Fertility Treatment Regulation

Earl of Effingham Excerpts

Thursday 4th June 2026 Lords Chamber

[The Earl of Effingham (Con)]

My Lords, I thank the noble Baroness, Lady Deech, for her focus on this subject, drawing on her extensive experience in the sector, including chairing the Human Fertilisation and Embryology Authority for eight years. I also highlight the deep knowledge of the noble Baroness, Lady Nargund, who combines her role as the lead consultant for reproductive medicine services at St George’s Hospital with being an honorary professor of women’s health at the University of London and an international advisory board member of the Lancet Obstetrics, Gynaecology, & Women’s Health journal. She is also the founder CEO and now medical director of a fertility clinic.

The UK has long been regarded as a world leader in the regulation of fertility treatment and embryo research. The Human Fertilisation and Embryology Act 1990 was landmark legislation. It established a framework that balanced scientific innovation, ethical oversight and public confidence in a way that was pioneering at the time. Much of that framework remains strong. The principle that the embryo merits special legal and ethical status continues to command cross-party support. Having treatment in licensed clinics remains safe, with incident rates low, even as IVF has become increasingly common.

In line with other noble Lords, I suggest that the question before your Lordships’ House is whether a framework designed in the early 1990s is appropriate for the fertility sector as it exists in 2026. There is an increasing consensus that it is not. As the noble Baroness, Lady Deech, highlighted, the sector has changed fundamentally. Around one in 32 births in the United Kingdom now results from IVF. As the noble Lord, Lord Winston, flagged, fertility treatment is no longer marginal or exceptional medicine; it is close to mainstream healthcare and, for many, a central route to family formation.

However, while demand and complexity have increased, the structure of provision has shifted dramatically. Treatment is now predominantly privately funded. While this plays a positive role in increasing capacity and reducing pressure on the NHS, it raises concerns for some. Increasingly, elements of fertility care are delivered through online or hybrid “virtual clinic” models that sit outside the traditional boundaries of regulation. This is creating a system that is more nuanced and potentially harder for patients to navigate. The HFEA has argued that the current legislative framework is increasingly out of step with the modern fertility sector. My noble friend Lady Owen highlighted the growth of online fertility services operating beyond the traditional licensed clinic model. The HFEA has argued that its enforcement powers are no longer sufficiently flexible and has proposed that the Act should contain an explicit, overarching focus on patient protection.

The right reverend Prelate the Bishop of Chelmsford talked about social media disinformation. My noble kinswoman Lady Boycott referenced the “Wild West”. The noble Baroness, Lady Gerada, pointed to hope that has been sold. The regulatory gaps become particularly visible in relation to online fertility services, where patients are increasingly looking for advice from charity websites, social media, online forums and clinic websites. Patients are increasingly encountering providers marketing themselves as offering “fertility services”. However, key clinical interventions take place elsewhere, sometimes under separate regulatory arrangements and sometimes outside clear regulatory oversight altogether. Patients may reasonably assume that a service presenting itself as a clinic-equivalent is fully regulated. However, as the noble Baroness, Lady Nargund, agreed, it can be a mistake to make assumptions. The fertility sector has evolved rapidly, with new online models and commercial networks that do not fit neatly within the assumptions of the 1990 Act. This is precisely the kind of gap that undermines transparency and public confidence, notwithstanding the related issue concerning surrogacy reform.

My noble friend Lady Shawcross-Wolfson gave us a deep and informed insight into the topic of surrogacy. The Law Commission has proposed reforms which would, for some arrangements, transfer legal parenthood to the intended parents from birth, place greater reliance on consent given before conception and reduce the role currently played by the courts and the Children and Family Court Advisory and Support Service after birth. Supporters argue that these changes would provide greater certainty for intended parents and children. However, others have questioned whether they would weaken important safeguards by reducing the significance of post-birth consent and judicial oversight.

Some are concerned that the proposals would make it more difficult for a surrogate mother to change her mind and move away from the long-established principle that the woman who gives birth is initially recognised as the child’s legal mother. These concerns arise against the backdrop of a growing international surrogacy market. Increasing numbers of British residents enter into commercial surrogacy arrangements overseas, raising wider questions around child protection, exploitation and the legal recognition of arrangements that would simply not be permitted here.

There are also legitimate questions about whether reforms designed to expand domestic surrogacy arrangements, including proposals allowing regulated organisations to recruit surrogate mothers, command public support. As reproductive technologies continue to evolve, parliamentary oversight of embryo research and emerging technologies must remain central. Given the Government’s decision not to proceed with the Law Commission’s proposals, can the Minister clarify whether the Government have reached a new, settled view on surrogacy reform and what safeguards they consider essential in any future review of the law?

While regulation is one challenge facing the sector, consistency of access remains an issue. Despite updated National Institute for Health and Care Excellence guidance recommending up to three NHS-funded IVF cycles for eligible women under 40, access remains highly variable across England, because ICBs are not required to implement that guidance. As a result, we continue to see variations in fertility treatment. The noble Baroness, Lady Deech, suggested a postcode lottery.

His Majesty’s loyal Opposition recognise that the Government have stated that ICBs should “consider and reflect” national institute guidance. We welcome efforts to improve consistency through NHS England. However, there remains a clear gap between guidance and enforceable entitlement. That inconsistency sits uneasily alongside the Government’s Renewed Women’s Health Strategy for England, which commits to ensuring that every woman “can easily access” fertility services and places strong emphasis on consistency of care and patient experience.

That commitment is most welcome, but it raises important questions. While some ICBs do offer up to three NHS-funded IVF cycles, in line with NICE guidance, what plans are there to help or encourage those ICBs which offer only one NHS-funded IVF cycles or impose additional eligibility restrictions? This was so well put by the noble Baronesses, Lady Gerada and Lady Pidgeon. If the patient experience is to be placed at the centre of women’s health policy, do the Government plan to embed patient protection explicitly within fertility legislation, as the HFEA has proposed?

In closing, I suggest that the strength of the 1990 Act was not only its technical design but its willingness to confront emerging science and changing societal realities head-on. The fertility sector has changed profoundly since then. It is more commercial, more technologically complex and more integrated with digital service delivery. Scientific techniques are evolving rapidly and the boundaries of what constitutes fertility treatment are no longer as clearly defined as they once were. The HFEA’s reform proposals are therefore measured and pragmatic. They seek not to dismantle the existing system but to modernise it through strengthening patient protection, clarifying regulatory scope and introducing more proportionate enforcement tools. At their core, these proposals are about ensuring that regulation keeps pace with reality. The United Kingdom became a global leader in this field because it combined scientific advancement with ethics and public trust. Long may that continue.