Before accepting a referral to the infertility clinic the following information is needed.
Names and CHIs of both partners
Luteal phase progesterone (unless oligo or amennorhea). This should be done 7 days before the date of the next expected period
Rubella status- serology if not vaccinated against rubella. If vaccinated then serology is not needed.
Chlamydia and Gonorrhea status for the female partner or partner intending to get pregnant
BMI for partner intending to become pregnant
If periods are irregular or absent, or luteal phase progesterone is less than 20, then we also require
LH, FSH, Estradiol, Testosterone, Prolactin and TSH. These blood tests should be done on day 2-3 of the cycle, unless periods are more than 6 weeks apart. If periods are more than 6 weeks apart these bloods should be done without waiting for the next period.
Semen analysis for the male partner- result must be attached to the referral.
If IVF is required the following criteria need to be met.
If donor insemination for same sex couples is required the same criteria apply
Access Criteria for NHS IVF Treatment in Scotland
Patient Information
Referral for NHS Funded In Vitro Fertilisation (IVF) / Intra-Cytoplasmic Sperm Injection (ICSI) treatment at Edinburgh Fertility Centre can only be made if all access criteria as set out below are fulfilled. Eligibility against the criteria is assessed before any new treatment cycle (fresh and frozen).
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Diagnosis
|
Subfertility with an appropriate cause of any duration – all couples
OR:
- Unexplained subfertility of two years – heterosexual couples
- Unexplained subfertility following six cycles of donor insemination – same sex couples
|
| Residency |
Live within Lothian or the Borders. |
| Stable relationship |
Couple have been co-habiting (at the same address) in a stable relationship for a minimum of two years. |
| Sterilisation |
Neither partner has had voluntary sterilisation (even if reversed).
|
| Biological child |
At least one partner must have no living biological child. Same sex couples who have previously conceived through assisted conception and are both named on the resulting child’s birth certificate are not eligible for future treatment.
|
| Body Mass Index (BMI) |
The prospective birth mother must have a BMI above 18.5 and below 30. |
| Smoking |
Both partners must not smoke, vape or use nicotine for at least three months before referral for treatment and couples must continue to be non-smoking/vaping and nicotine free during treatment. |
| Alcohol and Drugs |
Both partners must not use illegal and abusive substances. Both partners must be Methadone free for at least one year prior to referral for treatment and continue to be Methadone free for the duration of treatment. Neither partner should drink alcohol prior to or during the period of treatment. |
| Age |
If a couple is referred for IVF/ICSI treatment where the intended birth mother is aged 39, the couple is unlikely to receive more than one NHS funded cycle. Couples where the intended birth mother is over the age of 42 years old will not be eligible for any NHS funded treatment. |
| Previous treatment |
All frozen embryos stored in any centre in the UK must be used before NHS treatment can commence. |
| Welfare of the Child |
Satisfy the requirements Welfare of the Child Assessment. |
What is the ‘welfare of the child’ assessment?
During a patient’s first consultation at a fertility clinic, their doctor will ask them a number of questions about their medical history to determine the best course of treatment for them. The doctor will also ask the patient a series of questions relating to their social circumstances in person or by asking them to complete a questionnaire.
These questions are part of an assessment, known as the welfare of the child assessment, which clinics are required to perform in order to determine whether the prospective child is likely to face serious medical, physical or psychological harm.
Definition of one full cycle of IVF
One fresh cycle includes ovarian stimulation, egg retrieval, fertilisation, and transfer of fresh embryo (if appropriate), followed by the freezing of suitable embryos and the subsequent replacement of these, provided the couple still fulfil all access criteria. If suitable embryos are frozen these must be transferred before the next NHS funded stimulated treatment cycle.
No individual can access more than the maximum number of NHS funded IVF treatment cycles supported by NHS Scotland under any circumstances, even if they are in a new relationship.
Single embryo transfer
Patients with a good prognosis are always expected to have single embryo transfer and this will be discussed with patients at clinic appointments. The single biggest risk of fertility treatment is a multiple pregnancy. Further information can be downloaded from the information section of the Fertility Network UK website or ask staff at your clinic for a copy of Fertility Network’s leaflet.
Number of Cycles initiated by the date of the intended birth mother’s 40th Birthday
Up to three cycles of IVF/ICSI may be undertaken where there is a reasonable expectation of a live birth. Clinical judgement will be applied to determine this, using an assessment of ovarian reserve before the first cycle. If fewer than 3 eggs are retrieved in a cycle, no further IVF/ICSI treatment will be funded.
Number of cycles for couples if intended birth mother aged 40 to 42 years old
If the intended birth mother is aged 40 to 42 years old, and she meets all other criteria, one cycle of treatment may be funded if:
- The couple has never previously had IVF treatment
- There is no evidence of poor ovarian reserve, and it is in the treating clinician’s view it is in the patients’ interest
- There has been a robust discussion regarding the additional implications of IVF and pregnancy at this age.
Couples must have been screened for treatment by the time of the intended birth mother’s 42nd birthday at the latest and all treatment including any subsequent frozen embryo transfers must be completed by the time they reach 42years + 364 days.
Referring clinicians must be realistic when referring couples in this category, both in respect of the additional criteria, and whether they are likely to start treatment before the time of the intended birth mother’s 42nd birthday.
Frozen embryos
Should circumstances change and couples no longer meet the NHS eligibility criteria, self-funding for any future transfers will be required.
Ineligible for treatment.
For those who do not fulfil the NHS eligibility criteria, options for alternative provision are available on the Human Fertilisation & Embryology Authority website.
For couples who require ovulaion induction for anovulatory infertility, BMI of the female partner/partner intending to become pregnant must be under 35
Borders Ref Help Toolkit
