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Offer egg freezing to all with medical need, say guidelines

8 January 2018
Appeared in BioNews 932

The NHS should offer patients the chance to freeze their eggs before they receive treatments that could damage their fertility, say new guidelines published by the British Fertility Society (BFS).

Treatment for a variety of conditions, including cancer, lupus, sickle cell and gender dysphoria can leave patients unable to have children in the future. In new guidelines published in the journal Human Fertility last Wednesday, the BFS suggests that patients due to undergo these procedures should be allowed to store their eggs through the NHS to allow them a chance to have a family later.

'There are a number of situations where the preservation of fertility is needed,' said Professor Adam Balen, chair of the BFS. 'This has to happen at a time before a person is ready to start a family and can sometimes be the only hope for becoming a parent in the future.'

The NHS currently provides fertility preservation services for female cancer patients where infertility can be caused by side-effects of chemotherapy drugs or radiation. Services for patients with non-cancerous conditions that affect fertility are far patchier, and are only provided by certain Clinical Commissioning Groups (CCGs), leaving many patients uncovered.

For example, patients requiring stem cell transplants for blood diseases such as sickle cell or some types of thalassemia undergo chemotherapy to prepare their bodies for the new tissue, but although the side effects are comparable to those receiving chemotherapy for cancer, they are not necessarily given the same fertility preservation options.

Patients undergoing gender reassignment can have their fertility affected by hormone therapies and gonadal surgery, and according to Dr James Barrett, lead clinician at the Gender Identity Clinic at Tavistock and Portman NHS Foundation Trust: 'The number of people coming forward with gender dysphoria has increased rapidly over the past decade.'

Additionally, there are patients who have genetic or chromosomal conditions which will likely affect their fertility. Individuals with Turner Syndrome (monosomy X) are generally able to carry a pregnancy but can't make viable eggs. However, the BFS reports that mothers of girls with the condition may wish to donate their own eggs for freezing so their daughter can have a genetically related child later in life.

Fertility preservation technology has been available for over thirty years, and can include freezing either embryos, unfertilised oocytes or ovarian tissue. It costs around £5,000 to privately freeze eggs or embryos and around £300 a year to store them, making it unaffordable for many. Patients are then dependent on local CCGs who may or may not provide the needed services.

'Some CCGs say they will only fund for cancer,' said Dr Melanie Davies from the Department of Woman's Health, University College Hospitals London. 'What I would like to see is equity.'

NHS England responded to the publication of the new guidelines by saying that funding of fertility preservation treatment is a matter for local clinical commission groups.

SOURCES & REFERENCES
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HAVE YOUR SAY
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Is it just to pre-empt treatment? What about other needs? (User:114377 - 08/01/2018)
What about the possibility for girls with Turner Syndrome to have their eggs frozen (or ovaries/ovarian tissue)? This is not related to a treatment for a condition but potentially the treatment itself, given the girls who have viable ovaries are likely to have their ovaries die away at a very young age. Doesn't this count as a medical need?
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