Fertility concerns affect a significant number of individuals, with one in six facing infertility, yet the existing pathway to accessing support in the UK is riddled with longstanding obstacles. As a primary care practitioner, Hannah emphasizes the necessity for new treatment options, increased transparency on costs, better data collection, and embracing innovative approaches to provide more effective and inclusive fertility care
In recent months, a spotlight has been shone on some of the barriers people seeking fertility care are facing. Access to IVF on the NHS is subject to a discriminative postcode lottery, and a number of groups – from single women to same-sex couples and people over a certain BMI – face additional hurdles on their fertility journeys. Meanwhile, the costs (both upfront and hidden) of pursuing fertility treatment privately present a considerable financial burden and leave many in debt or unable to fund treatment altogether.
As GPs, we’re often the first port of call for patients struggling with fertility challenges. In my own practice, I find myself increasingly frustrated at the lack of power I have to provide the guidance and direction patients need. We need new fertility treatment options in primary care so we can help patients access the right support. IVF is not a panacea; we need a new path.
Lowering the drawbridge to treatment
While IVF has long dominated fertility treatment in the UK, it is far from a one-size-fits-all solution. Often, patients who are struggling to conceive are directed straight to IVF, before alternative, less invasive treatment options are considered. This can leave many joining long wait lists and undergoing intensive treatment unnecessarily. We need a better understanding of the different routes open to patients and improved triage to ensure that all options can be effectively explored.
For patients who do need IVF, last year’s Women’s Health Strategy revealed promising aims to remove inhibitive barriers. But we are yet to see these promises translate into action. Disparities remain in what different ICBs can offer patients, leaving many at a disadvantage when it comes to accessing fertility treatment on the NHS. Increased funding and support would help ensure national guidance – which suggests three rounds of IVF should be offered to women under 40 – can be followed nationwide.
For those still unable to access fertility treatment on the NHS, or who choose to go private, we need more transparency on the costs involved. The Human Fertilisation and Embryology Authority (HFEA) recently updated their ratings system for IVF add-ons to help patients navigate the complex and emotionally-fraught private treatment process. Creating more resources like this can help primary care provide clearer guidance and remove some of the obstacles preventing patients from accessing effective fertility support.
Closing the fertility data gap
Despite significant strides having been taken in our understanding and treatment of fertility over the last few decades, around 25 per cent of patients are still being diagnosed with “unexplained infertility”. A severe lack of data is perpetuating gaps in our fertility knowledge, leaving us unable to always give patients the definitive answers they so desperately need.
We urgently need more representative data to be collected methodically and regularly made available to practitioners to provide a clearer understanding of fertility issues, who may be more at risk, and how we can best support and treat fertility patients to boost their chances of conception. Data is the key to unlocking a better understanding of the underlying issues that may be at play in patients’ fertility struggles and facilitating more effective care as a result.
Embracing innovation and expanding the treatment horizon
Lastly, we must look beyond traditional treatment options, such as IVF, and embrace new ways of providing primary fertility care. Innovation is already driving change, with new tools empowering patients to test or treat themselves from the comfort of their own homes. Whether that’s sperm and hormone testing kits or pioneering treatments such as Intracervical Insemination (ICI), technology is broadening the horizon of fertility care, and patients are eager to explore.
As primary care practitioners, we have an integral role to play in supporting patients to safely access care at home. We need to keep abreast of innovation and learn about the different tools now available to patients who are trying to conceive in order to provide them with reliable, professional advice on how to use them safely – and alert them to any risks they should be looking out for.
For many of us supporting patients to navigate their fertility journey, it can feel like an uphill battle. But we have the opportunity to drive change. We need a collective push from the government, health tech innovators, and clinicians alike to fix the broken fertility care pathway and ensure that we’re able to give everyone equal footing on the road to parenthood.
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