STRUGGLING to have a baby can take its toll on a couple.
But the journey to getting IVF on the NHS can add even more strain.
There are strict criteria in Scotland that couples must fulfill to get fertility treatment.
And the rules left Amanda McEwing and her partner devastated to discover they wouldn’t be eligible.
Today, she tells JENNIFER JONES about the little-known rule and why she believes things need to change to reflect modern Scotland.
AMANDA McEwing has been trying for a baby with her partner of seven years Scott for five years.
But the couple has been refused IVF because they don’t live together — a little-known criteria buried in the NHS website.
The post-Covid double whammy of the cost-of-living crisis and ongoing housing shortages means stable, long-term couples like Amanda and Scott can be denied fertility treatment on the NHS because they don’t cohabit.
The couple got engaged two years ago and have been trying for a baby for five years while they saved for a home.
Doctors later confirmed to Amanda she had endometriosis after a gruelling ten-year journey to diagnosis.
One in ten women are affected by the crippling condition, which has side-effects including chronic pelvic pain, painful bladder and bowel movements, pain during or after sex, fatigue and difficulty getting pregnant.
She said: “I have been going back and forth between the gynecologist and the fertility clinic to establish what was preventing us from getting pregnant naturally.
STRICT CRITERIA
“On July 12, the doctors confirmed I had ovarian cysts and said if I wanted a family, I would have to look at IVF.
“I began to fill out the forms to start the process, and the doctor asked me to prove we lived together — it was only then we found out about the cohabiting criteria.”
Increasing bills and inflation had taken a toll on the couple’s finances, so they delayed buying a home until they could save more for added security.
Amanda continued: “Our savings are getting eaten up just to survive and now we need to find at least £5,000 to begin exploring private IVF, now I have my endometriosis diagnosis.
“If we had known about this sooner, when we started the fertility journey with the NHS, we could have done something, but the cost-of-living crisis and the time wasted only to find out we aren’t eligible is heartbreaking.”
Support worker Amanda currently lives with her gran in Pollok, Glasgow, after the couple declared themselves homeless to try to speed up the process of getting on the social housing waiting list.
But recent figures show there are nearly 250,000 on the waiting list for social housing in Scotland. The number of allocations across the country is just 26,102 annually.
Amanda said she sees Scott, from Clydebank, as he stays with her at her gran’s property six times a week.
She added: “We spend every day together and have been going through this process to have a baby for over five years.
“Our relationship is serious, but we just don’t live together yet. Seven years together doesn’t count for anything when it comes to accessing treatment.”
In 2016, the Scottish Government updated the couple criteria for IVF in Scotland in consultation with the National Infertility Group.
The Minister for Public Health at the time, Aileen Campbell, said changes would make Scotland “the fairest and most generous” across the UK, with couples who have children in the home but where one partner does not have a biological child being eligible for IVF access.
The new policy also increased the number of cycles on the NHS from two to three.
However, the guidance does not explain the reason behind the decision to restrict long-term couples who do not live together from accessing NHS IVF treatment.
Sharon Martin, development manager for Fertility Network UK, who was part of the working group and supports couples through the IVF process, said one reason for the cohabiting criteria could be to prevent single people from accessing IVF.
She said: “It is really unfortunate they have to be cohabiting and the clinics ask for proof of that.
“There is a rising trend in women who may want to pursue a solo fertility journey.
“The Scottish Government’s cohabiting criteria could partially be because of that — to stop single people accessing it.
How does the technology work?
BY JENNIFER JONES
IVF stands for in-vitro fertilisation and is one of several techniques available to help people with fertility problems.
During the treatment, an egg is removed from the woman’s ovary and fertilised with sperm in a lab.
The egg is then returned to the woman’s womb to grow and develop.
IVF involves six main stages:
- Surpressing the menstrual cycle with medicine.
2.Helping the ovaries to produce extra eggs using medication. - Monitoring progress and maturing the eggs.
- Collecting eggs via a needle inserted throug the vagina into the ovaries.
- Fertilising the eggs with sperm – this process takes a few days.
- Transferring the embryo or embryos into the womb.
Once the embryo has been transferred to the womb, the woman needs to wait two weeks before taking a pregnancy test to see if the treatment has worked.
“But this growing trend is a result of Covid putting women in a position where they haven’t met a partner.
“We’ve also got the cost-of-living crisis, where women are having to work harder and don’t have time to develop a relationship. The next thing they know, their biological clock is ticking louder.
“However, there has been an increase in individuals solo fostering and adopting children — they are eligible to do so on their own.
“So perhaps it’s time to update the IVF criteria so those who don’t previously live together, and single women, are eligible — as a reflection of modern families in Scotland.”
PHYSICALLY DISTANT
Couples who did not cohabit before Covid were locked out of seeing their partners for nearly four months, with government guidelines stating they must remain physically distant from each other because they did not live together.
Women going through IVF treatment with the NHS at the time were slapped with extended Covid restrictions for over two years, which were only lifted in August 2022.
Many going through difficult and upsetting fertility journeys felt unsupported and overwhelmed during the often stressful consultations.
Sharon added: “Many people have had their infertility diagnosis delayed because of Covid restrictions and not being able to see a GP.
“It is only now they are finding out they may need fertility services and precious limited time has passed.”
Emma Haslam, 44, set up yourivfabroad.co.uk after she was locked out from NHS-funded IVF when she was 34.
Who can access IVF NHS funding?
BY JENNIFER JONES
MORE couples than ever are receiving NHS-funded in-vitro fertilization treatment – but it is only available to those who meet strict criteria set by the Scottish Government.
Couples struggling to conceive in Scotland are entitled to three rounds of IVF treatment on the NHS if there is a reasonable expectation of a live birth.
The definition of infertility for couples is either unexplained infertility of two years in heterosexual couples or unexplained infertility following six to eight cycles of donor insemination for same-sex couples.
Depending on the area you live in, couples eligible for NHS funding can wait from a few months to three years to start fertility treatment.
But to qualify for funded IVF, the pair must have lived together for at least two years.
The rules also require one of the partners to not have any biological children – and the couple must not drink alcohol, take drugs or smoke cigarettes during the process.
Weight is also a factor – with the women’s BMI needing to be above 18.5 (underweight) and below 30 (obese) to access funding for NHS IVF.
She has helped dozens of Scots access advice to safely seek IVF abroad within their budget.
She said: “I believe these criteria are to preclude people. Having a rule that couples have to live together for a couple of years is discriminatory.
“With Covid and the cost-of-living crisis, families are more squeezed than ever and they are choosing to move in with family to save money to access stable housing later on. It is not unusual.
“It’s unfair to find out this criteria after many years of trying — it is wasting fertility years. Plus, many people wanted to do it three years ago, but services were delayed by Covid. This has held them back further.
Emma is calling for a change to the system. She says: “NHS IVF treatment is bound by arbitrary rules. Being turned down can have a massive impact, as you can be consumed by infertility.
“It shouldn’t be the government deciding how a couple gets through this financial crisis.”
An NHS spokesperson said: “NHS IVF treatment in Scotland is only available to couples who meet the criteria for treatment. NHSGGC follows national guidelines in relation to IVF treatment.”
A Scottish Government spokesperson said: “NHS IVF treatment is only available to couples who meet the access criteria. We’ve invested around £40million over five years to improve waiting times and meet wider access criteria.
“Scotland continues to have the most generous access to NHS IVF in the UK.”