Referral to gynaecology/eligibility criteria for NHS treatment

[tryingforsolong]

I have just picked up a referral letter from my GP and its the NHS choices appointment booking system, asking me to choose from 4 hospitals (all over 20 miles away, as my local PCT/hospital does not fund any treatment).

Briefly, we have already been referred to one of them, over two years ago, and after having all the blood tests, semen analysis, appt with nurse, then wait 12 weeks for appt with Consultant, he told us there was no reason we can't get pregnant, but as my DH has a son from a previous relationship, we were not eligible for NHS treatment. If we wished to continue, we would need to pay upfront for IVF.

We can't afford to do that. I'm now 40 and still not pg. I went to my GP and she gave me clomid for 3 months, which hasnt worked, so she said she would refer me to gynaecology.

How do I find out criteria for each hospital? I cant believe I'm saying this, but I feel so desperate, if we lie and say we have no children, will they be able to check this? I know the NHS needs the money to spend elsewhere but even if we try IUI which is a lot less expensive, it's like we are not just giving up.

Is it worth going through all this again, only to be told the same?

Its so unfair. We have been trying for almost 5 years.

I've been googling all morning and found some interesting information, but most of it is out of date.

Could we appeal the decision? Is it worth appealing? How do I find out where to appeal?

This is our last hope and the hopelessness has hit me really hard.

Thanks for reading this.

I'm so sorry you are at this point. Firstly you can look up your pct online and you should be able to find their eligibility however most pcts won't treat anyone over 40, even though the recent NICE guidelines have recommended treatment upto 42 or 43 years, I can't remember which now. I was 39 about to turn 40 so we just squeezed in being eligible for my NHS ivf round. I'm surprised your consultant turned you away last time, I think if anything I would have appealed against that. Good luck.

Hi it is not each hospital that has different criteria it is the Clinical commissioning group (used to be called the pct) that you live in. The fact that your local hospital is not on the list may be because tour gp does not offer that hospital as an option or because they do not have the treatment options there.

Yes NICE guidelines have changed saying treatment if under 42 now but each area has own rules. Where I live they only offer 1 cycle despite NHS nice guidelines saying 3 Ivf free cycles. My area treats 1 Ivf cycle, 39 or under ( at point of referral that is) and no children for either partner for free funding. But each area varies so you need to find what area your house is in. It is irrelevant which hospital you go to for treatment as your funding comes from where your house is. You can choose where to go for tests or treatment but cannot go to a hospital in an area that offers different funding options in the hope you will get their funding options sadly ( otherwise everyone would go to where they do 3 free cycles to under 42's and if you have existing children etc!.

A frustrating system. But if you look up what your area offers then you will know. You can still have basic tests and clomid no matter what in most areas but not funded IUI or Ivf if you not fit the criteria.

Might be worth looking what private options there are in your area in case you not eligible to help you work out if it is feasible etc.

Hope it goes ok for you

You could appeal the original decision from your pct but if there rules were no previous children then that may not be successful. You may not need to appeal now as you may get some treatment options if criteria changed. Lying about previous children is not helpful if your age is now the issue sadly.

thanks for your replies.

I think my head was all over the place yesterday, I really couldn't focus, so your replies have really helped me.

I am going to find out which CCG I am in and go from there.

Some of the hospitals on the choose and book list are over 30 miles away, so I don't think they would be under the CCG would they? Its all a bit confusing.

I just want to make the right decision and feeling anxious about missing something important.

You can go to any hospital in the country in theory so do not worry about that!!

All you need to do is find out the rules of your CCG and it is those rules you have to follow for funding. You can choose any hospital off the list as it is your CCG that funds your treatment and not the CCG of the area where the hospital is.

I will give an example. Say you live in ( am making up an area which is not where I live so may get details wrong but it is a hypothetical situation!!!) South Yorkshire in a village near Doncaster. Your CCG may fund treatment for one cycle up to age of 40 ( am making all of this up and not looking it up!) and they do not do this treatment at Doncaster so you get Sheffield, Barnsley, Leeds and York hospitals on our choose and book system. But Leesds and York are in different CCG and do not fund treatment unless you are under 35 ( again made up rubbish!!) but they will treat you ( made up!!) because your CCG is funding it not that of Leeds or York!!!

Sorry I have probably made is worse. Either way just choose a hospital off the list you like the look of. Do not worry about choosing a hospital due to whether they will treat you as treatment is dictated by your house and where you live not where you go for treatment. It is possible they will not fund Ivf at all but they may do lots of helpful tests ( ask of copies of results if possible!!) at the very least.