Nine out of 10 primary care trusts in the NHS are failing to offer the recommended level of fertility treatment to patients, according to a survey conducted by The Independent.
The financial crisis in the health service means that many trusts are cutting back even further on IVF provision, denying thousands of couples the chance of a family and resulting in a postcode lottery of care.
At least four PCTs have suspended all fertility treatment provision in the past six months, while others have cut back on the number of cycles and many have introduced restrictive criteria that make more couples ineligible.
Some trusts now have waiting lists of five years for treatment, by which time the success rates for many women will have plummeted because of their age.
The postcode lottery is evident across the country; for instance, Manchester PCT offers just one cycle of treatment, but in neighbouring Trafford patients can get three.
Campaigners said the results of the survey were "appalling" and called for more money to fund treatments.
The National Institute for Health and Clinical Excellence (Nice) ruled in 2004 that all PCTs should offer three cycles of in vitro fertilisation (IVF) to couples.
Nice set a small number of eligibility criteria, including that women should be between 23 and 39, and couples should have either a proven fertility problem or have been trying to conceive for three years.
John Reid, who was Secretary of State for Health at the time, said all trusts should be offering at least one cycle by the start of 2005 and three cycles "as soon as possible". However, two years on, The Independent's survey of more than 70 PCTs around the country found that 90 per cent have failed to implement the Nice guidance. The number of trusts surveyed accounts for about half of all trusts.
Four trusts have suspended treatment since May because of budget cutbacks and new patients in their areas cannot be referred for or receive treatment: North Lincolnshire , North Stoke, South Stoke and Northamptonshire.
Two thirds of trusts - 68 per cent - offer just one IVF cycle per couple and 17 per cent provide funds for two cycles. Just six PCTs offer three cycles, but these trusts also have some of the longest waiting times for new patients. Only three of the trusts not yet providing three cycles said they had plans to reach the standard, and two of those did not intend to achieve it before 2010.
Others have reduced the number of cycles to one, rather than increasing them in line with the guidance.
The majority of trusts have also imposed other criteria that prevent many couples from receiving treatment. One in five refuses to treat couples who have had previous IVF. This means many patients, who may have resorted to paying for IVF before the Nice ruling, and cannot afford any more, are now ruled ineligible even for one free cycle.
About half of trusts also refuse to treat couples who already have a child, while the Nice age range of between 23 and 39 has also been ignored by many trusts.
Clare Brown, who chairs the National Infertility Awareness Campaign, said: "It is absolutely appalling that the PCTs are still not implementing the Nice guidance. The eligibility criteria being imposed by the PCTs are unfair."
Cash-strapped trusts warned that the problems were likely to worsen, following a government decision to allow single women and lesbian couples to be eligible for NHS treatment.
A spokeswoman for the Department of Health said: "PCTs consider a range of factors, in liaison with local health bodies and patients groups, when deciding their policy on the provision of treatment services locally. This policy will reflect local health needs and priorities."
Nicola and Nigel Dawson: 'Access to treatment should be equal'
Nicola and Nigel Dawson funded two cycles of IVF while waiting for the Nice guidance to come into effect - then found themselves banned from NHS provision because of the earlier private treatment.
The couple, who live in Maidenhead, Berkshire, discovered in 2004 that they would need fertility treatment. Mr Dawson, a recruitment manager, had contracted mumps as a child and had been left with a low sperm count.
They heard about the Nice guidance and that all PCTs should be offering at least one free cycle of treatment by April 2005.
Mrs Dawson, 33, a project manager, said: "We decided we really wanted to crack on and get started with IVF, so we went privately.
"The first two cycles didn't work but by then it was 2005 so I went to the GP and asked for the free cycle I was entitled to on the NHS. Shesaid I wasn't eligible because I had had previous treatment and the PCT had also put in criteria saying you had to be at least 36."
Mrs Dawson said: "We couldn't see the criteria before we started the treatment so we had no way of knowing we would not be eligible.
"We had just failed at our second cycle and then we are hit with this. What makes me so angry is that it is unfair; if I lived in another part of the country I would be able to get three NHS cycles; in Maidenhead I can't even get one.
"I know there is a big debate about whether fertility treatment should be available on the NHS. But if it is going to be available, we should make it equal across the country."
The couple are now planning to adopt.