Nearly 70% of NHS areas in England now offer only one cycle of IVF treatment, leaving millions of women without access to the level of fertility care recommended under national guidelines, new research has found.
Data compiled by the fertility charity Progress Educational Trust shows that 29 of England’s 42 integrated care boards fund just a single round of IVF for women under 40 who have been unable to conceive for two years. Official guidance recommends up to three full cycles, but four ICBs have reduced access further in the past year.
The findings mean that almost seven in 10 areas are now falling short of best practice, creating what campaigners describe as a growing postcode lottery in NHS fertility treatment.
Sarah Norcross, director of the Progress Educational Trust, said the consequences for patients were severe.
“Infertility is already incredibly stressful for people, and it puts them under even more pressure, because there is so much riding on whether that one NHS-funded cycle is going to work,” she said.
“And for some people, that will be their only chance, because private fertility treatment is so expensive.”
The analysis found that only two ICBs — NHS North East and North Cumbria, and NHS North East London — currently have policies that fully align with guidance from National Institute for Health and Care Excellence, which recommends three full cycles of IVF for eligible women under 40. While NICE guidance is not legally binding, it is intended to set a national standard of care.
Regional differences were stark. Across the whole of the north-west of England, just one IVF cycle is funded. “It’s a postcode lottery, and we’re seeing a race to the bottom,” Norcross said.
Of the 29 ICBs that fund only one cycle, 19 provide just a partial cycle, meaning not all viable embryos created are transferred. Only one area — NHS South East London — has expanded provision in recent years, increasing access from one partial cycle to two full cycles in July 2024.
The findings come against a backdrop of falling fertility rates. In England and Wales, the fertility rate dropped to 1.41 children per woman in 2024, the lowest level on record and well below the replacement rate of 2.1. The NHS estimates that around one in seven couples experience difficulty conceiving, while a single cycle of private IVF can cost £5,000 or more.
Health minister Karin Smyth said last month that it was “unacceptable” for access to NHS-funded fertility treatment to vary so widely depending on where people live.
Updated NICE fertility guidelines are expected later this spring, but Norcross questioned whether revisions alone would make any difference.
“Fertility treatment has always been a Cinderella service. It’s always been the one they’ve chosen to cut or to ignore,” she said.
“NICE has recommended three full NHS-funded cycles, for women under 40, for more than 20 years. This has never been implemented across England, unlike in Scotland.”
She argued that England should adopt a centrally commissioned model similar to Scotland’s, which introduced IVF funding in phases to manage demand and capacity. “It is a tried and tested plan that England could follow,” she added.
A spokesperson for the Department of Health and Social Care said: “We recognise access to fertility treatment varies across the country and we are working with the NHS to improve consistency.
“NICE provides clear clinical guidelines, and we expect integrated care boards to commission treatment in line with these.
“Updated NICE fertility guidelines are expected this spring and we will continue to support NHS England to make sure the guidance is fully considered in local commissioning decisions.”
A spokesperson for NHS England said: “These clinical services are commissioned by integrated care boards for their area based on the needs of the local population and prioritisation of resources available. All ICBs have a responsibility to ensure services are provided fairly and are accessible by different population groups.”