Assisted Conception on the NHS

The NHS does provide a number of different fertility treatments, including assisted conception techniques like intrauterine insemination and IVF. It is important to note however that there is variation in how these are offered and where because different NHS trusts have their own funding policies and limitations, all under the management of their local primary care trusts (PCTs) who have the final say in what a trust can afford in terms of treatment. Generally speaking however, the NHS offers assisted conception according to the general guidelines and in the manner discussed in this article.

Is intrauterine insemination (IUI) available on the NHS?

Intrauterine insemination is a form of assisted conception that involves helping sperm to access the uterus (also known as the womb) by means of a very fine tube. The first step in this process is to collect a sperm sample from a male and filter out the fastest moving sperm which are hence the most fertile. These sperm are the ones used for IUI, and is performed at the same time as female ovulation, just as eggs are being released into the uterus for conception, all to give a couple the best possible chance for conception.

IUI is used by the NHS when there is no available explanation for a couple’s infertility, or if that infertility has a male component, namely a poor sperm count, poor motility, or impotence. It is also used where endometriosis, the unwanted growth of the lining of the uterus in other areas, is the cause of female infertility.

The NHS operates under advice from the National Institute for Health and Clinical Excellence (NICE’s) guidelines where treatment provisions are concerned. NICE suggests that up to 6 IUI cycles should be available to couples, each of which can have a success rate of about 15% for women under 35. Again however, this is extremely variable between trusts and depends on the local PCT.

Is in vitro fertilization (IVF) available on the NHS?

IVF is quite different to IUI in that the fertilization of an egg by sperm is conducted outside the body in a laboratory. The process is longer as first a series of drugs affecting a woman’s natural menstrual cycle are used to stimulate egg production before these eggs are collected for IVF. After this a sperm sample is collected and used to fertilize eggs and form embryos which are then placed back into the female womb to grow.

There are many different refinements to the general IVF technique, each of which offers a solution to a problem that may have appeared during an early IVF cycle. Different trusts and PCTs will be able to offer different methods, but broadly speaking these can include ICSI (intra-cytoplasmic sperm injection), which involves injecting a single sperm into an egg, and blastocyst transfer to help women who have healthy embryos that fail to implant for some reason.

NICE guidelines tell trusts that they should be able to offer as many as 3 cycles of IVF provided the woman involved is above the age of 23 and younger than 39 and either the cause of infertility is known of infertility has been present for a minimum of 3 years. At least one round of IVF is made available in most trusts, and some PCTs can offer the recommended 3 cycles. However because funding is limited couples without existing children are given priority. The NHS reports a success rate of 29% if IVF used on women under the age of 35.

Egg and sperm donation on the NHS

The NHS also makes provisions for egg and sperm donation if necessary as part of infertility treatments. Receiving these donations is treated with sensitivity and discretion as it can be a hard decision for some couples to make, and many will choose for alternatives rather than make use of the donor facilities available. Donor sperm can be used for artificial insemination like IUI and for IVF, while donor eggs can be used during IVF.

While previously egg and sperm donors could choose to remain anonymous, legislation around the issue has changed as of 2005. Donors no longer have the option to retain their anonymity as it has been deemed that a child born as a result of donor eggs or sperm has the right to find out the identity of their biological donors when they get to 18 years of age.

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