As a result, they face spending up to £25,000 privately before being eligible for NHS care.
National Institute for Health and Care Excellence (Nice) guidelines state that NHS-funded IVF is only available to women “who have not conceived after two years of regular unprotected intercourse or 12 cycles of artificial insemination (where six or more are by intrauterine insemination)”. The guidelines are currently under review and will be updated in 2024.
This means that heterosexual couples can access NHS fertility treatment by simply saying they have been trying to conceive for two years while women in same-sex relationships must “prove” they cannot conceive by undergoing artificial insemination, campaigners say.
This is most commonly done via intrauterine insemination (IUI) – when sperm is directly inserted into a woman’s womb – but this must be done by a healthcare professional at a registered clinic and it can be costly.
The Government’s Women’s Health Strategy, launched in July last year, pledged to remove barriers to IVF for same-sex couples but fertility doctors and campaigners warn the commitment has not been undertaken by the majority of local health bodies – known as Integrated Health Boards (IBCs).
NHS England is currently preparing commissioning guidance to issue to ICBs to support the implementation of the strategy which is due to commence this year, i understands.
But there is no timeline and it is unclear exactly what the changes will look like – and campaigners say same-sex couples do not have time to wait.
Data obtained by LGBT+ rights charity Stonewall, seen by i, shows that 19 per cent of IBCs do not offer NHS fertility support until same-sex couples have self-funded 12 rounds of artificial insemination. Rules differ between each health board, but most state that six of these 12 rounds must be IUI.
Couples in affected areas could spend up to £25,000 before being eligible for NHS care, with each round of IUI costing between £350-£1,600 per cycle at a private clinic, as well as additional costs.
It affects same-sex couples in Gloucestershire, Cambridgeshire, Hampshire, Buckinghamshire, Oxfordshire, Berkshire, Suffolk and parts of Essex, the data revealed.
ICBs covering north-west London and Cornwall and the Isles of Scilly also have to go through 12 rounds of self-funded treatment but said their policies are currently under review.
The postcode lottery of fertility services across England for same-sex couples (Photo: i)
Laura-Rose Thorogood, 37, from Essex, has spent between £50,000 and £60,000 over the past 13 years on 13 rounds of self-funded IUI and IVF.
She and her wife, 40, have three children together and a fourth on the way. They wanted to take turns in carrying their own children rather than going down an alternative route, such as adoption.
“We’ve fought to have our kids and it’s cost us an absolute fortune,” she said. “We’ve had to save, scrimp and scrape, get credit cards, get loans and save every penny.
“We were living on £50 a month after all our bills but we knew that we had to do it to be able to afford to have a family.
“But there are a lot of people that aren’t that fortunate. We’ve got three children. And my wife’s pregnant at the moment. But it’s a really expensive journey. It’s not financially viable to go down that route for so many people.”
Mrs Thorogood has been campaigning for equal access to fertility treatment via her organisation, LGBT Mummies.
The community was “celebrating” when the Women’s Health Strategy was launched last summer thinking they would get “equal access”, but she said little progress has been made.
Mrs Thorogood is covered by Mid and South Essex ICB which said it has recently updated its fertility policy with “improved, more equitable access”. The new policy states that same-sex couples must privately fund six cycles of IUI to “demonstrate infertility” before being eligible for two rounds of IVF on the NHS.
However, she disputed that this equated to “equitable access” as same-sex coupled still have to self-fund fertility treatment when heterosexual couples do not.
Dr Peter Scolding, assistant medical director at the ICB, said: “This took place after a careful, year-long review process, including expert clinical input, public consultation and operational review, before the new policy came into effect in April 2023.
“The updated policy brings services more closely in line with Nice guidance and means that IVF is available to anyone who meets a defined set of criteria. The 10-year Women’s Health Strategy sets out national aspirations and we await further national funding announcements related to this.”
Robbie de Santos, from Stonewall, called on Health Secretary, Steve Barclay, to hold a summit with NHS England and “thrash out a way forward”.
“Same-sex couples facing a postcode lottery for fertility services literally can’t wait years to start their family,” he said, adding: “They need clarity now.”
The majority of ICBs require women in same-sex relationships to self-fund six cycles of artificial insemination, according to the data collected via Freedom of Information requests in April.
Just four ICBs offer NHS-funded fertility treatment to help women in same-sex relationships conceive biologically: West Yorkshire, South Yorkshire, Somerset and Surrey.
Parts of NHS Humber and North Yorkshire ICB offer fully-funded fertility support, while others require six self-funded IUI cycles. This is because the ICB has not yet brought in a blanket policy to cover the entire area since transitioning from several clinical commissioning groups (CCGs) to one ICB.
Kate Osborne, the Labour MP for Jarrow, Tyne and Wear, said she was “saddened” to see there has been “little progress in terms of equal access to IVF” since she went through the same-sex IVF process with her partner 14 years ago.
She said: “The process remains a hugely costly process, both financially and emotionally, with unfair financial barriers in place for same-sex couples wanting to start their own families – essentially creating an LGBT+ fertility tax.
“The Government must clearly outline their plans to improve access to IVF, to put an end to the postcode lottery for NHS fertility treatment and do more to ensure the LGBT+ community has equal access in all walks of life and set out a clear timeline for when the Women’s Health Strategy commitments will be implemented to end unequal access to IVF treatment for LGBT+ people.”
‘Having kids should be a human right’
Kerri Bennett and her wife fear conceiving biological children could be inaccessible for them (Photo: Supplied)
Kerri Bennett, 31, from Hastings in East Sussex, said she and her wife want to start a family but cannot afford to pay privately for artificial insemination.
She said: “We would like to have a few children but maybe that will be compromised by how difficult it is.
“We shouldn’t have to be questioning whether we can have the family we’ve always wanted just because we can’t afford to physically have a child. We can afford to provide for one but the problem is shelling out the money to get there.”
There are other options such as adoption, but conceiving children should be a “human right” and it should not be so “difficult” for LGBT+ couples, said Ms Bennett.
After the Women’s Health Strategy was launched, the couple “put everything else on hold”, thinking that it would be a “massive saviour” and they waited to see what provisions would be brought in.
NHS Sussex ICB recently updated its policy so same-sex couples must self-fund six cycles of IUI before accessing further fertility treatment.
Ms Bennett has spent days over the past few months going back and forth with the ICB over what provisions are available – only to find out there is still no NHS funding from the offset.
“Now we just feel like we’ve wasted time,” she said, adding that the ICB has claimed to be “one of the most inclusive”.
She said: “We’ve spent so many hours and days trying to dissect the information. You trawl through all that stuff just a find out that you’re not entitled to anything and it doesn’t feel like that’s going to change any time soon.”
Fertility specialist professor Geeta Nargund, medical director at fertility clinics: Create Fertility and abc ivf, said the number of IVF cycles funded by the NHS for same-sex couples is “unacceptably low”.
“Given that same-sex couples need access to fertility treatment to conceive, many expect to pay privately to fund treatment due to the variable, and often-biased, local criteria to access NHS-funded treatment,” she told i.
Nice states that all women aged under 40, regardless of sexual orientation and relationship status, should be entitled to three full cycles of publicly funded IVF treatment.
“However, the lack of a national IVF tariff means that women and couples often find themselves ineligible for treatment due to the IVF postcode lottery,” said professor Nargund, calling for the Government to place a cap on IVF pricing to allow more cycles to be funded within the existing budget.
Kayleigh Hartigan, who formerly held senior roles in the Department for Health and Social Care (DHSC) and the NHS, said many same-sex couples have to jump through “additional hoops” to access fertility treatment compared to heterosexual couples, causing “huge financial strain”.
Ms Hartigan, who now runs Fertility Mapper, a fertility clinic review and advice platform, said commitments in the Women’s Health Strategy had “not yet been fully implemented”.
“We can see that several ICBs have decided not to follow the national commitments and are still asking female same-sex couples to pay privately for several rounds of costly IUI treatment before they can access NHS-funded IVF,” she said.
She said it is down to the Government and the NHS to use “old-fashioned diplomacy” to persuade local ICBs to fund fertility services for same-sex couples, but added that full implementation of the Women’s Health Strategy will take “years, not months”.
The Human Fertilisation and Embryology Authority (HFEA) said the most recent data from 2019 showed that 2,435 IVF cycles (4 per cent of all cycles) involved a female partner but only 14 per cent were NHS funded compared to 39 per cent of cycles for patients with a male partner.
Clare Ettinghausen, director of strategy and corporate affairs, said there are around 70,000 IVF cycles performed in the UK and over time, there has been a “gradual shift in the types of families accessing services”.
She said: “We welcome the UK Government’s Women’s Health Strategy which committed to provide fairer funding for same-sex couples by ending the need for self-funded artificial insemination before accessing NHS treatment. We hope this will make a difference for many of those trying to access NHS treatment.”
An NHS spokesperson said: “While these decisions are legally for local health commissioners who have to balance the various competing demands on the NHS locally, it is absolutely right that they provide equal access to services according to the needs of people within their areas and the health service nationally is supporting them to do this with further guidance being considered.”
A DHSC spokesperson said: “Our Women’s Health Strategy for England sets out our 10-year ambitions for boosting health and wellbeing and improving how the health and care system listens to women and girls.
“We are clear Nice guidelines should be followed and the strategy contains a number of important changes and future ambitions to improve the variations in access to NHS-funded fertility services – which we expect to start this year.”
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