CHILDLESS women who are obese should not get NHS fertility treatment unless they lose weight, and the most seriously overweight should not be treated free at all, an influential group of IVF specialists said yesterday.

Free IVF should be limited to women of healthy weight because obesity reduces success rates and adds to the risks of pregnancy, the British Fertility Society recommended.

At the moment the Government has asked primary care trusts to offer women at least one free cycle of IVF treatment, but has produced no detailed guidelines on who should qualify or any extra funds.

This has led individual trusts to impose a bewildering range of restrictions. Many set different obesity limits and refuse to treat smokers and couples who already have children, even when adopted or from previous relationships. Others will not fund treatment of couples who have paid for IVF themselves.

About 27,000 women receive IVF in Britain each year and around a quarter of treatments are provided by the NHS.

Under the proposals from the British Fertility Society, which represents doctors involved in assisted conception, couples with children from previous relationships would qualify. Those who have had a child together would be eligible if local funds permit, though the childless would have priority. Couples treated privately in the past would gain access to NHS therapy, and there would be no discrimination against single women and lesbians.

Only men and women who had previously been sterilised, severely obese women and women aged over 40 would be automatically barred from free treatment, and women would not be accepted on to a waiting list within six months of their 40th birthdays. Male age and weight would not be considered relevant.

Smokers would not be excluded from treatment, as such a restriction is judged too difficult to police, but they would be given advice on quitting and its implications for fertility.

The one in five British women who is clinically obese, with a body mass index (BMI) of 30 or more, should be accepted by NHS fertility clinics only if she diets and exercises, the society’s guidelines say. The same restrictions should also apply to very underweight women, with a BMI below 19.

The severely obese with a body mass index above 36 —about one in 20 women — should not qualify for NHS treatment at all because of a poor prognosis and risks to their health, particularly if an anaesthetic is required during childbirth.

At the average female height of 5ft 4in, a BMI of 19 equates to weighing 8 stone. A BMI of 29 equates to 12st 2lb and a BMI of 36 is 15st 1lb.

The recommendations are significantly tougher than those of the National Institute for Health and Clinical Excellence (NICE) which advises only that patients should “ideally” have a BMI of between 19 and 30, and sets no upper or lower limit for treatment.

The society’s proposals, which will be sent to all primary care trusts responsible for funding NHS fertility treatment, are part of the first attempt to draw up national eligibility criteria.

Richard Kennedy, of University Hospitals Coventry & Warwickshire NHS Trust, who led the society’s working party, said the guidelines would put access on a transparent and clinically justifiable basis. “These guidelines conform to principles of equity and clinical judgement,” he said.

Limiting access to IVF for obese women, he said, was a matter of effectiveness and safety, not discrimination. “Obesity is known to influence fertility and the outcome of fertility treatment, as is being very underweight. We are trying to make sure the funds available are most effectively used.”

Patient groups welcomed the idea of a framework for eligibility, but insisted that the obesity guidelines should be interpreted flexibly. Clare Brown, of Infertility Network UK, said: “We would continually remind trusts that every patient is different, and these should be guidelines not laws.”

Caroline Flint, the Health Minister responsible for fertility treatment, said that although the Government is not planning to impose national eligibility criteria, it would study the proposals with a view to advising trusts on best practice.

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