The charity BPAS Fertility have released the results of an investigation into NHS-funded fertility care for female same-sex couples, highlighting the additional, hidden financial burdens they 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.”

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 shocking 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.

Read the full report by BPAS here.

Whitney and Megan Bacon-Evans, LGBTQ+ influencers @whatwegandidnext and cofounders of Find Femmes and The Femme Edition, 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 to
discuss discrimination in fertility care. Sign up here!

Exciting News

This year BPAS will launch a not-for-profit fertility service, BPAS Fertility, to provide ethical, evidence based, person-centred care that supports patients. BPAS 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. Hurrah!

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.