PARLIAMENTARY DEBATE
IVF Provision - 24 October 2023 (Commons/Westminster Hall)

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.

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.

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.

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.

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.

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the hon. Member for Jarrow (Kate Osborne) for securing this important debate about IVF provision for the LGBT community, but I think we need to talk about the whole of IVF provision across the country. This is so important, particularly in the week before National Fertility Awareness Week. We are not here next week, unfortunately, so we have to speak about it this week.

IVF has become a focal point for much of the work that I am doing in Parliament, ever since I received disturbing correspondence from a constituent. She told me her story and when I looked into it, I found that it resonated with women across the country. She was working in the financial sector and had had a very successful career for 20 years. She decided to use IVF to get pregnant because of her fertility issues. After complications, her employers discovered that she was undergoing IVF treatment, and from that day onwards, they put pressure on her to move from the UK to Switzerland for her job, which meant she would not be able to continue with her IVF treatment.

My constituent made the really difficult decision to leave her job. She went to an employment tribunal and ended up getting a non-disclosure agreement. She has not been able to speak publicly about her experience and the unfairness that so many people face when it comes to IVF provision, whatever their sexuality or gender, and that is why I have taken up her case.

Unfortunately, stories like that are repeated too often across the country. To make matters worse, the issues relating to the availability of treatment—the inability of people to access it due to work commitments—are countrywide. Work commitments are not the only constraint on accessing IVF treatment. For example, the availability of treatment has, for years, been based on where an individual lives. However, 2023 has provided us with reasons to be hopeful for the future: for the first time in over a decade, all areas of England now have access to NHS-funded facility treatment. But as we heard from the hon. Member for Jarrow, that does not always mean that people can get instant access to it. It is vital that we end the postcode lottery that has been established in this country when it comes to accessing IVF treatment.

The NHS estimates that one in seven couples may be struggling to conceive, and obviously, for the LGBT community that is higher because of same-sex marriages. I have always said that infertility does not discriminate. It does not matter what a person’s background is. I have heard some really emotional testimony from people from ethnic minorities who have struggled even further in this country because of egg donation, and who have to go to Nigeria, in particular, to get their eggs. We have to widen the understanding of how people from ethnic minorities in the LGBT community struggle even more than same-sex white couples in this country. That is why it is so important to have this debate.

There are, of course, many in the LGBT community who will suffer from infertility, but the reality is that, as a starting point, it is not necessarily the infertility that is the issue; it is that we are same-sex. Does she recognise that the guidelines are based on infertility rather than recognising the unique nature and differences of various LGBT families?

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.

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.

The hon. Member makes a very good point. On sex education in schools, it is imperative that we teach our children about all types of relationships, including same-sex and heterosexual couples, at an age-appropriate time. In my opinion, four and five-year-olds need to be taught about same-sex couples as much as about heterosexual couples. I really hope that that goes ahead—but I digress.

I want to pay tribute to all the organisations that have been helping me on my fertility workplace journey: Fertility Matters at Work, Fertility Network UK, TwoDads UK and many more whose help has unquestionably been vital to push towards the fertility workplace pledge and improve access to IVF for everyone.

As we have heard, there is one particular group who can benefit greatly from IVF and deserve equal access. The LGBTQ+ community are reliant on IVF to have their own biological children. I was pleased to hear the Government promise to make access to fertility treatment fairer last year. For too long, many in the LGBTQ+ community have faced what has been labelled the gay tax. This is because LGBTQ couples have to pay privately for their first six to 12 rounds of artificial insemination to prove their infertility, which would then grant them access to NHS IVF treatment or, as the hon. Member for Livingston (Hannah Bardell) said earlier—

I remind the hon. Lady—not to boast too much, but to share positive experiences—that that is only in England in Wales. People in Scotland do not have to go through that process.

I thank the hon. Lady for pointing that out. It is not often that Scotland is ahead of England on the NHS. I am delighted to hear that.

I acknowledge that the change in policy will take time to implement. However, I ask the Minister to look into speeding up support to our LGBTQ communities. Such support is needed desperately in this area. They should not have to wait longer even than heterosexual couples.

Ultimately, I believe that we are on the cusp of real progress in access and attitudes. As the hon. Member for Pontypridd (Alex Davies-Jones) made clear about attitudes towards IVF, it is important that we break down the barriers from as early an age as possible. I know that the Minister is as passionate as I am about supporting individuals as they decide to go through fertility treatment. I therefore see it as vital that we all work together to bring down the remaining few barriers to make IVF treatment a viable option for everyone and anyone who wishes to start their own family, and to make it as stress-free as possible.

It is a pleasure to speak in this debate. I thank the hon. Member for Jarrow (Kate Osborne) for raising the issue of IVF provision and setting the scene so well. I will raise some examples from my constituency, where IVF treatment issues have had a detrimental effect on ladies who wish to have a family, with costs and financial implications for their lives, which have been changed in dramatic ways. A number of my constituents have contacted me about the issue over the years.

I am ever mindful that the Minister present does not have responsibility for the figures or the subject matter in Northern Ireland, but there is a real anomaly that I have to put on the record. I always bring a Northern Ireland perspective to these debates, as everyone knows. I do so because I hope to add to the conversations that we are having and perhaps show where the shortfalls are.

This important issue has an impact on many parents daily—it is indeed daily—and it is a pleasure to speak about it as my party’s spokesperson on health issues. Nothing is more precious than the gift of life. It is awful that for so many it is a struggle, so it is great to have the opportunity to debate, discuss and request further provision of IVF across the United Kingdom.

I will first highlight some differences between the mainland and Northern Ireland to add perspective to the debate. It was recently brought to my attention by a young constituent going through the process of IVF that on the mainland a person whose BMI is 35 can access medicated ovulation support, but in Northern Ireland it is 30. Sometimes that request is difficult for people in Northern Ireland to achieve. On the mainland, too, a person whose BMI is 30 can qualify for IVF, but in Northern Ireland it must be 25. Again, the criterion set in Northern Ireland is more stringent and difficult to achieve than that on the mainland. That is not the Minister’s fault, but it provides perspective for the debate.

Many women in Northern Ireland have stated that the BMI issue is by far the biggest, and it leaves them with a feeling of sheer inequality. We have a clear issue of inequality in the system. Some of my constituents have come to the mainland to get IVF treatment. It can have a significant cost for them, which cannot be ignored. Why do they have to have a lower body mass index and be smaller to achieve the same fertility treatment as their English counterparts?

There is definitely an equality issue to be addressed. The hon. Member for Jarrow set out inequality in the system, and I support what she said. I reiterate the clear inequalities that my constituents face in comparison with those here. It is also worth mentioning that a woman suffering from polycystic ovary syndrome will struggle to lose weight at the same pace as someone who does not have PCOS.

There is already a prolonged process in place before people even achieve the criteria set back home. In England, according to NICE, women under 40 should be offered three rounds of NHS-funded IVF treatment if they have been trying unsuccessfully to start a family for two or more years. In Northern Ireland, it is only one round, and if the person or their partner has prior children, the entitlement is zero. As the hon. Member for Jarrow set out, the inequality is very apparent. Additionally, given that the chances of success vary depending on age, one round can be completely worthless in some cases. Unfortunately, some of the ladies who have come to me over the years have put themselves into debt in excess of a five-figure sum just to have a child, and the treatment may not be successful. Some of them are still paying the money back, and they have not had the child they sought to have in their life. It really is frustrating.

The Stormont Executive committed in 2020 to increase the number of funded cycles for a woman to have a baby. However, this is purely dependent on the money that Northern Ireland receives under the Barnett consequentials. Financial capacity restraints are the reason why the change has not been implemented. In this afternoon’s Westminster Hall debate on the future of NHS funding, I will highlight the issue of IVF funding and how it affects my constituents. We cannot expect to have a sustainable NHS if we do not make the effort to fund it properly.

I understand that capacity is different in Wales, where women are able to have only two rounds of IVF treatment. The fact that women in Scotland and England get three is completely unjust, as those in Northern Ireland get only one. It is a clear example of how we continue to be left behind, and it demonstrates the inequalities in the system for us in Northern Ireland.

NHS funding for IVF cycles varies considerably across the United Kingdom. In 2021, Scotland had the highest rate of NHS-funded IVF cycles, at 58%, compared with 30% in Wales and 24% in England. I know that the hon. Member for Livingston (Hannah Bardell) will give the figures for Scotland; I commend the country for achieving that percentage. Let us give it credit for doing so, because we should all be trying to achieve that.

The figures for Northern Ireland are not available, although I have sought hard to get them. I have written to the Department of Health back home to see whether they can be accessed, so hopefully I will have them in the next week or two. Self-funding is not always an option for couples due to the sheer cost of the process, but it is important to note the comparison.

Every time a lady undergoes an IVF cycle and is not successful, anxiety, depression and disappointment creep into the process. Then she might do it again and again. I know of one lady who has had IVF treatment at least five times, but it has never been successful. I feel for ladies who are keen to have a child and who go through the cycles of IVF treatment but are not successful. I believe that children make a marriage or a relationship. They might sometimes stress parents out but, at the end of the day, children are a bonus and a pleasure to have. I am pleased that at least some of us have had that opportunity.

I urge the Minister to take my comments into consideration and to discuss these matters with the Department of Health in Northern Ireland. I seek the Minister’s input; she always responds with compassion and understanding, which we appreciate. In relation to where we are in Northern Ireland, will she accept my request to have discussions with the Department of Health back home and see whether there is some way we can work together better to help my constituents and those across Northern Ireland who do not have funding for IVF? We must allow people in Northern Ireland the same right as those in the rest of the United Kingdom, and implement NICE’s recommendation to have three cycles of IVF for women struggling to conceive.

I wanted to make this small contribution to the debate, because it is important that we share our experiences. For those in Northern Ireland whose IVF treatment has been successful, the experience has been wonderful, but for many people it has not. The inequalities are clear.

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.

We now come to the Front-Bench speeches.

It is a huge pleasure to serve under your chairship, Mr Robertson, and I sincerely thank the hon. Member for Jarrow (Kate Osborne) for bringing forward this debate. She spoke beautifully and eloquently about her experiences; it enhances debate when Members, like the hon. Member for Pontypridd (Alex Davies-Jones), bring their own personal experiences.

It is very clear that there is unanimity, which does not happen often. I trumpet and champion the positive equality and the better standards that we have in Scotland, but I would love to see those standards rolled out, so that they were the same throughout the UK. It is not about political point scoring; it is about genuinely working together and sharing best practice. However, although it is significantly better in Scotland, we still have arbitrary limits across the board on the age when women are offered IVF. That is global—not just in the UK.

A recently-published report showed that, for the first time since the second world war, more women in their 40s than women in their 20s are having children. That is just a reality. There are all sorts of reasons for that—the cost of living crisis, the cost of accommodation, women’s career paths and the lack of childcare. All Governments in the UK are trying to do more around childcare and I recognise those challenges, but the reasons are varied and complex.

A Conservative Member recently said that more people need to have babies. I will not mention the Member, as I have not given due notice. It was an offhand comment and it rightly came in for a lot of criticism because of the intent. However, there is an irony there in that some on the Government Benches are saying that, yet we need more action from the Conservative Government. They need to reflect on that. They should look at the reasons why we have a stagnant birth rate and fewer people having children, and at what more can be done.

We have heard, particularly from the hon. Member for Jarrow, about the issues with the women’s health strategy: it is ambitious and the guidance is good, but it is not mandatory. We need it to be. We need to move away from the pot-luck nature of treatment, particularly in England and Wales. I was struck by the briefing, which led through the different levels of care, all the different boards across England and Wales and how challenging that must be for people—not just LGBT people but anyone seeking fertility treatment.

The hon. Member for Jarrow also spoke about the outdated BMI criteria and how those can vary. That is particularly challenging as well. Women’s bodies come in all shapes and sizes and for all different reasons. We must recognise that. The hon. Member for Strangford (Jim Shannon) also spoke about that issue in relation to Northern Ireland: that arbitrary line is discriminatory. We need to remove the discrimination and those barriers.

The hon. Member for Jarrow also spoke about those with HIV and how they are being discriminated against, and both she and the hon. Member for Pontypridd talked about black-market sperm. Members may remember the 2017 BBC Three documentary. I watched it and was horrified. It showed LGBT couples and female same-sex couples searching the internet for donors and often facing quite dangerous situations. In 2023, people who so desperately want to have a family and to have children should not be forced into those situations. It is unthinkable.

Someone very close to me has been through several rounds of IVF. It cost her tens of thousands of pounds. She talked to me about going to a fertility fair in London, and all the different stalls and what an amazing experience that was in her journey; but a man came up to her and, in the middle of the fair, handed her a note with his phone number and a really inappropriate message, basically trying to push himself on to her to offer his sperm. She reported it and that person was removed, but that is a truly shocking story, showing just how predatory some men can be in such situations.

We also have to recognise that there are a lot of incredible men out there who donate their sperm and make it possible for others to use it, and there are also incredible women who donate their eggs. Such people make it possible particularly for those in the LGBT community but also heterosexual couples to have children.

It is a particular privilege to be able to represent Scotland’s approach to IVF, which, as I said, I am extremely proud of. Not only are we providing a higher proportion of NHS-funded cycles of treatment, but that means that the ability to have a baby is less affected by income.

There are particular challenges for LGBT couples, but I think we are pioneering some work in relation to those challenges. In addition, one of the things that happens if there is more standardised NHS treatment is that the clinics across Scotland—in Edinburgh, Glasgow, Dundee and Aberdeen; I think that is correct—collaborate, whereas when people are moving around, particularly in the private sector, they find that those private clinics keep their pioneering work—I am afraid to say—to themselves. I am sure that there is some collaboration, but that seems to be the case.

So, under the SNP-led Scottish Government, we have become a “gold standard” for IVF treatment. Those are not my words but those of Sarah Norcross, the director of Progress Educational Trust, which is an independent, London-based charity that advocates for people affected by fertility issues.

I must say that this is an area where the priorities of the Scottish Government and those of the UK Government are different. I hope that the UK Government will follow our lead; if they did, I am sure that my colleagues in the Scottish Government would be happy to share their experiences and best practice. Ms Norcross said that in Scotland IVF services were

“as good as it gets”.

The UK Government obviously have a different standard. So, as I say, I hope that this is something that we can share best practice on.

I also recognise that, as has already been mentioned by other hon. Members, the briefing yesterday by Megan and Whitney, LGBT Mummies and TwoDads UK was particularly powerful. It was really stark about the challenges that our community—I say this as a member of the LGBT community—has to face.

However, I also have heterosexual friends who have been through IVF. I have one friend who was fortunate enough to have her first baby through natural means. However, for various reasons she then went on to have secondary infertility. She cannot get fertility treatment on the NHS in Scotland. We will offer it to blended families. So, in the situation of the hon. Member for Pontypridd, I can tell her that if she had lived in Scotland, she would have been entitled to treatment. However, if someone has one child and wants to have more children with the same partner, unfortunately they would not be entitled to treatment. That is something that we need to look at in Scotland. Blended families are very much the norm now. If it is the case that someone has a child, or they and their partner both have children from previous relationships, and they are unfortunate enough to experience secondary infertility, they should have access to fertility treatment.

NHS-funded cycles in England decreased in number from 19,634 in 2019 to 16,335 in 2021, which is a 17% reduction. Covid will undoubtedly have played a part in that. In Wales, the number of NHS-funded cycles decreased from 1,094 to 704 over the same period. In Scotland there was a slight decrease, of just 1%, in that period.

In England, treatment is much more likely to be outsourced to private clinics, even when the costs are covered by the NHS, which has a serious negative impact on overall services. Fertility experts have pointed out that the major reason that fertility care in Scotland is so consistently excellent is that there is the collaboration that I mentioned.

I have also heard from a number of people I have spoken to that people are going abroad for fertility treatment. It would appear that they are going to clinics in Europe because the service there is better. That IVF tourism, as some people call it, is cheaper and seems to be better than the treatment here in the UK, but we do not want people to have to go abroad for that reason; we want people to be able to have their babies here.

The hon. Member for Cities of London and Westminster (Nickie Aiken) spoke very powerfully about her work in workplace fertility support. That is interesting, because a lot of people will not want to disclose information about their fertility, or they will not feel comfortable about doing so unless their employer is being open. I have perhaps a slightly different opinion from that of the hon. Member. Of course businesses should just provide such support, but businesses have a lot of pressure on them, and sometimes legislation can be the precursor or the catalyst for changes in behaviour and lead to the provision of real, solid support for people who are going through things such as IVF treatment.

Obviously, National Fertility Awareness Week is coming up; however, it was Baby Loss Awareness Week just the other week. I know somebody who, having gone through expensive fertility treatment, only managed the one embryo transfer, which unfortunately did not work. It can be very upsetting when an embryo transfer does not work, no matter the person’s sexuality.

I thank LGBT Mummies for the excellent job it has done on briefings. I will briefly go through its asks for the LGBT community, which include equal and equitable access, national mandated funding policy and provisions for all LGBTQI people. As the hon. Member for Jarrow powerfully highlighted in her speech, the LGBT community is facing discrimination and attacks like never before, including the removal of health services, which is something we all have to reflect on and look to improve. Its asks also include personalised fertility care and education for staff—something I have experienced myself, in the language health practitioners use and in their understanding of the different healthcare requirements of the LGBT community. They also include access to funded medication and tests for home insemination, co-produced funding provision with the community, and the ability to create our families safely by our chosen routes—not being forced down a route.

The difference in Scotland is that we do not have to go through those IUI cycles, but a challenge we have across the board is the arbitrary two-year timeline, where people have to have been in a relationship for two years. I do not know of anywhere where we say to heterosexual couples, “Don’t be having a baby until you’ve been together for two years.” We don’t do that, do we? So why are we doing that to LGBT people? That really does not make any sense.

Briefly, I want to reflect on my personal experience. I had a partial failed attempt at IVF with a former partner—I will not go into the details—but I did not start my journey until after I turned 40. I now regret that, because I am 40 and I will get only one shot, rather than three. I am only at the very beginning. I want to highlight to the Minister that piece about those of us who came out later in life. When I came out at 32, most of my friends were getting married and having kids, or already had kids, and I was just working out who I was. One reason that I did not come out earlier was that I so strongly wanted to have a family, and I did not think that would be open to me if I was gay. Equal marriage came much later in life for many people. Like many of us who did not start life as their authentic self, as some people say, until much later, I have felt like I am perennially playing catch-up, and I have now decided to just do it on my own. I do not know where my journey will take me, but I know there is a lot of support out there, and a lot of incredible people.

I am in a very fortunate position, but not many are that fortunate. As we have heard, people are going to the black market and putting themselves in massive debt; we should not be putting anybody in that situation. I hope the Minister will hear the calls from across the House, and I look forward to working with colleagues on this very important issue.

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the hon. Member for Jarrow (Kate Osborne) for tabling this important debate, and all Members across the Chamber for their contributions. It has been a positive debate—a good example of putting politics aside and debating how to do the right thing. While I am not denying the challenges for the LGBT+ community raised by the hon. Member, I want to highlight that the Government have brought in major changes over the years with the introduction of same-sex marriage, and the transformation of the management of HIV with the roll-out of opt-out testing and PrEP treatment.

I am pleased to announce that, following the advice from the Advisory Committee on the Safety of Blood, Tissues and Organs, the Government will be introducing secondary legislation to allow the donation of gametes by people with HIV who have an undetectable viral load; we will be introducing that as soon as we can. We will also be addressing the current discriminatory definitions of partner donation, which result in additional screening costs for female same-sex couples undergoing reciprocal IVF; again, amendments through statutory instruments will be introduced as soon as possible.

Those are some of the measures that we have been working on, but I absolutely understand from what I have heard today that there are many issues still to be dealt with, and I welcome the hon. Member for Jarrow holding my feet to the fire to deliver change. Hopefully some of these updates will provide reassurance. This is a priority area, which is why IVF, fertility, and particularly same-sex access to IVF, were in the first year of the women’s health strategy, and it is why we are not going to wait for the 10 years of the strategy to introduce the changes.

To be clear, the Government are implementing a policy that no form of self-financed or self-arranged insemination is to be required for same-sex couples to access fertility treatment. I acknowledge that is taking a little while to be rolled out across the country. Hon. Members, especially the hon. Member for Pontypridd (Alex Davies-Jones), have spoken about infertility a lot. We absolutely recognise that it has a serious effect on individuals and couples, which is why it is a priority—particularly for the women’s health strategy.

As the hon. Members for Strangford (Jim Shannon) and for Livingston (Hannah Bardell) pointed out, I can only speak on the provision of IVF in England, but I am very happy to work with colleagues in the devolved nations of Scotland, Wales and Northern Ireland to achieve a consistent approach. Although we are dealing with the inconsistencies in England, if we are a United Kingdom, these matters need to be addressed across all four nations and I am not precious about stealing best practice from other parts of the UK.

In our call for evidence for the women’s health strategy, women told us time and again that fertility was a key issue and that they felt very frustrated about the provision of, and access to, fertility treatment. Colleagues have made a number of important points which I will respond to in turn, but it has been recognised that there has been unequal access to IVF in England since the treatment was introduced; that is why this is such an important issue. There is resistance in some parts of the country to the changes the Government want to make, but I think we will be able to make progress on them.

NICE is reviewing its fertility guidelines, taking account of the latest evidence of clinical effectiveness. These will be published next year and we will be working with NHS England to implement these guidelines in England quickly and fairly. I am told that they will end regional variation and create a compassionate and consistent fertility service across England, but that does not mean that we cannot improve services in the meantime.

As has been set out, integrated care boards are now responsible for delivering IVF services. They were previously determined by CCGs, but from July last year the 42 ICBs across England are now responsible. Since the ICBs were created, we have seen a levelling up of IVF provision in many. Where CCGs have come together, ICBs have often adopted the higher rate of provision, rather than the lowest level. That is to be welcomed, but by no means does it mean that the level of provision is where we want it to be. Some, but by no means all, ICBs, including in north-east London and Sussex—I declare an interest as a Sussex MP—are now fully compliant with the current NICE guidelines and the provision of three cycles. Others are improving their integrated offer, but some ICBs have kept their pre-existing local offer. That is not good enough, and we are aiming to tackle it.

I will go through that. One of the first things we have done is to be transparent about what is being offered. We have asked every ICB—the whole 42—to detail their provision. We are now publishing that on gov.uk, so if ivf.gov.uk is entered, the table will come up. That illustrates the number of cycles offered by every ICB, the age provision, the previous children rule and what funding is offered for cryo-preservation. That is not just to say, “This is what’s on offer” so that women and couples can see what is available in their area; it is also the start of the process of holding ICBs’ feet to the fire—and for local MPs to be able to say, “Look, they’re offering free cycles in Sussex; why are we not offering that in our local area?”

As the hon. Lady will know, it was only last year that we published the women’s health strategy. IVF was front and centre of that—the first year priority. Getting that information is the first step, and then we are able to look at the ICBs that are not offering the required level of service, have those conversations about why and have a step change to improve the offer. That is just one tool in our box to fulfil our ambition to end the postcode lottery for fertility treatment across England.

Colleagues have also raised the issue of lack of information about IVF, both for the public and healthcare professionals. We are working closely with NHS England to update the NHS website to make IVF more prominent, and also with the royal colleges to improve the awareness of IVF across healthcare professions. One area we are dealing with is that of add-ons, which the hon. Member for Pontypridd (Alex Davies-Jones) and my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) addressed. As part of our discussions with the HFEA, it now has the add-on rating system, so that people can see what percentage difference an add-on would make and make an informed choice about whether they want to do that as part of their IVF treatment.

I have also just received the HFEA’s report about modernising the legislation, with particular regard to its regulatory powers. That will cover the provision of add-ons, and I hope to be able to respond to the report as quickly as possible. We are making really big changes to some of the issues that have been holding back IVF for a long time. I know that for many people this is not quick enough, but I reassure hon. Members that progress is being made.

For female same-sex couples and same-sex couples across the board, I know that this is a really important matter. I took the position that it was unacceptable for female same-sex couples to shoulder an additional financial burden to access NHS-funded fertility treatment. On the transparency toolkit now on the gov.uk website, we can easily see which parts of the country are asking for six cycles of self-funded insemination, for instance. In Cambridgeshire and Peterborough it is 12 cycles, in Bristol and north Somerset it is 10. As the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) said, that is exactly the information we need so that we can tackle the issue head-on and directly with the ICBs. Indeed, one of our key commitments in the women’s health strategy was to remove this injustice once and for all. We were hoping to do that completely in the first year; it will in fact take us a little longer, but it will not take us 10 years.

It is certainly comforting to hear that, but I urge the Minister to supercharge that work, so that female same-sex couples and, indeed, the trans community can make sure they can access that. Will the Minister say something about surrogacy, because I know that across the UK—though, again, we have somewhat better standards and access in Scotland—there are still major challenges, legal and otherwise, for male same-sex couples accessing surrogacy?

The Law Commission has recently produced a report on changes to surrogacy, which we are in the process of responding to. It will address some of the issues raised today. The Government’s position is to abolish the requirement for female same-sex couples to undergo six cycles of self-funded treatment before they can access NHS-funded treatment. We have been clear that the NHS-funded pathway should now offer six cycles of artificial insemination followed by IVF to female same-sex couples, giving everyone access to NHS-funded fertility services. Some ICBs are doing that already, but others have delayed implementation, and that is what we want to focus on now. We are clear that that needs to be urgently addressed, because same-sex couples’ expectations have rightly been raised and the service has not met them swiftly enough. I take that on board from the debate today and reassure colleagues that that is a priority.

To accelerate action, NHS England is developing advice to assist ICBs. I hope they will be able to share that soon. I will share that with the House as soon as it is available. When it is published, we expect ICBs to update their local policies. There should be no further delay and no waiting for NICE guidelines when they are published next year. ICBs must urgently address all local inequalities in access to fertility treatment. There is a reason that IVF was made a priority in the women’s health strategy and a reason it was a priority in the first year.

Our health service pioneered the use of IVF in the 1970s. It is a great British invention that should be available to every couple who want to start a family, because the Government back women and families and the accessibility of IVF to those who need it. I look forward to the hon. Member for Jarrow continuing to hold my feet to the fire until we have delivered the change—deliver it we must.

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.

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.

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.

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.

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.