National Infertility Group Report January 2013

7. Other areas on which we do not make recommendations

139. There were five areas which were discussed by the Group but where recommendations are not made because either they were considered to be outside the remit of the group or because there was insufficient evidence on which to make an authoritative recommendation.

7.1 Fertility preservation

140. Patients who are to receive oncology treatments which are likely to compromise their fertility are clinically eligible for fertility preservation treatment. However, it is important to note that access criteria will still apply for such patients seeking infertility treatment. At the present time most treatment centres have the ability to offer fertility preservation options to this group of patients where clinically feasible. A difficulty relates to the funding of such care since this falls outwith the remit of normal contractual arrangements for the provision of fertility care. This issue should be considered by the group tasked with the future provision of gamete donation.

141. SIGN Guideline 76: Long-term follow-up care of survivors of childhood cancer³² has made a big impact on numbers of patients seeking fertility preservation, and the Group foresees this trend increasing further over time. Additionally, there are treatments outwith oncology which impact on a patient's future fertility which will further increase the demand on this service.

7.2 Gamete donation

142. Patients who require access to donated gametes (sperm or eggs) are currently not having their needs met. NHS Boards in Scotland are finding it increasingly difficult to manage recruitment of both egg and sperm donors.

143. Initial discussions have taken place with the Scottish National Blood Transfusion Service regarding the possibility of providing gamete donation recruitment and storage nationally. This work will become stand alone once the National Infertility Group disbands at the end of January 2013, and further meetings will include representatives from each of the tertiary centres.

144. Donor insemination and IVF with donor gametes is outwith the 12-month waiting time commitment.

145. The Human Fertilisation and Embryology Authority (HFEA) conducted a consultation 'Donating sperm and eggs: have your say', in early 2011³³, and in October 2011 set out new levels of compensation for sperm and egg donation services. These are, for sperm donors, a fixed sum of £35 per visit including expenses, and for egg donors, a fixed sum of £750 per cycle of donation including expenses. For egg donors this is triple the previous capped limit of £250, and this cost will need to be met by NHS providers. These are guidelines and whilst centres are allowed to pay these amounts, they are not obliged to do so.

146. The HFEA also announced that, as a result of the consultation, it has agreed to take a proactive approach to donor recruitment, retention and care by working with the IVF sector, professional bodies and voluntary organisations to raise awareness, improve the care of donors and ensure that donation continues to take place within a safe and ethical environment.

7.3 Pre-implantation genetic diagnosis

147. The Scottish Pre-implantation Genetic Diagnosis (PGD) service³⁴ is centrally funded by National Services Division (NSD)¹ and was designated as a national service in 2005. The PGD service carries out genetic testing for fetal chromosome abnormalities at two centres in Scotland - Glasgow Royal Infirmary, and the Royal Infirmary of Edinburgh.

148. A short-life working group was convened in 2010 to define more clearly the access criteria for PGD, as it was not rigorously set out in the past. Members will ensure that NSD¹ is made aware of any decisions on access criteria made by the National Infertility Group.

7.4 Surrogacy IVF

149. IVF surrogacy is only provided where no other fertility treatment options are available to the couple, and the couple have been referred by a clinician as needing an IVF surrogacy cycle for medical reasons.

150. NHSScotland will not be involved in any of the process in identifying a surrogate or any financial or legal arrangements made between the surrogate and the genetic/commissioning couple. A patient can only be placed on the IVF waiting list once a surrogate has been identified.

• Surrogacy IVF should be provided to patients who meet the agreed access criteria.
• The age limit for couples needing surrogacy must be the same as that applied for IVF.
• Surrogates should meet all of the criteria applied to IVF, with one exception - they must have a child. The couple commissioning a surrogate must meet all of the access criteria without exception.

7.5 Intra-uterine insemination (IUI)

151. Over the course of the past 2½ years, the Group has discussed the provision and efficacy of intra-uterine insemination (IUI) many times, and has agreed the best way forward is to wait for publication of the NICE Fertility Guideline. Publication of the updated guideline is planned for 20 February 2013.

152. Previously, IUI was not covered by access criteria. However, as there is now a requirement for this procedure to be HFEA licensed, it could be argued that access criteria should now apply across Scotland, and NHS Greater Glasgow and Clyde currently do apply criteria. The Group considers that whilst NHS Boards across Scotland should apply consistent criteria for IUI, this should wait for the outcomes on IUI which are expected to be in the updated NICE Guideline on Fertility, when published.