IVF Provision

Alex Davies-Jones Excerpts

Tuesday 24th October 2023 Westminster Hall

[Kate Osborne (Jarrow) (Lab)]

I beg to move,

That this House has considered the matter of IVF provision.

It is a pleasure to serve under your chairmanship this morning, Mr Robertson. I start by thanking everyone who came along to the briefing on this matter yesterday, and in particular, Megan and Whitney, Laura-Rose Thorogood from LGBT Mummies, and Michael Johnson-Ellis from TwoDads UK for sharing their deeply personal stories and for the time they spent talking to MPs about this important issue.

As a mum of two wonderful boys, one of whom was conceived through IVF—in vitro fertilisation—this subject is close to my heart. Everyone deserves a chance to start a family, no matter their sexuality or gender identity. It was around 14 or 15 years ago that I started the IVF process as part of a same-sex couple. At the time, we went through unnecessary procedures, a long waiting list and significant costs, but despite the hurdles, it was achievable and my wonderful youngest son is now 13.

In the 13 years that my son has been alive, life for LGBTQ+ people in the UK has got progressively worse, and not just in terms of IVF. In many ways, life for LGBTQ+ people has gone backwards over the past decade. Homophobic and transphobic bullying is on the rise, trans hate crime has risen, waiting lists for LGBTQ+ physical and mental healthcare are through the roof, and virtually every day we see an attack on our community from this Government. From attacks on LGBTQ+ refugees to attacks on inclusive education in schools, to language outright denying trans rights, the Government have ramped up their war on woke using divisive and inflammatory rhetoric that is designed to stoke hate and distract from the mess they have made of this country, ahead of the next general election.

Ministers have failed to keep their promise to ban so-called conversion therapy in full, allowing the barbaric practice to continue. As for IVF for same-sex couples, we are still waiting for the Government to keep their promise to remove the discriminatory practical and financial barriers that LQBTQ+ couples face.

Since the IVF journey that I was part of, NHS waiting lists have become longer and the hurdles that LQBTQ+ couples have to jump through have increased. A fragmented NHS means that there is a postcode lottery for provision, and the financial cost is significantly higher. If I were starting my journey to become a parent now, even on an MP’s salary, I doubt I would be able to afford to complete the process. It is a disgrace that 14 or 15 years later, couples like Megan and Whitney still have to go through the same unnecessary fertility tests that we had to go through.

When speaking to people ahead of this debate, it has been depressing to repeatedly hear from women who have given up on their dream to become a parent because they have run out of money. LGBTQ+ people are being priced out of having a family. Lesbian, bisexual, non-binary and trans women couples are expected to demonstrate their infertility before the NHS will fund IVF. To do so, they must pay privately for up to 12 rounds of artificial insemination.

Yesterday, MPs heard at first hand from people this is having a huge impact on, including Megan and Whitney, who are here again today to listen to this debate. Megan and Whitney spoke about their integrated care board requiring them to pay for 12 rounds of artificial insemination before they would be eligible for any treatment on the NHS, which led to their decision to take their ICB to a judicial review. I have spoken to many couples who have spent £30,000, £50,000, or £60,000 on treatment, and many more have given up because they cannot afford to start the process. They have been priced out of having children. Last week, the BBC referred to the situation as a

“‘gay tax’ facing same-sex couples starting a family”.

Megan and Whitney’s legal case more than a year ago helped to prove that NHS England’s IVF policy discriminated against same-sex couples. The National Institute for Health and Care Excellence recommends that couples who have been unsuccessful in conceiving after two years should be offered three full cycles of in vitro fertilisation for women under 40 and one cycle for women aged between 40 and 42. The current requirement is that same-sex couples are expected to self-fund up to 12 intrauterine insemination cycles before they are eligible for NHS IVF treatment.

[Alex Davies-Jones (Pontypridd) (Lab)]

One thing that is becoming more dangerous as a result of same-sex couples having to pay for artificial insemination is the rise in people on Facebook offering their services at a low-cost price. This means that unofficial sperm donors are selling their sperm on social media sites, and that is not covered by the Online Safety Bill. It is really dangerous and exploits same-sex couples, and there are all the health ramifications to which this could lead.

[Kate Osborne]

My hon. Friend is absolutely right, and I will touch on that later. The guidelines are due to be updated next year. The Government have accepted that the situation is unfair and discriminatory. Last year’s women’s health strategy promised to remove the additional financial barriers to IVF for female same-sex couples in England, including removing the requirement to privately fund artificial insemination to prove fertility status before accessing NHS IVF services.

I am pleased that the Minister with responsibility for mental health and women’s health strategy is responding to this debate. In May she said:

“We expect the removal of the additional financial burden faced by female same-sex couples when accessing IVF treatment to take effect during 2023.”

On 11 September 2023, in response to a parliamentary question, she told the House:

“We remain committed to remove the requirement for female same-sex couples to self-fund six rounds of artificial insemination before being able to access National Health Service-funded treatment. NHS England are intending to issue commissioning guidance to integrated care boards to support implementation, which is expected shortly.”

We are still waiting for that guidance. The response also failed to acknowledge that, even now, some ICBs are still requiring self-funding for up to 12 rounds. With just 10 weeks left of 2023, the promise to remove the additional financial burden in 2023 will obviously not be met.

Of the 42 integrated care boards in England, only four offer fertility treatment to same-sex couples without the requirement to pay privately for artificial insemination. Ten more have said that they are reviewing their policies, but without the guidance from the Government or NHS England, there is not even a timeline for ICBs to make the changes needed. The Minister must ensure the full implementation of the recommendation from the women’s health strategy and work with NHS England to set out a clear timeline to bring an end to the inequalities experienced by LGBTQ+ couples when accessing fertility services.

In England, the NHS will fund in vitro fertilisation for heterosexual couples who have been trying for a baby unsuccessfully for at least two years and who also meet certain other criteria such as age and weight, yet even here, there is a postcode lottery for IVF. Some ICBs use the outdated tool of body mass index as a way of measuring health and refuse women IVF on the basis of their or their partner’s BMI. Some ICBs set their own criteria—that happened to one of my constituents—and refuse to offer IVF if either person in the couple already has a child with a previous partner. I hope that the Minister’s guidance deals with all those inequalities in provision.

Stonewall and DIVA’s 2021 LGBTQI+ Insight survey found that 36% of LGBTQI+ women and non-binary respondents who had children experienced barriers or challenges when starting their family. One in five of those stated that the greatest barrier or challenge was the high cost of private fertility treatment.

Stonewall’s latest research shows that 93% of ICBs are still falling short of the women’s health strategy’s target. The Government and NHS England have said that they have a 10-year strategy to tackle that. Most women cannot wait 10 years for the rules to change. For the majority of people, raising tens of thousands of pounds is impossible. The policy is making them financially infertile.

--- Later in debate ---

[Nickie Aiken]

Absolutely, and I will come on to that point. It is always about infertility, is it not? It should be about fertility and fertility treatment.

According to the UK fertility regulator—the Human Fertilisation and Embryology Authority—it takes, on average, three cycles of IVF to achieve success. I would like to praise the regulator for its recent announcement— I think from last week—regarding its grading of supplementary fertility treatment to help individuals and couples to determine what is a proven treatment and what is safe and cost-effective. That is most welcome, and I have had so many people come to me over the past year or so saying that the cost of IVF can be added on to all the time. In particular, people in clinics say, “Oh, you should have this scan” or “You might need to have this blood test—it might prove more successful.” When a person is in that situation, they will do anything they can to get pregnant. The costs do add up, so I am really pleased that the HFEA has released that guidance. I hope clinics across this country will take note.

Nevertheless, fertility treatment is still an emotionally draining, costly, risky and very long process. Undergoing treatment while juggling a job is particularly tough, regardless of gender or sexual orientation. Unlike employment legislation on pregnancy, maternity and paternity, there is no enshrined legislation that compels employers to give time off work for fertility treatment or any initial consultation. The Equality Act 2010 was well intentioned and removed some forms of discrimination in the workplace, but unfortunately it does not help to prevent discrimination against those who are pursuing fertility treatment, as it does not class infertility as a disability. For example, most workplace protection policies exclude elective medical procedures, putting fertility treatment on a par with cosmetic surgery.

Last year, I introduced the fertility workplace pledge. While my private Member’s Bill, the Fertility Treatment (Employment Rights) Bill, has faced its difficulties progressing through the House, the fertility workplace pledge that I launched asks businesses to sign up voluntarily to provide employees undergoing IVF treatment with the support and the time off they need. We have consistently seen new businesses signing up over the past year, including the likes of Channel 4, Aldi and NatWest—even the Houses of Parliament have signed up to become a fertility workplace ambassador. More and more businesses are signing up, and there are now several a week. I ask hon. Members to encourage employers in their constituency to look at the fertility workplace pledge and consider signing up. If we can do this voluntarily rather than through employment law, all the better, because it changes the debate, the discussions and the attitude towards fertility treatment.

[Alex Davies-Jones]

The hon. Member is making a brilliant speech; I thank her for all her work in this area. One of the problems is that the societal stigma around fertility treatments persists and is quite vicious and vocal. Infertility is not seen as a disease, and it is not seen as something with equal weight to other conditions. We need to change this in schools. There has been a lot of talk today about the Government’s sex education programme. In school we are taught how not to get pregnant, but we are never told that we might not be able to get pregnant. There are serious conversations to be had about how to change the cultural stigma around fertility treatment. That starts with education in schools.

--- Later in debate ---

[Alex Davies-Jones (Pontypridd) (Lab)]

It is a privilege to serve under your chairship this morning, Mr Robertson. I thank all colleagues for their contributions, which really have been excellent. This is the best of Parliament. I particularly congratulate my hon. Friend the Member for Jarrow (Kate Osborne) on her fantastic speech and on securing this vital debate.

It is fair to say that we are living in difficult times, with a huge range of issues facing us as parliamentarians, from healthcare to education and from energy prices to job insecurity. They all have an impact on our constituents up and down the country, but there is absolutely no reason why fertility and IVF provision—issues that clearly impact so many people—should not take centre stage.

It has been genuinely fascinating to meet and hear from so many families impacted by infertility and access to fertility treatment, including some who are here today. The brilliant Megan and Whitney Bacon-Evans, Michael Johnson-Ellis from TwoDads UK and Laura-Rose of LGBT Mummies are some of the many who have campaigned hard on this issue for many years.

As we have heard, one in six couples suffer issues related to fertility. My IVF journey began in 2018, and I have been open that I knew right from the start that my road to pregnancy would not be easy. I am certainly one of the lucky ones—I was able to take out a loan and borrow from family to pay for my treatment, and after only one round of IVF I was blessed with my beautiful son Sullivan—but I still had many eye-opening experiences during my fertility journey that have led me to this point today. Ask anyone who has experienced IVF, whether personally or from watching loved ones go through the process, and they will say that IVF is one of the most emotionally, mentally and physically challenging and financially demanding processes that anyone can ever undertake.

We must be clear that the current state of the IVF and fertility treatment offering across the UK is far below what would-be parents deserve. It is vital that we right those wrongs that I am many others have experienced at first hand as IVF patients. The main issue, as has been discussed today, is the sheer lack of consistency across the UK in IVF services and provision. I was incredibly fortunate because I was in a position to pay privately for my IVF and because my partner already had two children from a previous relationship, although that meant that we suffered from what we call the step-parent tax. It should not have to be that way.

As we all know, the NICE fertility guidelines are crystal clear; we have heard them this morning. The NHS should offer women under 40 three full cycles of IVF if they have been trying for a child for more than two years. When policies and cycles offered are so different between integrated care boards, and do not take same-sex provision into account, that means that women and would-be parents across the UK are not being offered IVF services in a fair and transparent manner. That is an incredibly important point, made even more complicated by the huge discrepancies between fertility treatment providers in the data they publish.

Colleagues may be aware of my private Member’s Bill, the Fertility Treatment (Transparency) Bill, which is due to have its Second Reading on 24 November. The Bill will

“require providers of in vitro fertilisation to publish information annually about the number of NHS-funded IVF cycles they carry out and about their provision of certain additional treatments in connection with in vitro fertilisation”.

Those add-on treatments, as we have heard from the hon. Member for Cities of London and Westminster (Nickie Aiken), have been offered to patients who are at their wits’ end and will do absolutely anything to improve their chances of having a child. I know their pain, because I was one of them. That is why I work closely with the HFEA, the Progress Educational Trust, Fertility Network UK and many others in the fertility sector who are concerned that many patients are frequently being offered and charged for optional extras to their treatment that claim to improve their chances of having a healthy baby, but are really exploiting people at their most vulnerable.

I was particularly pleased to see last week that the HFEA launched a new rating system to support patients undergoing fertility treatment. Patients are offered add-ons that claim to increase the success of treatment, but for most fertility patients the evidence to support that is missing or not very reliable. The HFEA add-ons rating will help patients to make better informed decisions about their treatment, although it is still only guidance and clinics have the right to ignore it. There is no right to enforce it: as we have heard, the HFEA as a regulator has very few teeth for enforcement. I urge the Minister to look at the issue more carefully and ensure that the regulations are being adhered to and that clinics are adopting the guidance. The new rating system, developed with patients and professionals in the fertility sector, has five categories giving detailed information for patients on whether add-ons increase the chances of success, along with other outcomes that also have an impact on miscarriage rates.

Although I welcome the progress, the wider issues on accessing IVF persist and we clearly have a long way to go in improving the situation. The Government’s women’s health strategy was a good starting point, but sadly we have still not seen any commitment on concrete action to improve access to IVF and fertility treatment. The strategy was published more than a year ago and was an opportunity for the Government to finally take some direct action, but instead it is once again clear that IVF is not an immediate priority.

I know that the Minister is listening. She has made her position very clear in previous debates on this subject, and I thank her for that engagement, but I sincerely hope that her colleagues in the Department and across Government are also listening and are taking the issue seriously. We have heard the strength of feeling this morning. I know that the Government are listening and that the Minister is listening; I just urge some direct action.

[Mr Laurence Robertson (in the Chair)]

We now come to the Front-Bench speeches.