According to a new study, experts say transgender people are routinely “denied chance to preserve fertility on the NHS” due to the archaic postcode lottery. As a result, there is ‘patchy’ care for egg and sperm freezing for trans people and women undergoing chemotherapy.
After the Equality and Human Rights Commission (EHRC) threatened a judicial review, NHS England now warns regional clinical commissioning groups (CCGs) that they are forbidden from discriminating against transgender people, as per the Equality Act.
NHS England now says, “in a significant number of cases, an individual’s need for fertility preservation will arise because of the threat to fertility from cancer treatment,” as well as hormone treatment “or surgery for the alleviation of gender dysphoria.”
The guidance continues, “given the legal duties identified…CCGs must not determine which patient groups might be offered fertility preservation services on a basis which discriminates against those patients because of a protected characteristic, including gender re-assignment.”
However, local CCGs are permitted to create and implement their own policies as long as they are in line with the law, “taking into account local needs and relative priorities, evidence of clinical effectiveness of the intervention under consideration, and available resources.”
University College London Hospital, Oxford University Hospital, and Ninewells Hospital and Medical School in Dundeehave aligned to call for a standard UK policy for anyone who needs to preserve their fertility. As the funding varies from place to place, there are currently millions of people being denied treatments to preserve their reproductive tissue, eggs, sperm, or embryos.
A recent study from the journal Human Fertility shows that transgender people are not alone when dealing with fertility preservation inequality. Those struggling with recurrent endometriosis, cancer treatments, and certain autoimmune conditions are also being denied services.
The same study shows that only 42% of CCGs in England have a specified policy and provision for local transgender patients.One in ten will not fund freezing for conditions that could impact fertility, and only 7% will preserve ovarian tissue in children with cancer, a treatment considered routine in other European countries. In contrast to official guidance, some CCGs also implement policies about patient’s weight.
According to the researchers, “the number of referrals for fertility preservation has risen considerably in the last few years, including referrals for people with gender incongruence … Public consultation regarding funding provision is needed and we hope that the findings from this study form grounds for debate.”
University College London Hospital’s Sania Latif says, “our study highlights the disparity in fertility preservation provision across the UK. Variation in provision creates a lack of parity between patients and affects the holistic care of the pathology being treated.”
“Notably, funding for those undergoing treatment for gender incongruence and ovarian tissue cryopreservation is inconsistent and needs to be addressed. This national audit serves as a tool for all stakeholders … to appeal to their local commissioners for uniformity of policy, equal access to care for patients and implementation of standardised fertility preservation provision in the UK.”
During the research, Scotland received top marks, as they have national policies to fund freezing reproductive material for most patients. This includes freezing ovarian tissue for girls dealing with cancer treatments.