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 treatment. With fertility clinics cutting capacity or closing their doors completely at the height of the pandemic, lots of women have experienced devastating delays to their fertility journeys. These delays have served to expose some dynamics in the fertility sector that we were not talking about before: primarily, a system that provides women with little choice in their fertility journeys, and a lack of transparency that inhibits women’s ability to make informed fertility decisions for themselves.
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 treatments currently available in the UK consist of IVF, 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 already have a child, or are a member of the LGBTQ+ community, the system can be all the more difficult to navigate. It isn’t impossible, but it isn’t straightforward, either.
Meanwhile, going private is expensive, with the average UK couple spending £12,000 on fertility treatment. When clinical treatment costs this much, only a very small group of people can afford to choose it.
It’s clear that new, affordable and accessible options would be a welcome change, to enable more women to access care on their terms. While the current system succeeds in helping many women start the families of their dreams, for those it prices out or excludes, it’s still falling short.
This is at least in part because fertility clinics are commercial entities, operating largely on their own terms. Some clinics have been known to manipulate success rates in order 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 the couples and individuals desperate for the fertility sector’s support. While some people are able to access treatment easily – thanks to the help of their CCG or their ability to afford private treatment – for others the options on the table are more limited. It is for these people that the sector needs a shake up.
The fertility sector must shape policies that put transparency and inclusivity first. Pricing must be regulated to improve access across the board. Regulators should also ban dubious treatment add-ons and label the unproven ones, to protect people at what is often a vulnerable time. Finally, eligibility for NHS provision should be reviewed to include LGBTQ+ families and people experiencing secondary infertility.
I know that change in the fertility sector is possible – and that new fertility solutions are out there. We’re building one in our at-home fertility startup, Béa Fertility. We’re bringing back a non-invasive clinical treatment called intracervical insemination, and building a kit which will enable people to carry out the treatment affordably at home. Elsewhere, startups like Apricity are making fertility clinics more accessible, while Hertility is helping women to understand their reproductive health. We’re proving that there are other routes to fertility in addition to what’s already on offer, and that new options can help create a treatment ecosystem that reflects the nuance in women's fertility experiences.
Not only does transparency, education and choice help those who want to start a family, 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’s lots about families and fertility that we don’t know enough about – not least the fact that the easiest way to rule out 50 per cent of fertility problems is to do a semen test. A culture of transparency around every aspect of fertility will make it easier for women to feel empowered in their fertility choices.
The fertility sector as it operates today allows just a small minority of people the freedom to make choices. But women 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 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.
Tess Cosad is a fertility expert and CEO and co-founder of Béa Fertility
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