The NHS has to catch up with legislation and policy when it comes to the preservation of fertility, according to a leading fertility expert
Dr James Barrett, of Charing Cross Hospital, gave a talk on the subject at Fertility 2018, held in Liverpool.
The annual event brings together leading professionals in the fertility world to discuss latest developments, research and expert opinions.
In 2013 NICE (the National Institute for Health and Care Excellence) updated guidance on fertility. This included a recommendation that the criteria for UK’s NHS fertility treatment should not apply to women seeking fertility preservation, and that no lower age limit should be used.
In reality, the provision of fertility preservation treatment is patchy, with local CCGs (Clinical Commissioning Groups) deciding on the availability of funds to enable people to take advantage of the latest clinical developments.
Professor Adam Balen, Chair, British Fertility Society said “There are a number of situations where the preservation of fertility is needed. This has to happen at a time before a person is ready to start a family and can sometimes be the only hope for becoming a parent in the future. Our guidelines are designed to help our members and the wider fertility community to decide on the best course of treatment, in consultation with these patients.”
Dr Melanie Davies, University College London Hospitals, an author on the paper, which has been published in the British Fertility Society journal, Human Fertility said: “Embryo preservation is the most established technique but it isn’t suitable for people who don’t have the sperm of a partner to fertilise eggs or are as yet unsure about committing to having a child with their partner.
“It is far more common now to freeze unfertilised eggs, and this is now considered an established method of fertility preservation.
There are also promising experimental approaches coming to the fore. For example, a person can now have part of an ovary frozen that can later be transplanted back into their body. This may be a particularly suitable technique for patients who have not yet reached puberty or where there is not enough time to undergo ovarian stimulation and egg freezing. The birth rates following this new technique are looking good and we hope that soon it will be available nationwide.”
For women undergoing cancer treatment, the medicine that cures them can also cause infertility. This can be down to the damaging effects of chemotherapy drugs, or the directed action of radiation treatment for pelvic and abdominal cancers. The fact that we are increasingly waiting until our 30s or 40s to start a family also means that the likelihood of a person having not given birth prior to cancer treatment is ever higher.
Fertility preservation has never been more important for those about to go through cancer treatment and the discussion of fertility preservation should happen ahead of the treatment for patients to be able to understand their options.
Genetic, congenital and other conditions
There are also a number of conditions that lead to infertility. A young person diagnosed with Turner Syndrome, for example, will be able to carry a baby in the future but cannot produce her own eggs. Although it is a relatively rare condition, the Society is finding that mothers of children with Turner Syndrome are prepared to donate and freeze their own eggs so that their daughter has an opportunity to become pregnant, if and when the time is right for her.
People who have undergone stem cell transplantation, for reasons other than cancer, such as sickle cell anaemia, for example, can also suffer infertility because of the medicines they are given during their treatment.
The society has stated it believes fertility preservation should be considered for all these conditions – not just for cancer patients.
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