More IVF cycles on the NHS mean nothing if women can't access care

Anastasia Shubareva-Epshtein, Founder and CEO of Carea, a pregnancy and postnatal wellbeing platform supporting women’s mental and physical health before, during and after pregnancy, including during fertility treatment.

The NHS just said women can have more IVF cycles. Sadly, it means almost nothing.

When the National Institute for Health and Care Excellence recently updated its fertility guidance, it was welcomed as a significant step forward. NICE recommended that women under 40 who have not succeeded after three NHS-funded IVF cycles should be considered for up to three further full cycles, if they have not yet reached the age of 40. On paper, this is progress. In practice, for the overwhelming majority of women in England, it changes very little.

Here is the painful truth - the original recommendation that women under 40 should receive three NHS-funded IVF cycles has been in place since 2004, and it has never been fully implemented across the UK in over two decades. We are not dealing with a new failure. We are watching the same failure repeat itself, in slow motion, while women's bodies and bank accounts bear the cost.

In 2023, just 27% of IVF cycles across the UK were NHS-funded. That number was 35% in 2019. The direction of travel is not towards more access. It is away from it. And the geography of that failure is not random: 40 out of 42 Integrated Care Boards in England currently fail to offer the number of NHS-funded cycles NICE recommends. 29 of those 42 boards offer only a single cycle. Some areas are moving to cut even that.So, when we talk about women potentially receiving six cycles, we must be honest about what that means for someone living in the wrong postcode, which is, sadly, nothing at all.I know this not only as the founder of a women's health company, but as a woman who has lived through fertility treatment and pregnancy loss. The emotional weight of IVF does not begin and end in the clinic. It sits with you in every waiting period, in every phone call you are dreading, in the grief that arrives when a cycle fails and you are already calculating how you will fund the next one. That grief does not take a break because your body needs to try again.The financial toll compounds everything. A single cycle of private IVF in the UK typically costs between £5,000 and £8,000 before medication. For many women, particularly those on average incomes, the choice is not between NHS and private. It is between trying again and accepting that this is the end of the road, being trapped in a system that rations hope based on where you happen to live.The reason so few areas meet national standards is not mysterious. Integrated Care Boards are required to weigh up local priorities when determining how many IVF cycles to fund, and it is no secret that the NHS has been dealing with significant financial challenges. Fertility treatment, despite the evidence of its clinical and cost effectiveness, is repeatedly treated as a discretionary service rather than essential reproductive healthcare. When budgets are squeezed, fertility is cut first- and the thousands of women affected rarely make the news.What needs to change is not another set of guidelines. It is Government mandated minimum standards that Integrated Care Boards are legally required to meet, with ring fenced funding to make those standards actually deliverable. The postcode lottery exists because there are no real consequences for the boards that ignore national guidance.The answer is so simple. We have to stop treating fertility as a luxury. One in six couples in the UK experiences fertility challenges. One in 32 children born here is conceived through IVF. This is clearly not a niche issue but a mainstream public health challenge that deserves a mainstream public health response.New guidance without new funding and without Government enforcement is not progress. It is the appearance of progress while women wait, grieve, and pay.