Borough baby blues: London's cruel IVF postcode lottery

For the past three years, Ella has been stuck in a fertility doom loop. At 36, after two years of trying to conceive with her partner, she got in touch with her GP to discuss IVF, aware that those in her area are eligible for three fully funded cycles on the NHS. But what has followed has been an exercise in heartbreak. She was told that, as she is registered with a virtual GP that doesn’t specifically operate within her local area, she is instead allowed just one NHS IVF cycle, parts of which she has had to pay for herself. If her upcoming embryo transfer doesn’t work, the prohibitive costs of private treatment may snuff out her chance of motherhood altogether.“It’s been really difficult,” Ella, now 39, says of this postcode lottery. “The clock is ticking… it’s just heartbreaking, and I’ve felt really unsupported in all of the steps,” she says of her NHS journey.“I might have to give up on my dream of parenthood”“And now I’m facing [the realisation] that I might not make it; this might not be successful, I might not be able to afford it, so I have to give up on my dream of parenthood.” Having a family is not owed to anyone, she realises. But seeing the future she envisioned potentially come crashing down “has been really emotional”.NHS figures show around one in seven people are affected by infertility, data that is particularly acute given our dwindling birth rates. The number of babies being born in the UK is now at a 50-year low, the greatest decline in the G7. The City of London plays host to the bleakest picture: the total fertility rate here is 0.37 children per woman, compared to 1.39 nationally, or half the number of babies being born during the mid-1960s.The number of babies being born in the UK is now at a 50-year lowPA ArchiveAlong with rising costs of living, home ownership and childcare fees that are among the highest in Europe, the NHS IVF postcode lottery is heaping on significant challenges. To qualify at all, individuals must meet criteria based on the likes of age and weight. Yet even if these are met, just two of England’s 36 Integrated Care Boards (ICBs, which make the decisions over NHS IVF funding) offer three paid-for cycles — despite this being the figure that the National Institute for Health and Care Excellence (NICE) recommends. Despite falling birth figures, provision is increasingly being scaled back across the UK: 70 per cent of ICBs now offer only one funded round. The end result is millions of women being denied the chance to have a child, and ultimately a city where children fade from view.London’s existential challengeIslington, part of the NHS West and North London ICB (which merged this year), which Ella falls under, is among the postcodes where family life is being erased. The borough has one of the lowest fertility rates in the country at 0.99 per woman, along with one of the highest average maternal ages; a first-time mother in Islington gives birth at 34.7 years old, compared to the national average of 31.1.Residents in Islington reportedly spend 46 per cent of their salaries on rentMatt WrittleCatrin Shi had her first child in October 2024, a time when nursery places in the borough were already shrinking so fast she had to sign up while 20 weeks pregnant. The nursery her son did eventually attend was then shut down in July — despite a major campaign effort from parents — forcing her to search through a yet smaller pool for a new place. “We are faced with very real questions around affordability”“The distress of resettling my son in a new nursery was really difficult,” Shi, 38, says. A fire then broke out at his new nursery seven weeks later, leading to that closing, too. “We now find ourselves back in the stressful situation of juggling childcare, a full-time job and finding a new nursery,” says Shi. “One private nursery that has availability would cost us at least £500 more a month. We are faced with very real questions around affordability when taking other living expenses into account, and we can’t be the only ones.”Fewer children on registers means institutions receive less government funding, and the snowball effect is mounting. More than 100 schools have either closed or merged since 2019; last month, a further three primary schools and one secondary school in Camden, the neighbouring borough to Islington with a fertility rate of 1.05, were lined up for closure due to the growing pupils crisis.What is emerging is “an existential challenge for London”, says Bassam Mahfouz, a member of the London Assembly. He thinks we are following the “doughnut effect” seen in Paris, where families have emptied out of the city centre and into the suburbs. More than 100 schools have either closed or merged since 2019PA“This is a huge issue not only in terms of schooling, but in terms of, what does London look like in a decade or two’s time?” he says. Children are considered an “indicator species” by researchers; the sign of a healthy city. Is London’s health — and potentially childless future — putting the capital at risk? “Absolutely,” Mahfouz believes. “That’s the concern.”Without more babies being born — and mothers being helped, where needed, to make this happen — school closures and an increasingly adult-only city are simply the tip of the iceberg. Many women report that qualifying for NHS-funded IVF cycles is so emotionally arduous, it is preferable to funnel their life savings into private treatment instead.Going private for fertility treatmentIn some situations, such as for solo parents or same-sex couples, where ICB criteria typically mandates that they must have had six failed attempts at intrauterine insemination (or IUI, a form of artificial insemination) in order to receive just one funded round, it can be cheaper to go privately at the outset.“In no other area of medical care would this be acceptable”Katie Rollings, CEO of campaign group Fertility ActionAvoiding NHS treatment is now “very, very common”, says Dr Ben Abramov, deputy medical director at the Evewell fertility clinic on Harley Street. “Very often, we see patients who have abandoned that [NHS] route to begin with because there were obstacles they could not cross or because it looked a lot longer than one would deally wish to have. And especially in women in their late thirties, there’s always the anxiety that the time waiting for the cycle might affect their chances.”While NHS-funded IVF accounted for 35 per cent of cycles in 2019, that fell to 28 per cent in 2024, and is likely dwindling further as ICBs keep cutting back. Private treatment costs, meanwhile, only tick upwards. A 2025 study from Queen Mary University found that a single IVF cycle cost patients £5,000-£13,000.Abramov notes that the mothers he treats are often older — a trend that can be seen globally. (In London, St Margarets near Richmond plays host to the oldest mothers in the country: in 2023, 75 per cent of babies were born to those aged 35 or older.) While many still hope for the 2.4 children commonplace throughout our parents’ generation, Abramov’s patients are increasingly having to accept that time is not on their side. By 2031, an estimated half of all UK families will be raising just one child.NHS-funded IVF accounted for 28 per cent of cycles in 2024When Abramov speaks with colleagues in Scotland, he says the differences compared to provision here become yet more stark. “They found that two cycles followed by embryo transfers of any viable embryos produced managed to get almost everyone pregnant and have a baby,” he says. “Sticking to the restriction of not giving patients the third cycle or worse, not giving patients the second cycle, is actually quite sad… if you provide your patients with two cycles and cover for any embryo transfers they need, you’ll get most of them pregnant.”Such pragmatism is yet to reach most of England’s decision-makers. Greenwich has experienced one of the sharpest fertility rate declines in the country — down from 2.17 children per woman in 2010 to just 1.18 today. Part of that may be down to the fact only two funded IVF cycles are afforded to residents — if they tick the requisite boxes.Resident Megan McKee, who began looking into IVF two years ago, says that the postcode lottery makes SE10 feel like a losing ticket.“I don’t want to have to move — it’s where I live. It’s where my roots are,” McKee, 27, says. “It’s just a shame that the access and the people that live here aren’t supported the same [as elsewhere in the country].”Hopeful parents face a postcode lottery on the level of healthcare providedGettyMcKee “always wanted to be a mum” and, with no interest in dating, decided to start looking into IVF in 2024. What she didn’t realise was that, as a solo parent, her ICB board mandated that she would have to pay for a significant amount of clinical help before accessing a single funded round. To qualify, she was to pay for six IUIs, with projected costs around £18,000.When the first three failed, “I just felt like I couldn’t go through that again.” She switched to IVF knowing that “it was my one shot”, says McKee. “I didn’t have enough savings to do this more than once, because I’d already spent quite a lot on three IUIs and four donor sperm vials. That’s a lot. So I always said, if this IVF doesn’t work first time, I’m going to have to really think about what I’m going to do next.”McKee gave birth to her first child six months ago; she hopes for a second from embryos that have already been frozen (for which she is paying for storage fees). But she knows she will have to continue saving — harder than ever, given the financial burden of being a single parent — in order to make that dream a reality.“No one should miss out on the care they’re entitled to because of where they live”Department of Health and Social CareA Department of Health and Social Care spokesperson said: “No one should miss out on the care they’re entitled to because of where they live in the country… We’ll keep working with the NHS to close these gaps and make sure everyone gets fair access to fertility treatment, no matter their postcode.”Still, repeated ICB board mergers and cuts to provision are doing little to help the women for whom time may be running out. “Where someone lives should not be the deciding factor in whether they have a realistic opportunity to build a family,” says Katie Rollings, CEO of campaign group Fertility Action. “The current system is expanding the divide between those who can afford private treatment and those who can’t, meaning only the most privileged get the chance to grow their families.” A postcode can be the difference between whether a baby is born, or isn’t; whether family life in London dies out completely, and fundamentally changes the city for good. “In no other area of medical care would this be acceptable,” Rollings says. “It’s about time we saw a change.”