In the past year alone, five areas have slashed NHS fertility treatment or cut eligibility criteria

In the past year alone, five areas have slashed NHS fertility treatment or cut eligibility criteria. This World IVF Day, Helen Coffey takes a deep dive into a severely unjust area of medicine that sees thousands of people priced out of having children at a time when it’s never been more vital I think we should stop calling it a ‘ postcode lottery ’.

A lottery implies that you’ve got some luck in this – but you’ve only got luck if you happen to live in that particular place. You don’t get any more luck once you’re there. You’re stuck. Sarah Norcross, director of the Progress Educational Trust (PET), a charity that improves choices for people affected by infertility, is talking about the current access to fertility treatment.

More specifically, access to in vitro fertilisation ( IVF ) on the NHS in England. It’s a particularly relevant topic, given that today, 25 July, is World IVF Day: it commemorates the birth of Louise Joy Brown in Oldham, Greater Manchester, in 1978, the first baby ever conceived through IVF. But although Brown’s remarkable legacy lives on, nearly 50 years later IVF provision is something of a roulette in the very country in which the pioneering treatment was invented.

Eligibility and the number of cycles couples are entitled to vary wildly between areas. Rules are governed by NHS local integrated care boards (ICBs), which are able to conjure up their own policies at will. In some places, IVF is offered to women up to the age of 42; in others, it’s capped at 35. In some places, couples are offered three full rounds of IVF; in others, one partial round.

In some places, as long as there are no children from the current relationship, the couple will be eligible; in others, the existence of any kids from previous relationships immediately prohibits treatment. There is no rhyme or reason to this – it’s just an issue of resource distribution amid a health service stretched wafer thin. It is, as Norcross says, “grossly unfair”.

The “luck” element is significant even at a granular level. PET research has revealed that female GPs are nearly 20 per cent more likely than their male peers to refer patients for NHS-funded fertility treatment. “Whether you can access treatment, what provision you’ll receive and under what conditions is fundamentally inequitable, says Gwenda Burns, chief executive of the Fertility Alliance, a national charity offering support to those struggling with infertility.

Rather than improving, provision is getting substantively worse. In the past year alone, five separate ICBs in England have reduced their IVF offering. On 1 April 2026, NHS Greater Manchester cut the number of cycles offered from up to three to just one.

Katherine Sheerin, NHS Greater Manchester’s chief healthcare commissioning officer, said that, while they know the decision will be “upsetting and disappointing” for some, “access to NHS-funded IVF depends on where someone lives, and that variation is unfair and cannot continue as it is. Moving to a single policy removes this postcode variation. From 1 February 2026, NHS Cheshire and Merseyside ICB also went from offering two or three cycles to one.

“We have a responsibility to ensure services are provided fairly for everyone across the region and by moving to a single funded IVF cycle, we can continue to offer treatment in a consistent way that remains clinically appropriate and financially sustainable, a spokesperson told The Independent. Whether you can access treatment and what provision you’ll receive is fundamentally inequitable Across South Yorkshire, IVF cycles were slashed from two to one in December 2025. “This decision has not been taken lightly by the Board, Chris Edwards, interim chief executive at NHS South Yorkshire, said of the decision. “However, in a difficult financial climate we have a responsibility to balance the needs of all our communities and ensure that we are delivering the best possible value for money within the resources available.

At the beginning of July 2025, NHS Sussex’s ICB reduced the number of cycles patients can receive from three to one; they declined to comment when approached by The Independent. Finally, in a double blow, Kent and Medway quietly announced in April this year that they would cut provision from two cycles for women up to the age of 40 to one cycle for women 37 and under. On the ground, these changes have caused patients and doctors a huge amount of stress as they’ve tried to fast-track referrals to beat the deadline.

“We’ve just been trying to get people through as quickly as possible so they can get their two or three rounds, says Nicola Tempest, a consultant gynaecologist and lecturer at the University of Liverpool. Holly, a 39-year-old psychotherapist who lives in Margate, was one patient whose IVF came under threat after Kent and Medway’s shrinkflation. Following a two-year wait for treatment, she and her partner started their first cycle in January; by the end of February, it had “dramatically failed”, she says.

“We didn’t get any embryos, and we were extremely unprepared for that. I was utterly devastated. On top of this grief, more anxiety was piled on.

For her second round, Holly was required to get an AMH test, which measures a hormone that indicates how many eggs someone has. By this point, it was the end of March. “I had an appointment with my fertility doctor and she told me about the change in funding, says Holly.

“She said, ‘you have to get this AMH test done now, because otherwise you might not get your second round.’” The NHS’s free AMH test would take too long – Holly was forced to arrange the test privately at a cost of more than £100, get up at 4am the next morning, and race home afterwards in time to start work. “The stress was insane, and the potential implications were incredible, she says. “To go from two rounds to one, four embryo transfers to two…” The sudden reduction of eligibility due to age in Kent and Medway was particularly brutal; 38 is the age at which, according to some studies, women see a more rapid decline in fertility, and are therefore more likely to need assisted reproduction.

I was utterly devastated One academic review, for example, found that the rate of women defined as infertile who conceived without medical intervention within a year held steady at 29 per cent from the ages of 35 to 38. After that, it dropped far more quickly. In fact, the backlash in Kent and Medway has been severe enough that the ICB has very recently pressed pause on this deeply unpopular move. “NHS Kent and Medway has listened to feedback following its decision to change the criteria for fertility services from 1 April 2026, and is now reviewing that change, a spokesperson told The Independent.

While the review is underway, the original criteria have been reinstated. While this is undoubtedly good news, the likelihood that IVF provision will stay the same or improve during this next review process seems low if the national landscape is anything to go by. Putting aside the ICBs that have recently cut access, it is very rare to find one that is following NICE guidance.

NICE stands for the National Institute for Health and Care Excellence – the official arm of the UK government responsible for providing evidence-based guidance, advice and standards for the NHS. NICE updated its IVF guidelines in March this year, replacing the previous recommendations issued in 2013. These state that people who meet the eligibility criteria and are under 40 should be offered three full cycles of IVF. If they have not conceived after three cycles and are still under the age of 40, healthcare providers should consider up to three further cycles.

The number of cycles is crucial because, although it might sound obvious, the more cycles someone has, the higher the chance overall that they will have a baby. “Clinically, multiple cycles increase the overall chance of a live birth, says Burns. “Reducing from three to one dramatically lowers the cumulative probability of success. Depressingly, only two ICBs in the whole of England are currently offering the recommended three full cycles: North East London and North East and North Cumbria.””””””””””””