Fertility preservation provision in the NHS in Scotland: guidance

Overarching Access Criteria to Fertility Preservation

When considering offering fertility preservation to patients the overarching criteria for access to NHS-funded fertility preservation are that:

• a specific, imminent and significant risk to the patient’s fertility is identified. Quantifying that risk is difficult and may be uncertain at the time of referral, but where it is clinically judged to be low (estimated on available evidence to be <30%), fertility preservation will not be offered
• there is a route to achieving a successful pregnancy and birth of a child for that patient in the future
• any clinical risks to the patient from the required intervention (and where relevant, of subsequent pregnancy) are identified
• long-term survival of the patient is expected, with the ability to be able to use their stored gametes

It is noted that these considerations mean that it is likely that NHS fertility preservation will not be offered to all patients for whom it might be considered, e.g. where the patient’s prognosis is poor, where there are significant medical complications, where the patient’s ovarian reserve is known to be already very low or where it is considered that a successful pregnancy is unlikely to be achieved. There may however be individual circumstances where provision of fertility preservation is considered appropriate, despite these overarching criteria for access not being clearly met. The NHS Fertility Centres, and other invited specialties as appropriate, meet regularly to peer review any such individual circumstances. This guidance does not specify a minimum chance of success; however, where there is only a very low chance of success, fertility preservation would not be offered.

All patients where fertility preservation treatment may be appropriate should be offered a consultation with an appropriately trained healthcare professional. It is also important that patients are provided with information on the full range of methods for fertility preservation that might be appropriate for that individual, along with risks and benefits of treatment to enable them to make an informed choice. In general, this discussion will take place at the referring clinic (e.g. Oncology, Gender Identity) with referral to assisted reproduction only where the patient wants to proceed to a fertility preservation procedure, and access criteria are met.

Referral pathways and initial assessment considerations

Pathways for referral to fertility services have been developed (see Annexes G and H) to ensure timely (often urgent) receipt of referral from a wide range of relevant clinical services (including Oncology, Haematology, Rheumatology, Gender Identity). A template referral form has been developed (see Annex C). This form should be used by the referring service (consultant or specialist nurse) giving an outline of the diagnosis and proposed treatment, other relevant medical issues, and documenting completion of initial tests.

Following referral to fertility services, clinicians should discuss with the patient how the gametes will be used in the future. Future options for fertility treatment should be discussed with patients, including the possible use of surrogacy (which should be managed as gamete donation) or stopping certain types of hormone treatment.

In many cases, particularly for people storing sperm, fertility preservation can be provided simply and quickly. However, for more complex cases, it is important for NHS Fertility Centres to optimise care as well as to ensure consistency in decision-making. NHS Fertility Centres may have an established local multidisciplinary group for this purpose, and should also consider case discussion and peer review with other NHS Fertility Centres.