You may be asked about your weight or asked to be weighed. It can take longer to get pregnant if you have a BMI (body mass index) under 19 or above 30 and your GP may encourage you to make adjustments to your diet as a healthy weight could increase your chances of conceiving naturally6.
- Cervical smear. Your GP will also make sure that your cervical smear is in date. The cervical screening is a way of checking if there are any abnormal cells in the cervix, which would sometimes need to be removed. This would need to be done before any potential pregnancy.
- Rubella status. Your rubella status will also be checked as you may need to have a vaccination before starting any potential treatment.
What fertility investigations can the NHS provide?
You may have blood tests to assess your hormone levels. A progesterone test can be performed during your cycle to check whether you’re ovulating. The timing of the test is based on the length of your menstrual cycle. If you have irregular cycles, you may have additional tests for FSH (follicle stimulating hormone), TSH (thyroid stimulating hormone), prolactin and testosterone7.
An ultrasound may be performed to check your uterus, fallopian tubes and ovaries. This is used to look for signs that your fallopian tubes could be blocked, preventing the eggs from travelling down after ovulation or preventing sperm from reaching the egg. It could also determine if you have any conditions affecting your uterus, like fibroids or endometriosis, as they may have an impact on your chances of conceiving.
A semen analysis is performed to check if there are any issues with the sperm, such as a low count or low motility (movement of the sperm). Laboratories that analyse semen samples use methods and reference values in accordance with the most recent World Health Organisation laboratory manual8. The results will include:
- volume (1.5mL or more)
- sperm concentration (15 million sperm or more)
- total sperm number (39 million sperm or more)
- motility, how sperm move (40% or more moving sperm)
- morphology, how sperm look (4% or more normal forms)
Fertility treatment availability on the NHS
Once your GP has completed your fertility investigations they will decide whether there is a need for further assessment, whether you should continue to try to conceive naturally or if you are eligible for treatment funded by the NHS. The NICE guidelines have recommendations on different treatment types. You could be eligible for 6 cycles of IUI (intrauterine insemination) or 3 cycles of IVF (in-vitro fertilisation) funded by the NHS. However, local ICBs (Integrated Care Boards, previously known as CCGs or Clinical Commissioning Groups) decide what is funded in your area so it’s important that your GP prepares you for what is available to you.
Eligibility for NHS-funded fertility treatments
In order to be referred for NHS-funded fertility treatment, an assessment must be made by your GP or fertility specialist which specifies certain criteria set out by the ICB. The criteria may include:
- Body Mass Index (BMI)
- Length of time trying to conceive
- Previous children
- Lifestyle factors
What are you entitled to?
Once it’s established if you are eligible for fertility treatment funded by the NHS, there may be limitations on how many cycles you are entitled to. BPAS (British Pregnancy Advisory Service) conducted a report on the provision of fertility services and concluded that only 17% of the previous CCGs9 funded the full 3 cycles of IVF as recommended by the NICE guidelines, and 3 of the previous CCGs didn’t offer IVF on the NHS at all. Your GP should explain what’s available in your area, as there can be large financial implications if you would need to fund treatment yourself.
- If you are concerned about your fertility | Information for the public | Fertility problems: assessment and treatment | Guidance | NICE
- Trying for a baby | Information for the public | Fertility problems: assessment and treatment | Guidance | NICE