Almost 70% of NHS areas in England offer only one cycle of IVF, data shows

Charity says situation breaks Nice guidelines and is having devastating impact on couples struggling with infertility

Millions of women in England are able to access only one round of IVF on the NHS because of health authority cutbacks and in contravention of official policy, research from a fertility charity has shown.

Nearly 70% of local areas fund just one cycle for women under 40 who have been unable to conceive for two years, rather than the three full cycles they should be offered in line with official guidance, according to data collected by the Progress Educational Trust (PET).

Twenty-nine of the 42 integrated care boards (ICBs), which control NHS budgets locally, now offer only the one round, after four reduced access in the past year.

Sarah Norcross, the director of PET, said the impact was “devastating” for those couples who were struggling with infertility.

“Infertility is already incredibly stressful for people, and it puts them under even more pressure, because there is so much riding on whether that one NHS-funded cycle is going to work. And for some people, that will be their only chance, because private fertility treatment is so expensive.”

The data showed that only two of England’s 42 ICBs – NHS North East and North Cumbria, and NHS North East London – have policies consistent with National Institute for Health and Care Excellence (Nice) guidelines, which they are not legally obliged to follow.

The data also threw up regional variations, with the whole of the north-west offering just one cycle. “It’s a postcode lottery, and we’re seeing a race to the bottom,” said Norcross.

Of the 29 ICBs that offer a single cycle of IVF, 19 provide only a partial cycle, where not all viable embryos created are transferred to the woman. There was just one recent example of improved services, from NHS South East London, which in July 2024 went from one partial to two full cycles.

Fertility rates in England and Wales have fallen since 2010 to 1.41 children per woman in 2024, the lowest on record and below the “replacement level” of 2.1 at which a country’s population is considered to be stable without immigration.

The NHS estimates that about one in seven couples may have difficulty in achieving a pregnancy. One cycle of IVF can cost from £5,000 at a private clinic.

The health minister Karin Smyth said in an answer to a written question in parliament last month that it was “unacceptable” that access to NHS-funded fertility services varied across the country.

Revised Nice fertility guidelines are due this spring but Norcross said changing them seemed like a pointless exercise.

“Fertility treatment has always been a Cinderella service. It’s always been the one they’ve chosen to cut or to ignore. Nice has recommended three full NHS-funded cycles, for women under 40, for more than 20 years. This has never been implemented across England, unlike in Scotland.”

She advocated centralised commissioning, and replicating Scotland’s approach, which included financial modelling and a phased implementation starting with two cycles in order to avoid lengthy waiting lists, moving up to three cycles once capacity was achieved. “It is a tried and tested plan that England could follow,” Norcross added.

A Department of Health and Social Care spokesperson said: “We recognise access to fertility treatment varies across the country and we are working with the NHS to improve consistency.

“Nice provides clear clinical guidelines, and we expect integrated care boards to commission treatment in line with these.

“Updated Nice fertility guidelines are expected this spring and we will continue to support NHS England to make sure the guidance is fully considered in local commissioning decisions.”

An NHS England spokesperson said: “These clinical services are commissioned by integrated care boards for their area based on the needs of the local population and prioritisation of resources available. All ICBs have a responsibility to ensure services are provided fairly and are accessible by different population groups.”