Nearly 90% of clinical commissioning groups (CCGs) are not offering the recommended three cycles of IVF treatment.
New figures reveal that of 208 CCGs in England, only 24 meet national guidelines, and seven offer no treatment at all.
The campaigning group Fertility Fairness has released the figures, which are based on Freedom of Information requests sent to CCGs across England, 208 of which replied.
The National Institute for Health and Care Excellence (NICE) issued guidelines in 2004 stating women under 40 who have failed to get pregnant after two years of trying should be offered three full cycles of IVF on the NHS.
But the recommendations allow local NHS providers to decide what they offer.
The Fertility Fairness figures show that between 2013 and 2017 the number dropped from 24% to 12% of CCGs.
It also found that 50 offered two cycles, 127 offered one, and seven did not offer IVF treatment on the NHS.
In Scotland, a new policy was introduced in April enabling couples to have three full cycles.
In Wales, they are entitled to two full cycles, and in Northern Ireland they are offered one partial cycle.
An NHS England spokesperson said that these are “legally decisions for CCGs, who are under an obligation to balance the various competing demands on the NHS locally while living within the budget parliament has allocated”.