Fertility Treatment Options: greater choice and transparency required

Why the fertility treatment options currently on offer in the UK aren’t enough.

The pandemic has made us acutely aware of the passage of time. But no one will have felt the loss of a year more keenly than those waiting for or undergoing fertility treatments. With fertility clinics cutting capacity or closing their doors completely at the height of the pandemic, many have experienced devastating delays. This has brought to light some dynamics in the fertility sector that we were not talking about before: primarily, a system that provides people with few treatment options, and a lack of transparency that inhibits their ability to make informed choices regarding their fertility.

There’s no question that fertility clinics in the UK perform miracles, helping people start families when it feels otherwise impossible. Yet, if you’re struggling to conceive, the options presented to you by a clinic can be expensive, invasive and physically draining. The experience of fertility treatment is different for everyone, and for many women, the existing options are financially feasible and physically manageable. But for others, the current offering doesn’t leave them with much of a choice at all.

The fertility treatment options currently available in the UK consist of IVF (in vitro fertilisation), IUI (intrauterine insemination), ovulation induction and egg/sperm/embryo freezing. All of these involve some degree of hormone stimulation and medical procedures that can put a strain on the body. If you’re able to access any of these treatments on the NHS, you’re one of the lucky ones: NHS fertility provision for IVF and IUI is a postcode lottery, with eligibility in some parts of the country hinging on your relationship status and BMI. If you or your partner already have a child (even one from a previous relationship), you live in an area with little coverage or are LGBTQ+, the system can be all the more difficult to navigate. It isn’t impossible, but it isn’t straightforward, either.

Meanwhile, going to private fertility clinics is expensive, with the average UK couple spending £12,000 on fertility treatment. When clinical fertility treatment options cost this much, only a very small group of people can afford to use them.

New, affordable and accessible options would be a welcome change, to enable more women to access care on their terms. Alternatives to IUI and IVF are badly needed to close the gap in the industry. While the current system succeeds in helping many start families, it’s still failing many by excluding them or pricing them out.

This is at least in part because fertility clinics are commercial entities, operating largely on their terms. Some clinics have been known to manipulate success rates to sell more treatments. Others have been openly accused of up-selling treatment add-ons that have little clinical backing. The Human Fertilisation and Embryo Authority (HFEA: the UK government’s industry regulator) uses a traffic light system for ranking the efficacy of these extras. Of the 11 most popular add-ons typically up-sold at most clinics, not a single one received the HFEA’s green light.

Poor regulation, limited NHS provision and a lack of transparency result in one thing: less choice for those desperate for the fertility sector’s support. While some people can access treatment easily – thanks to the help of their CCG or their ability to afford private treatment – for others the treatment options on the table are more limited. It is for these people that the sector needs a shake-up.

What needs to change?

• Increased focus on transparency and inclusivity.
• Regulated pricing to improve access across the board.
• Ban dubious treatment add-ons and label the unproven ones, to protect people at what is often a vulnerable time.
• Review eligibility for NHS provision to include LGBTQ+ families and people experiencing secondary infertility.

Not only does transparency, education and choice help those who want to start a family, but it also empowers those who don’t, or who aren’t yet sure. Having children isn’t for everyone, but knowing your options can help you to decide what’s right for you, allaying any anxieties about the ubiquitous ‘biological clock’. There is a lot about families and fertility that we don’t know enough about – not least the fact that the easiest way to rule out fifty per cent of fertility problems is to do a semen test. A culture of transparency around every aspect of fertility, including in fertility clinics, will make it easier for us to feel empowered in our choices.

The fertility sector as it operates today allows just a small minority of people the freedom to make choices. But we deserve more than that. In addition to the services that are already on offer – which help lots of families get the start they need – we must deepen and widen access to ensure nobody is missing out. We can do this by creating more new treatment options and fostering a culture of transparency in the sector at large. When it comes to our bodies and our families, this is the very least we deserve.

This article was written by Tess Cosad, the CEO and Co-Founder of Béa Fertility. The article was originally published in Harpers Bazaar in October 2021. This version has been edited for our website but you can read the original piece in full here.