The UKs oldest NHS fertility clinic is at risk of closure and another has been put out to private tender, as IVF provision is increasingly privatised and rationed.

Hospital bosses want to close the internationally renowned department of reproductive medicine at St Marys hospital, Manchester, saying they cannot afford to fund a 10m upgrade of the unit, the Guardian has learned.

In Leeds, the entire NHS provision of fertility and other gynaecology services was put out to tender earlier this year, with private clinics invited to bid for a 10-year contract estimated at 70m to provide reproductive care.

Two years ago North Bristol NHS trust sold off its IVF clinic to a private provider, saying it was no longer feasible because of a reduction in NHS-funded patients.

In England, the proportion of fertility treatment funded by the NHS dropped from 39% in 2012 to 35% in 2017, according to figures published last year by the regulator, the Human Fertilisation and Embryology Authority (HFEA). This is at odds with the rest of the UK, where public funding has remained stable or increased.

When it opened in 1982, four years after the first test tube baby, Louise Brown, was born in nearby Oldham, St Marys was the UKs first fully NHS funded IVF unit. It now performs over 2,000 fertility treatments every year, including around 1,200 IVF cycles, and offers highly specialised fertility preservation for cancer patients. It is also a top research centre, which led on the use of ovarian reserve tests to guide ovarian stimulation, the development of stem cell lines from human embryos, and the effects of IVF on baby birth weights.

The Manchester University NHS foundation trust (MFT) said no decisions had been made over the units future. But staff were briefed last month that the HFEA and local clinical commissioning groups (CCGs) had been told that all licensed treatment and research on the site may end by April 2021 if an alternative solution cannot be found.

MFT, which runs the hospital, is also exploring options including redeploying services and some of its 107 staff including many highly specialised roles but confirmed to staff that closure was a possibility.

The Guardian spoke to 10 members of staff at St Marys aware of the mooted closure. One said they understood the matter to be settled: St Marys have taken a proposal to the MFT group board to discontinue the IVF service and the group board have said, Yes, OK. How they discontinue it is what they need to decide next, they said.

If the change goes ahead, CCGs, which fund fertility treatment, will have to pay private clinics to carry out IVF and other fertility services. But staff at St Marys warn that the private sector will not be able to carry out some of the most specialised services currently offered by the NHS.

We offer highly specialised procedures in the NHS which private providers wont touch because they dont make money and are too difficult. For example, we aim to see women diagnosed with cancer within a week who want to freeze their eggs before they start chemotherapy. Many of these women are already very poorly and need really high quality anaesthetic care during egg collection, and that is just not available in the private sector because of the medical complications, said one source.

They added: Private clinics are also unlikely to help patients with kidney problems or heart problems. But when they come to us, we can address these issues before they begin IVF: a huge advantage of being part of a multi-disciplinary NHS Trust. Those patients will be disadvantaged if this happens.

They also expressed concerns about screening procedures in the private sector. In the NHS, anyone applying for fertility treatment undergoes a series of stringent checks, including an assessment of the welfare of the child: Our checks and ethics advisory committee often flag issues including prison sentences, a serious history of domestic violence, even people on the sex offender register. At private clinics they dont do anything like the same background checks.

A number of separate proposals were put to MFT to try to save some or all of the clinic, including turning the service into a social enterprise and forming a partnership with a private provider, as is being proposed in Leeds.

The deadline to apply to run the Leeds service was 23 March, the day the government announced the coronavirus lockdown in the UK. Shortly afterwards, clinics stopped all new treatments and the HFEA ordered private and NHS clinics to stop treating patients in the middle of an IVF cycle by 15 April.

A spokesperson for the MFT, which runs St Marys hospital, said no decision had been taken to shut the clinic permanently.

They said: Services provided by the department of reproductive medicine at St Marys hospital are regularly reviewed as part of a usual cycle to ensure that we continue to provide the best possible care and treatments for all our service users. No decisions have been made, therefore it would be inappropriate to provide any further detail before the outcome of any review has been finalised.

The HFEA said it could not disclose informal discussions between clinics and inspectors.

Many St Marys staff are worried not just about their patients and their jobs, but the logistics of closing down the clinic. Moving thousands of sperm samples and embryos held in freezers, for use in both treatment and research, was a mind-boggling challenge, said one.

One staff member said: Although possible relocation was mentioned, the fact that no viable alternative has been identified and that the cost was described as being too high left us thinking that this is not being explored and that closing the unit is the direction of travel. We are worried for our jobs but our biggest concern is for our patients, particularly those with the most complex needs who cannot be served elsewhere without high costs.

IVF provision has been put under pressure, nationally, by NHS funding cuts over the past decade leading to a postcode lottery of provision. Now only a minority of English CCGs offer the recommended three funded IVF cycles, with some refusing to fund any NHS fertility treatment at all.

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NHS's oldest IVF clinic at risk of closure amid increasing privatisations - The Guardian