Fertility treatment offered to single women but age cut
FERTILITY treatment will be extended to single women on the NHS in Bristol while transgender people are also included for the first time – but the upper age limit is coming down to pay for it.
At present only straight or gay couples are eligible for the service, which “discriminates” against some groups by excluding them unfairly, a health authority meeting was told.
Bristol, North Somerset and South Gloucestershire (BNSSG) Integrated Care Board (ICB) approved a new fertility policy on Thursday, December 1, after hearing the existing one was open to legal challenge under the Equality Act. It includes lowering the maximum age for prospective mothers from 40 to 39.
People undergoing cancer treatment can currently have their eggs or sperm frozen but others whose NHS treatment will have an adverse or irreversible impact on their ability to conceive will now be included, including patients having surgery on a second ovary or testes and transgender people on the transition pathway. Other changes include reducing the number of independently funded cycles of intrauterine insemination (IUI) - a fertility treatment where sperm is inserted directly into the womb - to demonstrate infertility from 10 to six to ease the financial burden on those being treated.
The new policy will also support people with diagnosed therapy-resistant psychosexual issues that prevent them from having children without assistance and will continue to offer individuals one fresh and one frozen cycle of IVF. Board members heard the decision to reduce the female upper age limit was based on evidence about the much lower effectiveness of treatment for women over 40.
Men aged up to 54 will still be eligible under the changes, which come into force on April 1. The new policy follows a review launched in March 2021 that gained the views of 438 people and organisations.
It involved consultation with local fertility specialists and a 12-week public engagement. Three common themes highlighted in the feedback were to widen the scope of people who can access reproductive cells preservation, to increase the number of cycles of IVF from one to three and that the length of time a person has not conceived should be considered more important than their relationship status.
BNSSG ICB’s Bristol chief nursing officer Rosi Shepherd said: “We know fertility funding and treatment policies impact on the lives of many people. The proposals aim to provide better equity of access for local people while staying within our limited resources.”
A report to the board said: “There is a risk that if the proposed policies are not adopted, the ICB will remain open to legal challenges under the Equality Act. The current commissioning policy for fertility assessment & treatment discriminates against single people, transgender people and those with a health issue that will prevent them conceiving.
“The rationale for lowering the upper age limit is backed by evidence and has been deemed a rational and legal position
“Under this criteria, prospective mothers must not be older than their 39th birthday at referral. A change that will ostensibly only have three months of warning the cohort of women disadvantaged by this should be allowed to transition, which would take nine months. BNSSG ICB’s executive team have indicated that for this ninemonth period, women aged between 39 and 40, who are known to their clinician as having suspected infertility and have been trying to conceive for at least one year, could still be referred for the funding of investigations and treatment of infertility should they meet the rest of the criteria.”