NHS funding
NHS funding: where you stand
Two pictures, both built only from the figures on this page.
What NICE recommends
Up to three full cycles for eligible women under 40
What most areas actually fund
Most Integrated Care Boards fund one cycle rather than three
Who pays for IVF cycles in England
Roughly a quarter of IVF cycles in England are NHS-funded; the rest are paid for privately.
The numbers as text
- NICE recommends up to three full cycles for eligible women under 40.
- Most Integrated Care Boards fund one cycle rather than three.
- Roughly one in four IVF cycles in England is NHS-funded.
- The remaining three in four are paid for privately.
Funding rules change and vary by area. Check the current position with your GP and your local Integrated Care Board.
How it actually works
, the body that writes national guidance for the NHS in England and Wales, recommends that eligible women under 40 who have not conceived after two years should be offered up to three full cycles of IVF. That is a recommendation, not a law.
The decision about what to actually fund is made locally, by your . Each one sets its own policy within its own budget. Most fund one cycle rather than three, and many add criteria that NICE does not include. Roughly a quarter of IVF cycles in England are NHS-funded; the rest are paid for privately.
Which ICB you fall under is decided by where your GP practice is. Scotland, Wales and Northern Ireland each have their own national arrangements, which are generally more consistent than England’s but differ from it.
If you are doing this on your own, or with a partner of the same sex, the criteria your area applies are often different again. Many policies ask for a number of self-funded cycles of insemination or IVF before NHS treatment is considered, and the number varies from place to place. The rules are specific enough, and change often enough, that the only reliable answers come from your GP and your ICB’s published policy — so ask for it in writing early, before you pay for anything.
One practical point worth knowing early: in some areas, having paid for private treatment affects later NHS eligibility. Ask your GP about this before you pay a clinic for anything.
The criteria commonly used
These are the things local policies usually consider. What each generally means, and why it exists. Your area may use some, all, or different ones.
Age
Most areas set an upper age limit for the person who would carry the pregnancy, commonly somewhere between 35 and 42. Some also set a lower limit. Areas differ on whether your age is counted at referral, at assessment, or when treatment actually starts — which matters when there is a waiting list.
Why it exists: The chance of IVF resulting in a live birth falls with age, and more sharply after the late thirties. National guidance treats the under-40 and 40-to-42 groups differently for that reason.
How many cycles are funded
NICE recommends up to three full cycles for eligible women under 40 who have not conceived after two years. In practice most areas fund one. What counts as a cycle also varies — some areas include the frozen transfers that come from it, others don't.
Why it exists: NICE guidance is a recommendation, not a legal requirement. Each Integrated Care Board sets its own policy within its budget, which is why funding differs so much between neighbouring areas.
BMI
Most areas set a BMI range, often somewhere around 19 to 30, and may require it to be met for a period of time before treatment. Some ask for it to be confirmed by the GP surgery rather than self-reported.
Why it exists: Clinics and commissioners point to evidence that BMI outside a certain range is associated with lower success rates and higher risks during stimulation, egg collection and pregnancy. Whether the specific thresholds used are fair is genuinely debated.
Smoking and vaping
Many areas require everyone being treated to be non-smoking, sometimes for a set period beforehand, and some now include vaping. This is occasionally checked with a breath or blood test.
Why it exists: Smoking is associated with lower success rates and with pregnancy complications. Some areas also frame it as making best use of limited funding.
Existing children
Most areas fund treatment only where you have no living child, including a partner's children from a previous relationship and adopted children. This is one of the most common reasons people are turned down.
Why it exists: Commissioners generally prioritise people with no children when funding is limited. It is a rationing decision rather than a clinical one, and it is why secondary infertility is so often self-funded.
How long you've been trying
Commonly two years of regular unprotected sex without conceiving. For same-sex couples and solo patients, areas usually ask instead for a set number of self-funded cycles of donor insemination or IVF first, and that number varies. Some areas count time differently or shorten it where a clear cause has already been found.
Why it exists: Many people conceive without treatment given time, so there is usually a qualifying period before IVF is considered. Where a specific cause is identified, that wait is often set aside.
Previous treatment
Policies often ask whether you, or a partner, have had IVF before, funded or self-funded. Some areas count previous private cycles against your allocation, and some don't. It is worth asking before you pay for anything privately.
Why it exists: Funding is allocated per patient or per couple rather than per attempt, so commissioners set rules about what counts towards it. The rules genuinely differ by area, so don't assume.
Where you live and who your GP is
Eligibility follows the Integrated Care Board your GP practice sits in, and there is often a minimum period of residence. Moving house or changing GP can change which policy applies to you.
Why it exists: The NHS in England commissions fertility services locally, so your address decides which policy you fall under. This is the single biggest reason two people in identical situations get different answers.
Reading this list and totting yourself up against it is a natural thing to do, and it will not give you an answer. Policies are detailed, they change, and they are applied by people with the full picture in front of them. If you think you fall outside a criterion, that is a question for your GP, not a verdict.
Ask your GP
Your GP is the gateway to NHS fertility investigations and referral, and they will know which ICB covers you.
- Am I able to be referred for fertility investigations now, or do we need to have been trying for longer?
- Which tests can be done here at the surgery, and which need a hospital?
- Can my partner be tested at the same time rather than afterwards?
- Which Integrated Care Board covers this address, and where is their fertility policy published?
- What criteria does our local ICB currently use for NHS-funded IVF?
- How many NHS-funded cycles does our area fund, and what counts as a cycle here?
- Are we able to be referred to any clinic, or only to specific NHS-contracted ones?
- How long is the current wait from referral to first appointment, and to treatment?
- If we don't meet a criterion right now, is there anything that would change that, and by when?
- Is there an exceptional funding or individual funding request process, and how does it work?
- If we pay for tests or treatment privately, does that affect any future NHS funding?
- Can I have a copy of our test results to take to any clinic?
Ask your local ICB
You can contact your Integrated Care Board directly and ask for their published fertility policy. You do not need permission to do this.
- Can you send me your current published fertility treatment policy?
- When was it last reviewed, and is a change expected?
- What are the age criteria, and is the cut-off at referral, at assessment, or at treatment?
- How many funded cycles are offered, and does a frozen transfer count as part of the same cycle?
- Does your policy include existing children from a previous relationship?
- What are the BMI and smoking criteria, and how and when are they assessed?
- How long do we need to have been trying, and what counts as evidence of that?
- Does previous privately funded treatment affect our eligibility?
- How long must we have been resident in the area?
- Is storage of any embryos included in funded treatment, and for how long?
- What is the process if we disagree with a decision?
If the answer is no
It is a hard letter to get, and it is worth remembering it is a funding decision, not a clinical one. Nobody has said treatment wouldn’t work for you.
There is usually a process for asking the decision to be reviewed, and most areas have an individual funding request route for unusual circumstances. Your GP can tell you what applies locally.
If you end up paying privately, go in with the whole cost visible. The true cost tool is there for that, and support is there for the rest of it.
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