Fertility preservation provision in the NHS in Scotland: guidance

Background

The National Fertility Group has acknowledged that the fertility preservation service for patients in Scotland could be improved. A Gametes Group was set up to consider a wide range of issues, including access to and provision of fertility preservation using modelling to better understand the numbers of patients who may need this service. A Fertility Preservation working group was then set up to continue looking in detail at how fertility preservation services could be improved and to provide a one-Scotland approach.

The Group considered access of individuals to NHS-funded fertility preservation. This assessment looked at which patients should be given the option to store their gametes, including as embryos. There are four tertiary NHS Fertility Centres in Scotland, located in Aberdeen, Dundee, Edinburgh and Glasgow, and one secondary care service, located at Monklands Hospital, NHS Lanarkshire (sperm preservation only) that provides fertility preservation. Further contact information and how to make a referral can be found at Annex C.

This document considers only fertility preservation through gamete/ovarian tissue cryopreservation for those who are pubertal or adult. Ovarian tissue is stored centrally in Edinburgh by the Scottish National Blood Transfusion Service (SNBTS) to current regulatory standards. Testicular tissue is also now stored centrally by SNBTS, but this remains experimental and is being conducted as a research study: it therefore falls outwith the remit of this document.

Other issues considered by the Group include equality of treatment, overtreatment, and the chances of (and pathways to) successful delivery of a baby in considering the need for fertility preservation. The level of risk of loss of fertility must be considered along with the prognosis for the patient. Current data indicate that the majority of patients do not use their gametes following fertility preservation. It is therefore important to ensure that NHS Boards do not keep gametes in storage for lengthy periods if this is unnecessary, for example in circumstances where criteria for access to NHS-funded assisted reproduction will not be met. Information sheets and patient pathways will be drawn up to inform patients and clinical teams and to clarify what is and is not provided by the NHS in Scotland.

Fertility preservation is a relatively new speciality with emerging evidence in methodology, need and efficacy. The guidance and recommendations for NHS Boards below are therefore based largely on national and international guidelines (notably from the British Fertility Society (BFS), the European Society for Human Reproduction and Embryology (ESHRE), the European Society for Medical Oncology (ESMO), supported by other higher level evidence (notably from the PanCareLIFE consortium) where possible, and taking into account the current provision of assisted reproduction services in the NHS in Scotland. A bibliography of these and other documents is provided at the end of the document.

In due course, following implementation of this guidance, there will be a need to assess the success of fertility preservation services, for patients, in the NHS in Scotland.