The Progress Educational Trust (PET) – the charity that publishes BioNews – recently responded to a call by the UK government, for evidence relevant to the forthcoming Women's Health Strategy for England.
We argued in our submission that fertility treatment should be discussed in the Women's Health Strategy, drawing the government's attention to five areas in particular that have far-reaching consequences for the health of UK women.
Our concerns about each of these five areas are summarised below, and our more detailed submission can be read in full here.
1. Law reform around fertility treatment
UK fertility treatment is governed principally by the Human Fertilisation and Embryology Act, which is in need of full-scale review to take account of the many changes in science and society that have occurred since its last thoroughgoing review in 2008. Two priorities should be an extension to the current ten-year storage limit for eggs frozen for non-medical reasons, and the removal of the exceptional status of medical secrecy that currently applies to fertility treatment.
The ten-year storage limit should be extended because it has no scientific basis, is discriminatory against women, limits women's reproductive choices, and harms women's chances of becoming biological mothers. The exceptional status of medical secrecy should be removed because it only exists for historical reasons that no longer apply, it is not a status that applies to other areas of medicine that are equally sensitive (such as termination of pregnancy), and it creates problems for both patients and health professionals.
2. Access to fertility treatment
The National Institute for Health and Care Excellence (NICE) has long since recommended that three full cycles of NHS-funded IVF be offered to women under 40, but compliance with this recommendation continues to be wildly inconsistent across England. In February 2020, Matt Hancock – Secretary of State for Health and Social Care – described this situation as 'absurd' and 'unacceptable in a national service'. PET agrees with this assessment.
In Essex alone, there are seven clinical commissioning groups with differing policies on IVF provision – two offer no NHS-funded IVF whatsoever, one offers a NICE-compliant service, and the other four offer something in between. This situation is appalling, when one considers that infertility is – according to the World Health Organisation – not just a misfortune, but also a disease. It is morally unacceptable for women with the same medical need not to be treated equally.
3. Add-ons to fertility treatment
The lack of access to NHS-funded fertility treatment has fuelled the growth and dominance of the private fertility sector. This has been accompanied by growth in the promotion of 'add-ons' – optional procedures and treatments offered alongside IVF, often at considerable expense – to women undergoing fertility treatment. Evidence for the effectiveness (and even the safety) of add-ons is often poor. Nonetheless, add-ons are marketed to patients by fertility clinics and by the companies who originally devise the add-ons.
The situation needs to be addressed by making more reliable information about add-ons available to patients, via official channels including the main NHS website and app, thereby equipping patients to better understand and evaluate scientific and medical evidence as it relates to fertility treatment. The NICE Fertility Guideline should also be updated, to address add-ons and (where their benefits are poorly evidenced) disincentivise their use.
4. Women's health following fertility treatment
Pregnancy, whether achieved via natural or assisted conception, can involve risks to women's health and even their life. There are simple and effective ways to reduce these risks, particularly in the context of fertility treatment. Assisted conception offers unique opportunities to identify, anticipate and minimise risks to pregnant women at an early stage. Unfortunately – as we know from data on women who die during or after pregnancy – these opportunities are not always taken.
There are variety of measures, mostly simple and inexpensive, which could be taken by fertility professionals to minimise risks to patients. In particular, there are measures recommended by the project Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) – and also by Professor Catherine Nelson-Piercy, editor of the Handbook of Obstetric Medicine – which should be promoted by relevant bodies as part of the treatment pathway.
5. Research related to fertility treatment
There are a number of areas of scientific research that could bring dramatic improvements to women who wish to have children. Counterintuitively, these include research into causes of and treatments for male infertility. By far the most common treatment offered as a solution to male infertility involves the infertile man's female partner undergoing all of the invasive and onerous procedures involved in IVF. If male infertility were better understood and could be treated, this could obviate the need to treat women.
Another key area is human embryo research, which has considerable potential to improve IVF success rates and/or help avoid miscarriage (following either natural or assisted conception). However, such research is dependent upon fertility patients donating embryos to research following treatment, and is also dependent upon fertility clinics being able to accept such donated embryos. Both of these prerequisites are currently being frustrated, and there are steps that should be taken to resolve this.