NHS patients requiring fertility freezing treatments face ‘postcode lottery’

A new study has identified a ‘postcode lottery’ in NHS treatment that helps patients with medical needs become parents in the future, especially for transgender patients and those with medical conditions that affect the ability to conceive. 

The study, published in the journal Human Fertility, audited UK healthcare commissioner fertility preservation policies and found that funding across the NHS is ‘variable’.

The results mean that millions of people can only access treatments such as the freezing of reproductive tissue, eggs, sperm or embryos if they live in the right place.

The research, carried out by experts from leading institutions across the UK, shows the postcode lottery is most evident for transgender people and those with non-malignant diseases that can affect the ability to conceive, such as recurrent endometriosis and autoimmune conditions.

Only 42% of English clinical commissioning groups (CCGs) specify any provision for transgender patients.

Ovarian tissue freezing is the only option for prepubescent girls to preserve their fertility in advance of chemotherapy, and for women who can’t delay cancer treatment. Yet just seven percent of NHS commissioners in England fund this type of fertility preservation, although they all do in Scotland.

The authors say some CCGs do not follow National Institute for Health and Care Excellence (NICE) guidelines for fertility preservation and that standardisation of policies is needed.

‘Our study highlights the disparity in fertility preservation provision across the UK,” says Sania Latif, from the Reproductive Medicine Unit at University College London Hospital.

‘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.’

Referrals have risen considerably for fertility preservation in recent years. These procedures, where reproductive cells (gametes) are extracted, frozen and stored, offer people the hope of having a family one day.

In England, all CCGs that responded fund gamete and embryo freezing for cancer. Nine out of ten (89%) fund fertility preservation treatments for both cancer and non-malignant conditions, while the remainder fund fertility preservation treatments for cancer only. The majority of CCGs fund storage of gametes for a decade – a third have a five-year limit.

Restrictive policies also exist in Wales and Northern Ireland where policies do not specify funding for ovarian tissue freezing.

In Scotland, the situation is by far the most inclusive according to the data. A national policy exists to provide funding for freezing of all reproductive material including ovarian tissue, and for most patients. Storage of gametes is funded for at least ten years.

The authors offer several reasons for the significant differences in provision across the UK. They say one factor could be that fertility preservation is considered part of fertility treatment such as IVF ‘which is notoriously underfunded’.

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