This article appears as part of the Inside the NHS newsletter.
Single women in Scotland who want to have a baby may be able to access IVF on the NHS for the first time.
Earlier this month, the National Fertility Group, which advises the Scottish Government, asked Public Health Scotland to model the cost, demand, and eligibility of expanding NHS IVF treatment to single people.
It would be the most significant shake up to the service since NHS Scotland increased the maximum number of cycles available to couples from two to three in 2017.
Trends
The review comes amid evidence that a growing number of singletons in the UK are seeking out fertility treatment.
According to the latest report from the Human Fertilisation and Embryology Authority (HFEA) – published on July 18 – the number of patients without a partner undergoing IVF has increased by 82% from 1,953 in 2019 to 3,548 in 2022.
This mostly covers private clinics but may include the NHS in a few cases. In England, around half of integrated care boards will provide IVF to single women if they have already paid privately for between three and 12 cycles of artificial insemination without conceiving (at which point they are considered infertile).
Egg freezing is also booming. In 2022, a total of 4,647 women in the UK underwent the procedure to put eggs into storage – up from 2,571 in 2019.
The HFEA said the increase is partly down to "improved egg freezing techniques", but mainly it points to more women seeking a safety net against the biological clock.
While the NHS does perform egg freezing and storage for medical reasons – for example, to young women undergoing chemotherapy for cancer – most procedures are elective, and therefore private.
Eligibility
In Scotland, IVF is currently available to couples only.
This includes heterosexual couples with unexplained infertility after trying to conceive naturally over a two year period, or same-sex couples where one of the female partners has failed to conceive after six cycles of artificial insemination.
Couples must have been in a relationship and cohabiting for at least two years prior to starting treatment, and the prospective mother must have a BMI of less than 30 – the benchmark for obesity.
Couples can access a maximum of three IVF cycles on the NHS, or one if the woman trying to conceive is aged 40 to 42 and has no prior history of IVF. Women older than 42 are not entitled to any NHS-funded fertility treatment.
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Demand
As of July 2023, there were 941 patients waiting to be screened IVF treatment on the NHS in Scotland. This is 28.7% higher than the monthly average in 2019.
Eligible patients are sent to one of four IVF centres – in Glasgow, Edinburgh, Dundee or Aberdeen – depending on where they live, and should wait no longer than a year to be seen. That target is currently being achieved.
However, despite growing demand, the number of patients attending for IVF appointments (330 between January and March this year) remains 10% lower than pre-pandemic levels.
This will be a key consideration for government advisors who will have to weigh up the potential impact on waiting lists of expanding eligibility to single women.
According to the HFEA, more than half (53%) of all the IVF cycles carried out in Scotland are performed on the NHS. That is still the highest in the UK (in England, the figure is just 24%, and 34% in Wales).
But access is becoming more difficult.
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UK-wide, the number of NHS-funded IVF cycles completed in 2022 was the lowest since 2008.
Between 2019 and 2022, the number of NHS-funded IVF cycles completed in Scotland fell by 7%, with England and Wales experiencing declines of 17% and 16% respectively.
Partly this reflects patients experiencing longer delays for investigations prior to accessing IVF, but also funding pressures.
Scotland has long boasted the most generous NHS IVF provision in the UK. Including single women would be trailblazing – but can the service cope, and can the NHS afford it?
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