Baroness Hussein-Ece
Liberal Democrat Peer and co-Chair of Population, Development and Reproductive Health APPGIn this article, Baroness Hussein-Ece discusses the barriers same-sex couples face to IVF treatment
The publication of the Women’s Health Strategy in July last year was a cause for jubilation for many female same-sex couples in England. The strategy listed one of its five “key commitments” as “improvements to fertility services” and stated the Government’s intention to “remove additional barriers to IVF for female same-sex couples”.
It went on to say that “There will no longer be a requirement for them to pay for artificial insemination to prove their fertility status and NHS treatment for female same-sex couples will start with six cycles of artificial insemination, prior to accessing IVF services, if necessary”.
IVF Treatment: The Reality for Same-Sex Couples
However, there is little sign of any progress in this area. Local Integrated Care Boards (ICBs) choose how to spend NHS funding and a Government report released in August of this year showing the current commissioning policies of local ICBs, reveals that of the 42 ICBs listed, 33 of them still require proof that same-sex couples have already tried a number of cycles of self-funded intrauterine insemination (IUI) in order to access NHS treatment.
Most of these ICBs require proof of six cycles, but some local authorities requiring proof of a staggering 12 rounds of IUI treatment, which can cost up to £1600 a time, meaning that many couples will have spent around twenty thousand pounds (often rising to £25kwith additional costs) on treatment before they are able to access NHS services.
It’s little wonder that a 2021 survey conducted by Stonewall and DIVA found that 36% of respondents who had children experienced barriers or challenges when starting their family and that one in five of those stated that the greatest barrier or challenge was the high cost of private fertility treatment.
What Wegan Did Next
In 2021 Megan and Whitney Bacon-Evans, a married couple from Berkshire, started a campaign which culminated in them taking their local ICB to the High Court. The couple had decided that they wanted to start a family and very quickly became shocked and dismayed to learn of the barriers in place to them accessing NHS treatment. In their local NHS area, Frimley ICB, female same-sex couples were required to pay for 12 rounds of fertility treatment, including six IUIs in a private clinic, to “prove” infertility before they would become eligible for NHS help.
Megan and Whitney subsequently launched a landmark judicial review against their NHS Clinical Commissioning Group for its “discriminatory” fertility policy, under which heterosexual couples merely had to claim that they had been trying unsuccessfully to conceive for two years, without any requirement of “proof”.
The response from Frimley ICB was to deny discrimination, but to request time to ”consider its policy”. In July of this year the couple withdrew their case, after Frimley ICB committed to an intention to introduce a new fertility policy, in the light of the Women’s Health Strategy, along with a consultation expected in November 2023. ‘Frimley ICB recognise the need to update their policy to remove the inequality between same-sex female couples and cis heterosexual couples,’ said Whitney and Megan in an Instagram post. ‘This combined with the Government’s commitment to removing the barriers to accessing IVF for same-sex female couples in 2023 leaves us feeling very hopeful for the future of LGBTQ+ families.’
Whilst the couple have claimed a victory for fertility equality, some campaigners however, have cautioned that a promise to review the policy does not guarantee any actual change will be made.
Whilst IVF treatment in England is very much a postcode lottery, female same-sex couples in Wales and Scotland currently fare considerably better when attempting to access NHS IVF provision. In Wales, the requirement for IVF treatment is that female same-sex couples have to have proof of six failed attempts at IUI, but these attempts are funded by the NHS, rather than self-funded.
However, under proposed changes from the Welsh Health Specialised Services Committee, those same couples will now have to prove their infertility by having 12 rather than 6 rounds of IUI, and the proposed policy is currently unclear on whether these 12 IUI cycles will be NHS-funded (IUI is not covered by this policy) or not. In Scotland, the policy is similar, where IVF will be provided after 6-8 cycles of unsuccessful IUI, but these cycles are also NHS-funded.
More Needs to be Done
Of course, once the barriers of ‘proof of infertility’ have been overcome, potential parents must also meet the other NHS criteria, such as being within what is considered a ‘healthy’ BMI and within the age range that your local ICB stipulates. Some areas have a cut-off age as low as 35 years old (Hampshire and the Isle of Wight), whereas others go up to 42.
In investigation by PET (Progress Educational Trust) into levels of knowledge concerning fertility services among GPs in England found nearly three-quarters of GPs have received a complaint about access to fertility treatment. With the slow progress that’s currently been made towards the Women’s Health Strategy’s promise, there must be many same-sex couples out there wondering if they will hit the upper age limit, before their local area’s ICB finally offer them an equal chance to start a family.
