Less than half of Clinical Commissioning Groups (CCG) in England specify gender affirmative hormonal or surgical treatment as a reason to qualify for fertility preservation, a national audit has shown.
Researchers from University College London Hospital, Oxford University Hospital and Ninewells Hospital and Medical School in Dundee carried out a national audit of fertility preservation funding in England, Scotland, Wales and Northern Ireland. They found that funding criteria for fertility preservation in England, Wales, and Northern Ireland varies considerably and deviates from NICE guidance which recommends all individuals undergoing treatment that may affect their fertility should have access to fertility preservation.
Lead author Dr Sania Latif, from the Institute for Women's Health at University College London Hospital, said: 'Our study highlights the disparity in fertility preservation provision across the UK. 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.'
The authors of the study published in Human Fertility analysed funding for all aspects of fertility cryopreservation, including the type, number of ejaculations or ovarian stimulation cycles, years for storage, and treatment to replace gametes. Additional eligibility criteria, like gender, age, and patient BMI, were also considered. A total of 155 policies active in the UK between December 2020 and February 2021 from NHS health trusts and boards responsible for providing treatment in Scotland, Wales and Northern Ireland were included, and 129 of 135 CCGs in England.
All CCGs in England fund cryopreservation of gametes and embryos for people undergoing cancer treatment, and 89 percent fund it for people who have conditions which may affect their fertility. Just 43 percent mentioned being transgender as criteria for accessing fertility preservation. Even though cancer treatment was specified as a reason to access fertility preservation, the length of time that freezing was funded for varied. Authors noted that the only form of fertility preservation available to pre-pubescent females was ovarian tissue freezing, which was only offered in seven percent of CCGs. Four CCGs listed BMI and ovarian reserve as criteria for accessing fertility preservation.
While Scotland was found to offer NICE-consistent policies across all seven of its health boards, Wales and Northern Ireland did not mention treament for transgender patients in any policy despite offering fertility preservation for people undergoing treatment likely to make them infertile.
Recent previous studies had highlighted the 'postcode lottery' for fertility preservation services for young people undergoing cancer treatment (see BioNews 1114) and IVF funding across different regions of the UK (see BioNews 1120).
Sources and References
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Fertility preservation provision in the NHS: a national assessment of care policies
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Transgender people 'denied chance to preserve fertility on the NHS'
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Transgender people 'denied chance to preserve fertility on NHS' according to Dundee study
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NHS patients face 'postcode lottery' for fertility freezing treatments
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