Fertility Treatment Regulation

Baroness Gerada Excerpts

Thursday 4th June 2026 Lords Chamber

[Baroness Gerada (CB)]

My Lords, I pay tribute to the noble Baroness, Lady Deech, for securing this important debate. Before I start, I will just clarify one issue: about 98% of abortion treatment is carried out in the not-for-profit sector, funded around 98% by the NHS. NHS hospitals do not make a profit from abortion care. In my experience, infertility clinics that were run through the NHS used to take both co-payments—that is, self-payment and not-for-payment—and it cross-fertilised and cross-funded so that women who are more deprived could get either NHS treatment or cheap treatment.

I have spent decades looking after women and helping them navigate a fertility system that too often fails them. At the root of that failure lies a simple truth—this outdated law governing fertility treatment. As the noble Baroness, Lady Deech, and others have already said, the regulatory framework, which was set up in the 1990s, was ground-breaking and was the first of its kind. As a young GP at the time, I welcomed it.

But, as we have heard, the law was enacted before the promotion of unnecessary and non-essential add-ons—they just did not exist—such as pre-implantation genetic screening for aneuploidy, which is an abnormal number of chromosomes; endometrial scratches, which, exactly as it sounds, means scratching the uterus in order to create a scar; or the adjunctive use of quite a dangerous growth hormone in the belief that it creates ovarian stimulation and increases chances of conception. This was all before the rise of virtual clinics or of AI embryonic selection. The HFEA itself, the architect of this law, has told us that it is no longer fit for purpose and that the law has not kept pace with the reality of modern care and has left a legislative vacuum. This House should listen to the HFEA.

I just want to mention a composite patient, drawn from many years of my clinical experience. Sarah was 38 when she walked into her fertility clinic. She and her partner had spent years trying to conceive: years of hope, disappointment, and quiet grief. By the time she sat down in that consultation room, she had run out of options. What happened next was not illegal; it was not even unusual. Sarah was offered a series of add-ons to her IVF treatment: embryo glue, immune therapies, time-lapse imaging, supplements and acupuncture. Each was presented as something she could have. None was framed as essential, and yet declining them felt impossible because when you are desperate, and someone in a white coat suggests something might help, how can you say no? It is a little bit like testosterone for men who are depressed. The clinic reminded her more than once that time was precious at her age. Every failed cycle brought a new suggestion and another invoice. By the end, Sarah and her partner had spent nearly £30,000 with still no baby. They spent not on treatment, as she reflected later, but on hope—hope that had been carefully packaged and endlessly sold.

Sarah’s story is not rare. In many clinics, it is routine. Individuals such as Sarah, who are desperate to have a child, are extremely vulnerable, and many find that they are prepared to do anything and to pay for anything to realise their dream of becoming parents. When given a shopping list of costly add-ons, some harmless but many invasive and time-consuming, most patients—and according to HFEA, 73% of patients—go to extraordinary lengths to raise the necessary funds, only to find that their hopes are never realised. Many of these are pure marketing, and, clinically speaking, to quote a professor at UCL, “nonsense”.

In 2023, the HFEA introduced a new five-point rating scheme for add-ons, which was well received, but it remains a regulatory sticking plaster on a structural legislative wound. The HFEA, as we have heard, has limited powers to intervene and no explicit statutory principle of patient protection within the 1990 Act. Without legislative backing, it lacks enforcement power.

Across modern healthcare regulation, the needs and interests of the patient sit at the centre of that regulation, but fertility law has not kept pace. That must change. Patients must be told clearly before they pay when a treatment is not evidence-based. Informed consent is not a courtesy; it is a right, and it is a legal and ethical obligation.

So why are so many women in the private system in the first place? It is because the NHS system has collapsed. The proportion of NHS-funded IVF cycles has fallen to just under 30%, the lowest level since 2008. Of the very few integrated care boards that provide NICE-approved IVF, that number has decreased as well. Even when they do provide it, it is usually only one cycle. In my own borough in Lambeth, it excludes couples who have had a child by a previous relationship, irrespective of how old that child is or where that child resides. Imagine that you have had a child in an abusive relationship way back when. That child is now living with the father or the mother, and you have no access to that child and may not have had for 20 years, but you are excluded from IVF. That does not sound like fairness.

We have heard about the digital revolution and the fact that the law has not kept up with that. In 2023, HFEA published Modernising Fertility Law and its proposals centre on three clear areas, which I commend to this House: patient protection as an explicit principle of the Act, regulation of online and virtual fertility services, and power to levy financial penalties.

The HFEA has already done much of the analytical work. What is needed now is a Government willing to move from consideration to commitment, and a timetable that women and their partners can hold on to. Women and their partners navigating fertility treatment are not seeking special treatment. They are seeking honest information, equitable access, and a legal framework that reflects the world that we currently live in. This is the least that this Government should be willing to deliver.