CH(03)02
25 February 2003
Dear Colleague,
Clarification of which IVF cycles are reportable to the HFEA, and those cycles that incur a fee
Further to a discussion at a meeting of the HFEA on 16th January, I am writing to make clear (i) the definition of cycles of treatment that should be reported to the HFEA, and (ii) which cycles should incur a fee.
i. Definition of reportable cycles
The Authority has confirmed that all cycles should be reported to it where there is an intention to provide an IVF cycle from the outset. In such cases the relevant HFEA consent forms, offer of counselling 'welfare of the child' assessment etc. would be carried out before treatment commenced. Unintended IVF on safety grounds (e.g. where IVF is performed on safety grounds because a woman has over-responded during ovarian stimulation, ovulation induction or planned intrauterine insemination treatment) should be rare, but should also be reported when the decision to carry out licensed treatment is made and the appropriate HFEA consent forms are completed. A frozen embryo transfer cycle should be reported when the embryo is thawed.
In time, the HFEA will require centres to report intended IVF cycles within three days of the start of ovarian stimulation. However, this requires the introduction of a reliable means of electronic data capture. The Authority expects to develop and install a robust means of achieving this, in consultation with centres, during the financial year 2003/4.
ii. Fees payable to the HFEA for IVF cycles
The Authority has confirmed that for treatment cycles that are reported to the HFEA on or after 1st April 2003:
Fees will not be payable for fresh cycles that do not result in the mixing of sperm and eggs. This includes cycles:
- that are stopped before egg collection (abandoned cycles);
- where egg collection is performed but no eggs are collected;
- where eggs obtained are not suitable for mixing with sperm.
Fees will not be payable for 'donor' cycles:
- where all eggs are donated.
Fees will be payable when eggs and sperm are mixed, or ICSI is attempted, including when:
- embryos are created and transferred, as in standard IVF (including when a woman receives shared or donated eggs);
- there is no fertilisation.
Fees will not be payable for cycles when:
- embryos are created but all are frozen.
Fees will be payable when:
- a cryopreserved embryo is transferred.
Fees will not be payable when:
- eggs are cryopreserved.
Fees will be payable when:
- cryopreserved eggs are mixed with sperm.
A table summarising this information is attached.
I hope this helps to clarify some areas of uncertainty. If you have any concerns or queries about this please contact Ann Furedi, director of policy & communications, on 020 7539 3330 or ann.furedi@hfea.qov.uk.
Yours faithfully,
Suzi Leather
Chair
Note: IVF is defined as the mixing of sperm or eggs or the injection of a sperm into an egg (ICSI)
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Possible outcomes of licensed treatment involving IVF
Cycles that are stopped before eggs and sperm are mixed
Fee? No
Egg collection performed - no eggs obtained
Fee? No
Egg collection performed - eggs obtained but none suitable for attempted fertilisation by mixing gametes or by ICSI
Fee? No
Fertilisation attempted - failed fertilisation
Fee? Yes
When? At mixing gametes/ICSI
Standard IVF/ICSI
Fee? Yes
When? At mixing gametes/ICSI
All embryos frozen
Fee? No
Standard IVF/ICSI cryopreserved embryo transfer
Fee? Yes
When? At embryo transfer
Ovulation induction/inter-uterine insemination converted to IVF on safety grounds
Fee? Yes
When? At mixing gametes/ICSI
Standard IVF/ICSI where a woman is donating some of her eggs as part of egg sharing arrangement (donor's own cycle)
Fee? Yes
When? At mixing gametes/ICSI
Standard IVF/ICSI where a woman is receiving eggs as part of an egg sharing agreement
Fee? Yes
When? At mixing gametes/ICSI
Egg donation (where all eggs are donated)
Fee? No
Donor egg (fresh or cryopreserved) recipient cycle
Fee? Yes
When? At mixing gametes/ICSI
Egg cryopreservation
Fee? No
Transfer of embryos resulting from cryopreserved eggs
Fee? Yes
When? At embryo transfer
GUIDANCE NOTES FOR IDENTIFYING NON-CHARGEABLE CYCLES
Scenarios 1-7 are dealing with embryos
Scenarios 8-13 are dealing with eggs
Scenario 1: Eggs and Sperm are mixed but there is no fertilisation. There will be eggs mixed but 0 embryos in 'mixed with sperm box' This is an abandoned cycle.
Chargeable? Yes
Section on form: 9
Scenario 2: Eggs and Sperm are mixed and embryos are created but all are discarded. There will be eggs mixed and embryos entered in 'mixed with sperm box' but all will be discarded. This is an abandoned cycle.
Chargeable? Yes
Section on form: 9
Scenario 3: When frozen eggs are thawed and mixed with sperm, even if no embryos develop. This is an abandoned cycle.
Chargeable? Yes
Section on form: 9
Scenario 4: Eggs and Sperm are mixed, embryos are created and they intended to treat but couldn't proceed possibly due to OHSS.
Chargeable? No
Section on form: 9
Scenario 5: Eggs and Sperm are mixed, embryos are created and all are either stored or discarded. The reason for treatment should state 'embryo storage', this could be because the patient or partner is undergoing chemotherepy.
Chargeable? No
Section on form: 9
Scenario 6: Eggs and Sperm are mixed, embryos are created and stored. Maybe the couple are using a surrogate who is not ready to treat.
Chargeable? No
Section on form: 9
Scenario 7: Eggs and Sperm are mixed, embryos are created and all are donated. These would normally all be stored anyway.
Chargeable? No
Section on form: 9
Scenario 8: When frozen embryos are thawed, but not transferred (because they are not viable) and are all discarded. This is an abandoned cycle. Chargeable? No
Section on form: 9
Scenario 9: When eggs are collected but are not suitable for mixing so are discarded. This is an abandoned cycle.
Chargeable? No
Section on form: 8
Scenario 10: When egg collection is performed but no eggs are collected. This is an abandoned cycle.
Chargeable? No
Section on form: 8
Scenario 11: When a cycle is stopped before egg collection This is an abandoned cycle.
Chargeable? No
Section on form: 8
Scenario 12: When eggs are collected but all are frozen or discarded. Chargeable? No
Section on form: 8
Scenario 13: When all eggs are donated.
Chargeable? No
Section on form: 8
Page last updated: 14 April 2009