Changes to NICE fertility guideline for same-sex couples

As Britain's leading lesbian, gay and bisexual equality charity, Stonewall welcome the decision by the National Institute for Health and Clinical Excellence (NICE) to update its fertility guidance to recognise recent changes in the law that will affect lesbian and bisexual women. The guidance, out to consultation, explicitly includes same-sex couples as an eligible group for fertility treatment.

Unfortunately, the NHS has a poor record in dealing with lesbian and bisexual women's health, often failing to acknowledge their specific needs. This was most apparent in the unfair 'need for a father' provision, which was interpreted by many clinics and healthcare professionals as an outright ban on same-sex couples accessing fertility treatment. Stonewall successfully lobbied to have these removed in the Human Fertilisation and Embryology Act 2008, putting gay people on an equal footing with straight people.

Now lesbians and bisexual women seeking fertility treatment on the NHS are entitled to exactly the same assessment as heterosexual women - the NHS is not allowed to refuse access to fertility treatment simply on the basis of sexual orientation. To support lesbians, bisexual women, and healthcare professionals on understanding these legal changes, Stonewall produced 'Pregnant Pause' (1), a guide for lesbian and bisexual women on getting pregnant.

However, at Stonewall we still hear of lesbian couples who have been denied treatment simply because of who they are: our research into the health of lesbians and bisexual women, 'Prescription for Change' (2), found one in two has had a negative experience of healthcare in the past year. Lesbians have told us common responses from healthcare professionals include: 'A couple is defined as a man and woman' and 'Civil partners are not entitled to the same rights on the NHS as married spouses'. These are examples of outright discrimination towards lesbians looking to start a family.

So does the NICE draft guidance on fertility resolve some of these issues? Yes and no. The document explicitly refers to same-sex couples for the first time, recognising the changes in the law and growing number of lesbians accessing fertility treatment. However, the guidance recommends lesbians fund six cycles of intrauterine insemination themselves, after which the NHS will fund a further six if they are unsuccessful. NICE has come to the conclusion that six self-funded cycles (with a potential cost of £6,000) is the equivalent to a heterosexual couple failing to conceive after 12 months of unprotected vaginal intercourse.

So while we welcome the recognition of same-sex couples, and the issues they face in the draft guidance, lesbian couples are expected to pay up to £6,000 before being considered by the NHS for treatment. This is unfair.

We are acutely aware that some lesbians conceive at home, which exposes them to a number of potential risks. This is precisely why we lobbied to lift the ban on lesbians accessing fertility treatment. Unfortunately, we are concerned that making lesbians pay for treatment will dissuade them from accessing safe clinical services.

Stonewall will continue to work with clinics, NICE and the NHS to ensure lesbians can access safe fertility treatment, and that healthcare professionals treat them with dignity and respect.