Tracking equity in fertility treatment: Two years on from the Women's Health Strategy

Two years ago, the launch of the Women's Health Strategy was welcomed with excitement and hope for the many people affected by infertility in England. The clear guidance to Integrated Care Boards (ICBs) was that they were expected to commission fertility services in line with the National Institute for Health and Care Excellence (NICE) Guideline for assessment and treatment, ensuring equitable access to fertility treatment across England (see BioNews 1152).

The NICE Guideline for fertility treatment is extensive and detailed, but perhaps most importantly, it says that eligible women should be offered three full cycles of IVF with or without intracytoplasmic sperm injection (ICSI). For a women aged 40-42 there should be provision made for one full cycle of IVF. The use of the term 'full cycle' is significant as it refers to the transfer of all viable fresh and frozen embryos produced.

The Women's Health Strategy also promised patients who are part of a female same-sex couple that they would no longer have to demonstrate they have a clinical need for fertility treatment by having to self-fund up multiple rounds of artificial insemination – sometimes as many as 12 and at considerable expense.

To mark this second anniversary of such an important commitment to the reproductive health of women in England, PET (the Progress Educational Trust) has undertaken a review of ICBs' fertility policies (where they are made available). The performance for each ICB has been added to the newly launched PET Fertility Policy Tracker. This simple-to-use and free-to-access tracker can be found on the PET website here for you to interrogate.

None of the major political parties included improving access to fertility treatment in their manifestos (see BioNews 1245), despite it being common knowledge that fertility treatment in England is subject to a postcode lottery (see BioNews 1120 and 1224). Provision falls well below what is recommended in the NICE Fertility Guideline and continues to discriminate against same-sex couples. PET launched the Power of Three Campaign last year to call for much-needed change and continues to encourage people to put pressure on their MP and ICB to address these shortfalls (see BioNews 1190 and 1193).

Here is a reminder of why it is important to raise awareness of this lack of fundamental care for so many people:

• Only three out of the 42 ICBs offer fertility treatment in line with the NICE Guideline.
• 19 ICBs do not offer IVF to women over 40, even though NICE recommends one full cycle be made available.
• The vast majority (34/42) of ICBs, where specified, still require same-sex female couples to self-fund the diagnostics needed to confirm subfertility.
• Only 17 ICBs offer any level of support to male same-sex couples – many not even making any reference in their policy.

Some areas are yet to harmonise fertility care provision across the ICB, some have policies which are out-of-date, and others have not made their policy publicly available. Many of the policies are written in a way that is confusing, and some sections had to be read by several members of the PET team before they were understood with confidence.

The PET Fertility Policy Tracker will shine renewed light on the lack of progress in fertility care for women, including those in same-sex relationships, across England – and by doing so will bring about change. In addition, the tracker will highlight the lack of support offered to men in same-sex relationships across many ICBs.

PET is pleased to be working with the newly-formed Fertility Justice Campaign Working Group, which includes LGBT Mummies, TwoDads UK, DIVA, Freddy McConnell, Stonewall, Fertility Network UK and LGBT Foundation to improve access to NHS-funded treatment for the LGBTQ+ community.

PET will review all available ICB policies for changes every month and will update the tracker accordingly. PET also aims to notify any updates to ICB's policies via the PET social media feeds, including X, Facebook, Instagram and LinkedIn.

Please share the tracker as widely as possible, in emails, on social media and websites, it will help make a difference to all those affected.

PET would like to thank Ferring Pharmaceuticals for providing the funding to make the development of the PET Fertility Policy Tracker possible.