Level 3 Criteria, Providers and Exclusions {Under Review}

AMH

5.4pmol/l measured in the last 12 months of referral from secondary care to the specialist IVF provider*.

*During the transition to AMH testing it is anticipated that some Trusts may not be able to offer AMH immediately. During this period, to be eligible the patient should have an FSH of <9 on day two of any menstrual cycle done within three months of referral from secondary care to a specialist IVF provider.

Prospective parents/parent aged 23 to 39 years and 364 days at the start of super-ovulation (treatment) but where a woman reaches the age of 40 during treatment they will complete that cycle in the 40th year and will not be entitled to commence further cycles. 40th

Same-Sex Couples

BMI eligibility criteria above apply only:-

To the female partner undergoing fertility treatment

Previous privately or NHS funded cycles will count towards the total number of fresh cycles funded by the NHS.

Previous privately or NHS funded cycles will count towards the total number of fresh cycles funded by the NHS.

Women aged between 40-41 years and 364 days may be entitled to 1 fresh cycle of IVF but where:

• They have never previously had IVF treatment
• There is no evidence of low ovarian reserve
• There has been a discussion of the additional implications of IVF and pregnancy at this stage

Where either a prospective parents/parent smokes, only those who agree to take part in a supportive and successful programme of smoking cessation with Carbon Monoxide verification as an evidence of non-smoking status will be accepted onto the IVF treatment waiting list.

E-cigarette users are classed as e-cigarette users not smokers. It is recognised that vaping is not the same as smoking, as there is no burning of tobacco which produces some of the harmful chemicals in cigarettes. It has been recognised by Public Health England that the long terms effects of e-cigarettes are not known but PHE current state that they are 93% than safer cigarettes.

There is no evidence whether there are any risks to the foetus from exposure to e-cigarette usage, therefore licensed stop smoking medications are currently the recommended option.

Referrals forms to Level 2 and 3 fertility services ask the Provider to state whether there is any reason due to past medical or social history of either prospective parents/parent, which may be of concern with regard to the welfare of the unborn child. In the event of a disclosure, a referral should not be made, instead the GP or Level 2 clinician should contact the ICB Designated Nurse or Doctor and/or local children’s services in order to assess the risk.

• The prospective parent/parent must be registered with a GP within Norfolk & Waveney ICS for 12+ months.

and /or

• In the case of prospective parents, one of the prospective parents must be registered with a GP within Norfolk and Waveney ICS area for 12+ months.

If prospective parents/parent are registered at different GP Practices, the relevant ICB policy is where the female is registered.

Norfolk and Waveney Integrated Care System(ICS)

This is distinguished from requests for Intra Uterine Insemination (IUI) as a treatment option, as described on page 6 of this policy which is line with NICE guidance.

• Laparoscopy and/or hysteroscopy and/or hysterosalpingogram  or ultrasound scan where appropriate
• Rubella antibodies
• Day 2 FSH
• Chlamydia screening
• Hep B including core antibodies and Hep C and HIV status and core, within the last 3 months of treatment and repeated every 2 years.

Male:

• Preliminary Semen Analysis and appropriate investigations where abnormal (including genetics)
• Hep B including core antibodies and Hep C, within the last 3 months and repeated after 2 years.
• HIV status

Maximum of 6 cycles of IUI (as a replacement for IVF/ICSI and without donor sperm)