In this second blog in the series “Time to level up and stop discrimination against same sex couples”, I want to focus on NHS fertility funding for those in the LGBTQ community.
In the UK, NHS funding for fertility is still a post-code lottery-dependant fiasco that sadly excludes the vast majority of same sex couples and single people from accessing NHS funded fertility investigations and treatment.
In Brighton, long regarded as the LGBTQ+ capital of Great Britain, NHS funding in Sussex for donor sperm treatment has long been excluded from any fertility policy, but today I want to share some exciting news – significant changes to NHS fertility funding in Sussex is on the way. Watch the update below.
Clinical Care Commissioning Groups (CCGs) have a responsibility to review all the latest evidence based guidance before deciding on funding policies for their area. For fertility funding that means CCGs must refer to the National Institute of Health and Care Excellence (NICE) Clinical Guideline CG 156 ‘Fertility: assessment and treatment for people with fertility problems’. This was first published back in 2013 and updated in 2017.
In this guidance, it is recommended that same sex couples and single people trying to conceive using donor sperm should be offered fertility testing and treatment when the female to be treated has failed to conceive after 6 cycles of either donor sperm self-insemination at home or intrauterine insemination in a clinic. No reference is made to same sex male gay couples.
This is deemed to equate to a heterosexual couple trying to conceive through unprotected intercourse for one year. Of course, this test for eligibility fails at the first hurdle. It’s like comparing apples and pears.
To conceive as a same sex female couple, you need professional help and guidance about donor sperm selection, how and when to inseminate if doing so at home, and ideally a clinic for the safest and most successful treatment pathway of intrauterine insemination of properly screened donor sperm.
You also need access to counselling and legal parenthood consent forms. All this can be very costly amounting to thousands of pounds. Unprotected intercourse on the other hand in a heterosexual couple is completely free. It does not carry any price tag.
NHS Fertility Funding in Sussex from 1st November 2021
Since the NICE guideline were published in 2013, I have spoken many times with the different Sussex CCGs about the merits of an inclusive NHS fertility policy in line with the Equality Act that supports all those needing fertility treatment, irrespective of gender identity or sexual orientation. They have never shown any appetite to change their fertility policy.
This is why I was so pleased to receive a letter at the end of October from Sussex CCG advising us of the following significant changes to NHS fertility funding in Sussex from 1st November 2021:
- Same sex female couples and single women will now be eligible to receive IUI and IVF treatment with donor sperm. They can be referred for fertility investigations after 6 months of self-funded donor sperm insemination, either at home or in a clinic.
- Donor sperm treatment will now be funded in conditions of severe male infertility (obstructive and non-obstructive azoospermia) or where there is a risk of transmitting a genetic disease to a child.
- Up to 3 cycles of IVF treatment will now be funded in women up to the age of 40 (current policy only funds up to 2 cycles of IVF).
- One cycle of IVF will be funded in women over 40 but less than 43 (current policy does not fund any IVF treatment beyond a woman’s 40th birthday).
- Egg Donor treatment will now be funded in cases of premature ovarian failure (early menopause before the age of 40) or when a women has had her ovaries removed, when she has a risk of passing a genetic condition to her child or after certain cases of IVF failure.
- The CCG will now fund embryo freezing for up to 5 years (currently it only funds storage of frozen embryos created through NHS IVF treatment for one year).
- The CCG funding of fertility preservation for those with cancer or trans folk starting hormone treatment will continue unchanged.
In order to get NHS Fertility Funding in Sussex for any of these treatments you have to satisfy certain eligibility criteria including female age; you have to be registered with a GP, as the woman need to have a BMI of less that 30 kg/m2, both you and your partner, if you are in a relationship, must be non-smokers and neither you or your partner should have any living children.
in publishing their new policy on NHS Fertility Funding in Sussex, the CCG have stated that they wish to promote equality and address health inequalities and have in their policy changes given due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic as cited under the Equality Act 2010. I am not sure they have quite achieved this.
Whilst there is some good news in their new policy, there is still way to go on true health equality, most notably around the funding for IVF to create embryos in same sex male couples needing surrogacy.
There is also a fair bit of confusion about how and when people can actually access this new NHS Fertility Funding in Sussex and exactly how many IUI cycles same sex female couples or single people using donor sperm need to have undergone privately to be eligible for funded IVF treatment.
Finally, it is not clear whether they can go straight to IVF treatment with donor sperm to maximise their chances of success or be put through another 6 cycles of insemination which makes no sense at all if they have already done 6 unsuccessful cycles.
For me, the lack of gender neutral wording throughout the policy is also very disappointing, with reference being made throughout the policy to a ‘woman’ or ‘man’ as opposed to a person with ovaries or sperm.
On behalf of patients of the Agora Clinic and the wider LGBTQ+ community, I have written to Sussex CCG to point out those areas that need to be clarified and improved and will continue to engage with them in the hope that we can soon have a more workable and inclusive pathway to fertility treatment. Until that time, we will not unfortunately be in a position to answer the many questions I feel sure we will receive from those most affected by the policy changes.