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Why fertility treatment must be in the Women's Health Strategy

21 June 2021
By Sarah Norcross
Director of PET
Appeared in BioNews 1100

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.

Women's Health Strategy: Call for evidence
Department of Health and Social Care |  17 June 2021
6 December 2021 - by Daniel Jacobson 
The Human Fertilisation and Embryology Authority has detailed potential updates to current laws regarding fertility treatment practices in the UK, including improved patient protection...
25 October 2021 - by BioNews 
This film documents a Progress Educational Trust event about the future of egg freezing, in light of the UK Government's announcement that it intends to extend gamete and embryo storage limits...
4 October 2021 - by BioNews 
This presentation was given at the Progress Educational Trust event '#ExtendTheLimit: What Now For Egg Freezing?'...
13 September 2021 - by BioNews 
As the UK Government announces its intention to extend gamete and embryo storage limits, watch this short film about the campaign that led to this announcement – the #ExtendTheLimit campaign, led by the Progress Educational Trust...
13 September 2021 - by Dr Kylie Baldwin 
After several years of campaigning to #extendthelimit on the storage period of eggs frozen for social reasons, I like many welcomed the recent government announcement to change the maximum storage time from ten years to a maximum of 55 years...
14 June 2021 - by Michaela Chen 
Newly released guidance from the UK Competition and Markets Authority, would allow couples to initiate legal proceedings against IVF clinics that have falsely guaranteed their success rates...
22 March 2021 - by Dr Yvonne Collins 
It's not often you come away from an event thinking 'wow, that could really save lives'...
18 January 2021 - by Dr Ëlo Luik 
The first online event held by the Progress Educational Trust in 2021 was 'An All-Consuming Problem? How to Protect Patients in the Fertility Market'...
11 May 2020 - by Sarah Norcross 
In addition to continuing with its #ExtendTheLimit campaign, PET has developed ten key principles on egg, sperm embryo storage which have informed its response to the UK government's consultation on this area...
2 December 2019 - by Dr Charlott Repschlager 
The latest meeting organised by the Progress Educational Trust asked the question 'Does fertility treatment still need to be a medical secret?' The event in Edinburgh last week, held in partnership with the Scottish Government, took place off the Royal Mile - through a narrow alleyway in Riddle's Court, one of the many old and imposing buildings scattered through the city...
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