Current restrictions on access to NHS-funded fertility treatment exclude the majority of those trying to conceive: a retrospective cohort analysis

Objective: Evaluate NHS-funded fertility treatment policies across England, Scotland, and Wales, assessing their alignment with the needs of those trying to conceive and comparing eligibility against NICE guidance. Design: Review of current NHS-funded fertility treatment policies and retrospective analysis of participant data. Setting: Not applicable. Population: Reproductive-age UK-based women using Hertility Health services from 2021-2023, focusing on those actively trying to conceive (TTC) or planning future pregnancies. Methods: : Policy evaluation and data review without interventions. Main Outcome Measures: Eligibility for NHS-funded fertility treatment under UK regional policies versus NICE guidance. Results: : In total, out of 2980 individuals actively trying to conceive and 6282 individuals planning for future pregnancies, 1700 (57.0%) and 2750 (43.8%) respectively would be ineligible for state-funded treatment under current regional policies: 1551 (57.7%) in England, 123 (53.2%) in Scotland, and 26 (41.9%) in Wales for those actively trying to conceive, and 2558 (43.9%), 146 (41.7%), and 46 (44.2%) for those planning future pregnancies respectively. In contrast, only 248 (8.3%) of those actively trying to conceive and 149 (2.4%) of those planning for future pregnancies would be ineligible if the NICE guidance were universally applied. Conclusions: : By imposing outdated clinical and non-clinical qualifying criteria, the current NHS-funded fertility treatment policies exclude a substantial number of individuals requiring treatment. This necessitates a swift policy overhaul, as promised in the 2022 UK Women’s Health Strategy, to avoid further age-related fertility loss in women who require treatment imminently.