Professor Geeta Nargund, Medical Director, CREATE Fertility
© Akira Suemori
Fertility treatments are costly at the best of times, and unfortunately the current NHS provisions in place for lesbian couples who are hoping to start a family are shockingly sparse. Same-sex couples will be required to undergo up to 12 cycles of self-funded artificial insemination, before they can be considered for NHS funded IVF treatment.
© Akira Suemori
This entire concept is highly discriminatory. Heterosexual couples are required to prove that they have been trying for a baby for two years in order to qualify for NHS funding, but same-sex couples must pay repeatedly in order to attempt to try for a baby and prove that they have difficulties in conceiving. There are those fighting this system however, and in 2017, a lesbian couple successfully secured access to IVF treatment following legal action on discriminatory grounds, after being told they had to spend £6,000 on IUI before they could access NHS funding. This is inspiring, but should never have happened in the first place – the NHS’ guidelines on the matter have to change.
According to guidelines issued by the National Institute for Care and Health Excellence (NICE) in 2013, all women, regardless of sexual orientation and relationship status, should be entitled to three full cycles of publicly-funded IVF treatment, up to the age of 40. This then reduces to one cycle for those aged 40-42. However, this is rarely the case. Many couples of all sexualities will encounter the difficulties posed by the ‘NHS postcode lottery’, where different Clinical Commissioning Groups (CCGs) operate under different fertility policies. Indeed, the majority of CCGs do not abide by NICE’s guidelines, with only 12% offering the three full recommended cycles and some not offering any cycles at all, or only when stringent criteria is met. For same-sex couples, who will have had to spend a considerable amount of money on artificial insemination already, this could mean that funding is still eventually denied.
© Akira Suemori
Becoming a parent is a journey that both partners may want to be physically involved in, and Reciprocal IVF, sometimes called partner IVF, is an option that offers this for lesbian couples. In this process, one partner’s eggs are used and the other carries the baby. However, this is currently not available on the NHS, as NICE does not recommend that provision is made for this process – further injustice for same-sex couples who have dreamt of having a child with their partners. For gay men, there is even less on offer. Surrogacy is currently the only option for male same-sex couples to have a child who is biologically related to them, but isn’t currently offered on the NHS.
Additionally, most same-sex couples do not have any existing fertility problems, unless they are age related. This means that they don’t always have to undergo drug intensive IVF treatments that can be costly and carry long and short-term health risks to baby and mother, such as Ovarian Hyper-stimulation Syndrome. In some cycles of IUI (Intra-Uterine Insemination) or artificial insemination, women may receive fertility drugs to boost their egg production before the sperm is transferred into the womb, which is called a stimulated cycle. For those who have no issues with natural ovulation, this may be unnecessary. Natural IUI and mild IVF treatments can be a cheaper and safer alternative to women, where no or lower dosages of stimulation drugs are used. Not all IVF clinics offer these options, but it is important that same-sex couples are aware of the financial and health benefits that come from using less drug intensive IVF.
© Akira Suemori
For same-sex couples planning to start a family, an important first step is to find out what the funding criteria is for their area, and what treatment types are available. Heterosexual couples are able to prove they need IVF treatment without spending money, and similar adjustment should be made for those in same-sex relationships. The current funding policies for same-sex fertility treatments are unfair and unjust, and the NHS must wake up to the rights of same-sex couples to a family life. As one of the founding principles of our NHS is to provide equal and fair access to healthcare, same-sex couples should not be an exception to this rule – equality must be upheld up by the NHS, as it should be throughout our society.
