Publicly Funded Fertility Treatment in Northern Ireland Alastair Campbell Deputy Director of Secondary Care DHSSPS

Northern Ireland Access Criteria Treatment is limited to those with a medical cause for infertility. To qualify for specialist treatment, patients must have a diagnosed cause for their infertility or have been infertile without a recognised cause for three years. No qualifying period for couples with an appropriately diagnosed cause of infertility

Age Limits Upper age limit for a woman using her own eggs is 39. Upper age limit for a woman using donor eggs is 49. There is no age criterion for men accessing the service.

Number of cycles Access to treatment is restricted to those who have had three or fewer unsuccessful treatment cycles – whether publicly or privately funded. Those eligible for treatment are offered one publicly funded treatment cycle with one cycle of Frozen Embryo Transfer

Other factors Unlike the rest of the UK, there is no restriction on those with dependent children. Couples who have children living with them (in any capacity) have equitable access to treatment. In Northern Ireland we do not routinely restrict access based on BMI or whether either of the couple smokes. Where someone has previously been voluntarily sterilised, treatment can be provided at clinical discretion.

Legislative Position Fertility services are governed by the Human Fertilisation and Embrylogy (HFE) Act 2008. This a reserved matter – applied UK wide. However, each jurisdiction decides what services are publicly available within the framework of the parent legislation.

DHSSPS Policy/NICE Guidance Since 2006, DHSSPS has a formal link with the National Institute for Health and Care Excellence (NICE). NICE Guidance is reviewed locally for its applicability to Northern Ireland. Where applicable it is then endorsed by the Department for implementation in the HSC.

NICE Guideline 156 (CG156) CG 156 – Fertility: Assessment and treatment for people with fertility problems Amongst other things, CG 156 recommends three full cycles of publicly funded IVF/ICSI

Position across the UK Wales – two full cycles for women who meet the access criteria. Scotland – a maximum of two NHS cycles per couple. England – varies between one and three according to Clinical Commissioning Group (CCG). Recent figures appear to show a decrease in the number of CCGs offering three: www.theguardian.com/society/2014/sep/13/ivf-rationing-nhs-fertility-women

Current NI Position CG 156 was endorsed by the Department in November 2013 and passed to the HSCB to consider implementation. Current budget shortfall - £140 million. Due to difficulties with the departmental budget the Board is unable to provide definitive plans for implementation.

Next Steps Endeavour to continue to provide one full cycle of IVF/ICSI , plus a cycle of FET. Minister working with his Executive Colleagues to try to address the gap in the Health Budget. HSCB has carried out planning and modelling work. If, in future, we are in a position to expand the service, they are confident there is sufficient capacity within the Regional Fertility Centre.

Any questions?