IVF Provision

Kate Osborne 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.

[Hannah Bardell (Livingston) (SNP)]

I congratulate the hon. Lady on securing this debate. As well as the point about the strategy’s length of time, there is the age of some of us in the LGBT community. The fact that same-sex marriage did not come until some of us were older, and that many of us came out later in life, means that there is a very short window for older LGBT people to take the opportunity to get pregnant or be parents.

[Kate Osborne]

The hon. Lady is absolutely right. Generally, couples are starting their families later, and all these barriers make it almost impossible for so many to start a family.

Many organisations have been in touch with concerns about IVF provision, such as the Royal College of Obstetricians and Gynaecologists, the British Pregnancy Advisory Service, the Progress Educational Trust, the National AIDS Trust and many more. The National AIDS Trust has been challenging discriminatory legislation that prevents many people living with HIV from starting a family.

Under UK law, people living with HIV do not have the same rights as everyone else in accessing fertility treatment. Scientific evidence has demonstrated that there is no risk of HIV transmission through gamete donation, due to advances in HIV treatment. That has been accepted for people in a heterosexual relationship. Heterosexual couples are classified as being “in an intimate relationship” by the Government’s microbiological safety guidelines, and people living with HIV are allowed to donate gametes to their partner. However, that intimate relationship designation is not available to LGBTQ+ couples, creating yet another layer of discrimination on access to fertility treatment for LGBTQ+ people living with HIV.

Yesterday, LGBT Mummies told MPs that, in some cases, when people are denied fertility funding access, they look to alternative routes, such as home insemination. Going down that route comes with physical, psychological and legal implications, which, in turn, cost the Government and the NHS more than if the treatment and chance of family creation were offered in the first place. Laura-Rose told us that although home insemination has really worked for some people, and they have a great relationship with their donor, it can be dangerous for others. It has led to inappropriate proposals to donate only if people have intercourse with the donor. As well as the health risks, if people do not use registered banks or clinics to obtain sperm, there is the possibility that a donor could later try to claim parental rights over a child.

Laura-Rose spoke about how lucky she is to be a parent, but she is still paying off the debt after incurring costs of more than £60,000. So many families she is working with are simply priced out of having a family. TwoDads UK also raised similar concerns in their briefings and contact with MPs, with Michael setting out that the inequality is pushing a community of people to take risks. The Royal College of Obstetricians and Gynaecologists told me that there is significant and unacceptable variation in the availability of NHS-funded fertility treatments in the UK, and that it strongly believes there should be equal access to fertility treatment for same-sex couples. It called on the Government and NHS England to support integrated care boards to ensure that that commitment is realised as soon as possible.

I hope that the Minister has listened to all the concerns and evidence from the many organisations I have mentioned, and others will no doubt be referenced in the debate. Ministers and NHS England can put an immediate end to the discrimination in IVF provision facing LGBTQ+ couples. It is unacceptable that the fertility treatment available for women through the NHS varies depending on where they live. The financial burden on same-sex couples is unacceptable, and we cannot wait any longer. The Government’s guidance and timetable for this to end should be published now. The Minister has recognised that the discrimination is unacceptable, and I hope to hear in her response that immediate action will be taken to remove these unnecessary additional practical and financial burdens from LGBTQ+ couples.

--- Later in debate ---

[Kate Osborne]

I thank everyone for their valued contributions and support for this important issue. I am pleased to have been able to secure this debate ahead of National Fertility Awareness Week. I thank the hon. Member for Cities of London and Westminster (Nickie Aiken) for an excellent contribution and for all the work she has done on fertility and employment practices, and for highlighting the disproportionate impact on black and minority ethnic women who need fertility treatment.

[Sarah Dyke (Somerton and Frome) (LD)]

I apologise to the Minister for not being here at the start of this debate on a subject that is very important to me. I echo the concerns about the dangers of the current system, which may drive same-sex couples towards potentially unsafe methods, such as seeking sperm donors who might not be known to them. I have friends who have experienced that very thing. If not married or in a civil partnership, the donor will be considered the legal parent of any children, giving him rights over and responsibilities for the child. The safety of sperm is also a concern as the donor might be less likely to have their health and medical history fully screened, which is important.

[Kate Osborne]

I thank the hon. Member for her intervention. In my contribution I touched on the unsafe and inappropriate online advances facing same-sex couples, which the hon. Member has just raised, as did my hon. Friend the Member for Pontypridd (Alex Davies-Jones). Megan and Whitney told us yesterday of horrific, very detailed, explicit and inappropriate proposals that they have received online, and many other couples have reported the same. In 2023, we should not be forcing desperate women to turn to black market sperm and be pushed into tens of thousands of pounds of debt.

I thank the hon. Member for Strangford (Jim Shannon) for describing the situation in Northern Ireland and adding to the concerns that I raised around the inappropriate use of BMI as a factor in deciding IVF provision, particularly how BMI is different for people with PCOS. I would add other conditions such as lipoedema. BMI is not an adequate measure to deny people IVF. Indeed, I believe that BMI is not an adequate measure in pretty much anything.

I thank my hon. Friend the Member for Pontypridd for sharing her story, for highlighting financial risks taken and the concerns about regulatory practices in fertility clinics, and for her incredibly important private Member’s Bill.

[Hannah Bardell]

One other condition or disease that has not been spoken about is endometriosis. Endometriosis sufferers often have a terrible time conceiving and face significant challenges. I hope the hon. Lady will recognise that we must include them in all our conversations.

[Kate Osborne]

I absolutely agree that we should include those sufferers. The hon. Lady’s own contribution to the debate was incredibly powerful. She shared her personal story and pointed out how much better the situation is in Scotland, although improvements can always be made. She rightly pointed out that people are going abroad for treatment. TwoDads UK made that point eloquently in our briefing yesterday.

My hon. Friend the Member for Erith and Thamesmead (Abena Oppong-Asare) spoke about the need to end the postcode lottery, with that additional emotional and financial toll. I am pleased the Minister confirmed that she will remove discrimination against HIV as soon as possible through secondary legislation. I hope that “as soon as possible” means imminently and that we are not still talking about this in a year’s time.

The Minister mentioned the HFEA and changes to regulation. The 2021 guidelines for fertility clinics highlight the need for improved understanding of consumer law and how it applies to clinics and patients. The guidance significantly improves the availability of knowledge of the topic, but it still misses out conditions and vulnerabilities faced by same-sex couples and transgender people, so I look forward to receiving her update.

I am glad that the Minister welcomes me holding her feet to the fire on discrimination in provision for IVF. I will continue to do so. She said that it has taken a bit longer than she would like—but not 10 years. I want to see an urgent timeline from her. The inconsistency in IVF provision across the UK is unacceptable. We must end the postcode lottery for fertility treatment and the unacceptable financial burden on same-sex couples. As has been pointed out today, many women cannot wait any longer.

Question put and agreed to.

Resolved,

That this House has considered the matter of IVF provision.