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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.

26 July 2021 - by Michaela Chen and Jen Willows 
A knowledge gap may mean that women and girls living with sickle cell disease are not getting the best reproductive healthcare...
6 July 2020 - by Dr Catherine Hill 
The largest study looking at long-term outcomes of fertility preservation in female cancer patients has demonstrated how successful it can be, in particular for breast cancer patients...
17 September 2018 - by Georgia Everett 
The age at which a woman freezes her eggs has a significant impact on IVF success when they are thawed, suggests a new report by the UK's fertility regulator...
13 August 2018 - by Dr Sam Sherratt 
Women who freeze their eggs for social reasons need to be better informed about the potential difficulties of the process, experts from the Royal College of Obstetricians and Gynaecologists have warned...
13 August 2018 - by Dr Sue Avery 
The UK's Equality and Human Rights Commission is threatening legal action if 'outdated' NHS policies, which it says discriminate against the transgender community, are not changed urgently. Specifically, it is concerned that trans people should have equal access to fertility preservation services...
16 January 2017 - by Lone Hørlyck 
A 20-year-old man, who was originally born female, is the first in the UK to become pregnant through sperm donation after the NHS refused to pay for egg freezing...
31 October 2016 - by Sarah Norcross 
The Progress Educational Trust's event on preserving fertility was held in Edinburgh on 25 October...
15 August 2016 - by Dr Mary Yarwood 
Transgender men are being permitted to freeze their eggs at NHS-funded fertility clinics, prior to gender re-assignment...
15 May 2012 - by Dr Vardit Ravitsky and Professor David Heyd 
Sex reassignment is an intricate and sensitive physiological, psychological, and social process that usually entails the loss of reproductive capacity. Reproductive technology can prevent this loss, but should it be used for that purpose? A recent case in Israel raises this question...
Is it just to pre-empt treatment? What about other needs? ( - 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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