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Research finds significant barriers to NHS-funded fertility treatment for female same-sex couples

• BPAS Fertility today releases the results of an investigation into NHS-funded fertility care across the UK for female same-sex couples, and the additional, hidden financial barriers so many face.
• One fertility patient told BPAS Fertility, “I generally feel quite comfortable with my sexuality, but the fertility process is the first time in my life that I have felt deep sadness at being gay.”
• While fertility services are commissioned at a national level across Scotland, Wales, and Northern Ireland, patients in England face varying NHS-funded support based on local Clinical Commissioning Groups (CCGs), creating a ‘postcode lottery’.
• Female same-sex couples are often forced to “prove” their fertility status by undergoing several expensive rounds of artificial insemination (AI) privately before they are eligible to receive NHS care.
• BPAS Fertility is calling for equal access to fertility treatment. As Director of Embryology, Marta Jansa Perez, says: “The barriers faced by these patients amount to a tax on LGBT+ families.”

BPAS Fertility today releases the results of an investigation into NHS-funded fertility care for female same-sex couples, highlighting the additional, hidden financial burdens they face.

Fertility services in the UK, including in vitro fertilisation (IVF), are provided by a mixture of NHS and private services. NHS fertility services are commissioned at national level in Scotland, Wales and Northern Ireland. In England, responsibility for commissioning is taken by Clinical Commissioning Groups (CCGs), which plan and commission services for their local area.

NHS-funded care is commonly given to heterosexual couples once they can demonstrate they have tried to conceive naturally for 2-3 years. However, female same-sex couples are required to establish their “fertility status” by self-funding several rounds of artificial insemination (AI) privately, at considerable cost.

BPAS Fertility’s new report turned up key data concluding:

• Over a quarter of CCGs (29%) will not fund the cost of donor sperm to be used in IVF treatments.
• The majority (76%) require a minimum of 3 self-funded AI cycles and frequently up to 12 cycles, which can cost as much as £1,600 per cycle, or almost £20,000 in total.
• Over half (57%) will fund just one cycle of IVF, less than 20% will fund 3 rounds, and in some areas no care is provided at all.

Despite NICE guidance on best practice – released eight years ago – stating that intrauterine insemination (IUI) should be considered as a treatment option for people in same-sex relationships, there are still significant barriers to care, including:

Restrictions on the use of donated gametes

Three CCGs (NHS Brighton and Hove CCG, NHS East Sussex CCG and NHS West Sussex CCG) do not fund procedures involving donor genetic materials for any patient group. This is likely to have a disproportionate impact on female same-sex couples, since it effectively bans them from accessing NHS-funded care.

Criteria for establishing “subfertility”

Only 17 (of 106) CCGs adhere to NICE guidance by providing NHS-funded AI as an alternative to vaginal intercourse for female same-sex couples. Over three quarters (76%) of CCGs require a minimum of 3 cycles of AI to be self-funded before patients become eligible for NHS care, with 29 CCGs requiring between 10 and 12 cycles of self-funded AI. Cycles can cost up to £1,600, meaning the total could be around £20,000.

Restrictions on the funding of donor gametes

31 CCGs (29%) said they do not fund the cost of donor sperm to be used in IVF treatments for female same-sex couples, even if the couple has previously met the eligibility criteria by self-funding multiple rounds of AI. Again, this financial burden is likely to disproportionately impact same-sex couples.

Other postcode-dependent restrictions

Female same-sex couples are also subject to the same postcode lottery as all other fertility patients. Three CCGs do not fund any fertility treatments at all, for any patient group. The overwhelming majority of CCGs fund fewer cycles of IVF than recommended by NICE: our analysis found that only 21 CCGs fund up to three cycles, while 60 CCGs (57%) fund a maximum of one cycle.

Previous research by BPAS Fertility has highlighted other postcode-dependent criteria, including female age (with some CCGs restricting female patients over the age of 35), BMI, and the fact that a patient’s partner has a child from a previous relationship.

Jess*, a fertility patient who has been affected, said:

“The requirement of our CCG to self-fund 12 attempts to conceive means that we have ruled this out as an viable option. We would likely have spent tens of thousands of pounds and be a few years down the line by the point we are eligible for support. Our heterosexual friends who have required fertility support from the NHS have had a very different experience.

“It has made me and my partner feel unsupported and discriminated against by the National Health Service for which we both work, and at times had made us seriously consider whether we will be able to start a family at all. This has inevitably put our relationship under pressure. I generally feel quite comfortable with my sexuality, but the fertility process is the first time in my life that I have felt deep sadness at being gay.

“Thankfully we are in a position to be able to consider different self-funded options (though the uncertainty, variety of options and cost has put an emotional and financial strain on us), but I hate to think of the extra challenge lesbian couples who don’t have other options. The process of ‘shopping’ around private clinics with their vastly different approaches, advice, and prices (and often heteronormative approaches and lack of appropriate support and advice) sadly has taken any of the joy out of this for us.”

Marta Jansa Perez, Director of Embryology at BPAS Fertility, said:

“Fertility services are crucial in supporting the development of different family structures, providing same-sex couples with the ability to try to become parents. This report lays bare the harsh reality of access to NHS-funded treatment for female same-sex couples. The barriers faced by these patients are striking and amount to a tax on LGBT+ families.

“Going through fertility treatment can be a vulnerable experience, and even more so for patients funding their own treatment at great personal cost. As a society we are not used to paying for healthcare, and an already complex process can be complicated further by unfair gate-keeping and red tape.

“Against this backdrop of increasing restrictions to NHS-funded care, we are proud to be launching our not-for-profit IVF service in 2021. We intend to only charge what it costs to provide a safe, high-quality and accessible service to patients who may be unable to access NHS funded care. BPAS Fertility is committed to being at the forefront of ethical, compassionate, high-quality fertility care and research, and are excited to open our first clinic later this year.”

Eloise Stonborough, Associate Director of Policy and Research at Stonewall (she/her), said:

“All lesbian, gay, bi, trans and queer people who want to, should be able to start their own families. While accessible, inclusive, and fair fertility services should be available to everyone who needs them, in reality, there are many barriers to LGBTQ+ people accessing NHS-funded care and causing obstacles to LGBTQ+ people forming a family of their own. BPAS’s vital report shines a light on the inequalities that still exist for female same-sex couples looking to start their family, from lack of funding to a postcode lottery. Much more needs to be done so that Clinical Commissioning Groups ensure their fertility services are following NICE guidance, and we will continue to work to ensure that every LGBTQ+ person can access the services they need to start a family.”

Whitney and Megan Bacon-Evans, online influencers and current fertility patients, have been calling for an end to fertility discrimination in fertility services, recently launching a petition that has almost 6,000 signatures. They said:

"After being together for over 12 years, we were excited at the prospect of starting our family. However it quickly became apparent that this would not be a very joyful experience and that there are many barriers in place that prevent LGBTQ+ / same-sex couples from creating a family. In particular, we were devastated when we found out that we cannot legally do home insemination with sperm from a sperm bank, and in turn, forced to self fund IUI/ IVF.

“We were also shocked when we discovered that the requirements to receive help from the NHS 6 rounds of self-funded IUI for same-sex couples, as opposed to two years of unprotected sex for most heterosexual couples, which albeit a long time, holds no additional financial cost. This is discrimination, plain and simple. A lot of our followers have had to pay between £10,000 - £100,000 and have even had to give up on having a family.

“We launched our petition as we believe that sexual orientation should not be a barrier to having a family and that fertility equality is needed. We hope this investigation by BPAS helps to raise awareness about the unfair financial burden put on LGBTQ+ couples who are just trying to create their family and live their lives like everyone else."

On Thursday 17th June, BPAS Fertility will host a free online event with Whitney and Megan Bacon-Evans to discuss discrimination in fertility care. Sign up here.

ENDS

For further information please contact BPAS on press@bpas.org or 07570 707134.

The full report is available to view here.

About BPAS
BPAS is a charity which sees almost 100,000 women a year for reproductive healthcare services including pregnancy counselling, abortion care, miscarriage management and contraception at clinics across the Great Britain. It supports and advocates for reproductive choice. BPAS also runs the Centre for Reproductive Research and Communication, which seeks to develop and deliver a research agenda that furthers women’s access to evidence-based reproductive healthcare, driven by an understanding of women’s perspectives and needs. You can find out more here: https://www.bpas.org/get-involved/centre-for-reproductive-research-communication/

This year BPAS will launch a not-for-profit fertility service, BPAS Fertility, to provide ethical, evidence based, person-centred care that supports patients. We intend to only charge what it costs to provide a safe, high-quality, and accessible service to patients who may be unable to access NHS funded care.