An extensive UK study has revealed that people needing fertility preservation treatment on the NHS face a ‘postcode lottery’ to receive the therapy.
Fertility preservation treatments, which include freezing reproductive tissue, eggs, sperm, or embryos, are vital for patients with medical needs such as cancer or transgender issues, enabling them to become parents in the future.
A new UK study performed by researchers from University College London Hospital, Oxford University Hospital and Ninewells Hospital and Medical School in Dundee has identified significant disparities in access to these treatments. The investigation audited UK healthcare commissioner fertility preservation policies, finding that funding across the NHS is ‘variable’.
The investigation highlighted that the postcode lottery is most evident for transgender people and those with non-malignant diseases that can impact their ability to conceive, such as recurrent endometriosis and autoimmune conditions.
The full findings of the research are published in the journal Human Fertility.
Analysing access to fertility preservation
Referrals for fertility preservation – procedures where reproductive cells (gametes) are extracted, frozen and stored so that patients can have a family in the future – have risen dramatically in recent years.
To understand potential barriers to treatment access, the researchers examined 155 fertility preservation policies in the UK between December 2020 and February 2021. The study included all NHS health trusts and boards responsible for providing fertility preservation treatment in Scotland, Wales, and Northern Ireland and 129 of England’s 135 clinical commissioning groups (CCGs).
The team analysed all aspects of fertility preservation, such as the type of cryopreservation procedure, number of ejaculation/ovarian stimulation cycles, number of years for storing gametes (eggs, sperm etc.), and treatment to replace gametes. Moreover, eligibility criteria, including the patient’s age and body mass index (BMI), were also investigated.
Disparities across the UK
The study results showed that only 42% of CCGs in England, which assign the funding to the NHS health trusts, outline any provision for transgender patients. Additionally, only 7% fund ovarian tissue freezing, a type of fertility preservation that is the only option for prepubescent girls to preserve their fertility in advance of chemotherapy or for women who cannot delay cancer treatment. However, this treatment was available all across Scotland.
All of the CCGs in England that responded currently fund gamete and embryo freezing for cancer. 89% fund fertility preservation treatments for cancer and non-malignant conditions, with 11% only funding the treatment for cancer. Most CCGs support the storage of gametes for a decade, with a third having a five-year limit. Wales and Northern Ireland also have restrictive policies that do not specify funding for ovarian tissue freezing.
The data illuminate that Scotland has the most inclusive system, with a national policy implemented to ensure funding for the freezing of all reproductive material for most patients, including ovarian tissue. Furthermore, the storage of gametes is funded for at least ten years.
The researchers explained that some CCGs do not follow National Institute for Health and Care Excellence (NICE) guidelines for fertility preservation and believe that standardisation of policies is urgently needed.
Sania Latif, from the Reproductive Medicine Unit at University College London Hospital, said: “Our study highlights the disparity in fertility preservation provision across the UK. Variation in provision creates a lack of parity between patients and affects the holistic care of the pathology being treated.
“Notably, funding for those undergoing treatment for gender incongruence and ovarian tissue cryopreservation is inconsistent and needs to be addressed. This national audit serves as a tool for all stakeholders to appeal to their local commissioners for uniformity of policy, equal access to care for patients and implementation of standardised fertility preservation provision in the UK.”