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National Infertility Group Report January 2013

DescriptionThe report was produced by the National Infertility Group in January 2013, with recommendations on IVF criteria for all eligible couples, for the consideration of Scottish Government Ministers.
ISBN9781782564300
Official Print Publication Date
Website Publication DateMay 15, 2013

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ISBN 978 1 78256 430 0
DPPAS 13946

This document is also available in pdf format (2.4mb)

Contents

1. Introduction

2. The aim:
2.1 Reduce inequity and waiting time to 12 months
2.2 Achieve this by using short-term money to target waiting times
2.3 Ensure that the long-term cost of provision is similar to current cost
2.4 Align our recommendations with 20:20 Vision

3. What are we talking about?
3.1 Definition of infertility
3.2 Three levels of care
3.3 The main issue is IVF/ICSI
3.4 How are IVF services arranged in Scotland?
3.4.1 The financial arrangements for IVF are different to other NHS services
3.5 Why do we have a problem of inequity and long waits?
3.6 What has been done in the past to manage the problem?

4. What did we do?
4.1 Main Group
4.2 Working Groups
4.3 Review of the evidence
4.4 Gathering information (from units, HFEA etc)
4.4.1 Data collection
4.4.2 Obtaining routine data
4.5 Modelling
4.6 Discrete events simulation modelling

5. What did we find?
5.1 Overall activity in Scotland
5.2 Trend over time: the reason for the increase in demand
5.3 Numbers being commissioned by Health Boards, criteria and waiting times
5.4 IVF in Scotland compared to the rest of the UK
5.5 The activity in each unit and the capacity
5.6 Numbers/proportions self-funding and why people self-fund
5.7 Cost of IVF

6. Clinical effectiveness of IVF
6.1 Factors affecting fertility, maternal and infant health
6.1.1 Obesity
6.1.2 Smoking
6.1.3 Substance misuse
6.1.4 Alcohol
6.1.5 Maternal age
6.2 How many cycles should be provided?
6.3 Should we treat couples with existing children?
6.4 Waiting list management
6.5 The role of support organisations
6.6 The important implications of single embryo transfer and the increase in frozen embryo transfers

7. Other areas on which we do not make recommendations
7.1 Fertility preservation
7.2 Gamete donation
7.3 Pre-implantation genetic diagnosis
7.4 Surrogacy IVF
7.5 Intra-uterine insemination (IUI)

8. What do we recommend?
8.1 Infertility in the context of the NHS Quality Strategy
8.2 Raising awareness of the risk of infertility in the general population
8.3 Improving the pathway of care
8.4 Better patient support
8.5 The same criteria for all Health Boards
8.6 Definitions of a cycle of treatment and when waiting time clock starts and stops
8.6.1 Definition of 'one cycle of IVF'
8.6.2 Definition of waiting time
8.7 Recommended criteria for treatment and the date of introduction
8.8 Number of cycles
8.8.1 Previous cycles - NHS
8.8.2 Previous cycles - self-funded
8.8.3 Frozen embryos
8.9 Waiting list management
8.10 Increased activity within current capacity to reduce waiting times
8.11 Communication

9. Summary of recommendations
9.1 Information to NHS Boards
9.2 Implementation of criteria
9.3 Definition of infertility from 1 April 2013
9.4 Access criteria recommendations for all couples from 1 April 2013
9.5 Phasing in of further criteria

Appendix A Waiting times modelling scenarios
Appendix B Economic modelling
Appendix C Membership and original remit
Appendix D IVF activity and success rates of Scottish units
Appendix E Comparison of IVF data delivered regionally across the UK
Appendix F Commissioning rate by NHS Board
Appendix G Cost effectiveness of IVF
Appendix H Proportion of births due to IVF/ICSI
Appendix I Single embryo transfer principles
Appendix J Pathway infertility referral
Appendix K Glossary
Appendix L References