Fertility preservation provision in the NHS in Scotland: guidance

Individual Patient Access criteria

All NHS patients referred for fertility preservation treatment and storage will be assessed using the same overarching criteria (please see above) and individual patient access criteria (please see below).

In many but not all cases, the urgency of the required treatment will mean that patients should start fertility preservation treatment without delay. The following individual patient access criteria for fertility preservation have been agreed, taking into account access criteria for assisted reproduction:

1. For those storing eggs/embryos, BMI needs to be under 35^[1]. This is higher than other types of fertility treatment, including IVF (In vitro fertilisation)/ICSI (Intracytoplasmic sperm injection) criteria due to time constraints.

2. BMI should also be under 35 for surgical sperm recovery.

3. Upper cut off age for oocyte/embryo fertility preservation should be before 40th birthday^[2].

4. Upper cut off age for ovarian tissue should be before 36th birthday as per Research Ethics approval and international guidelines^[3].

5. The Group consider that before 53rd birthday is an appropriate age limit for those storing sperm because of increasing risk to offspring with paternal age.^[4]

6. An individual seeking to preserve their fertility will be eligible if they do not have any living biological children, nor are they the deemed parent of a living child.

Here are some possible scenarios where point 6 applies. Please note this list is not exhaustive:

If person A is seeking fertility preservation, they may be eligible even though they already have a biological child if their partner, B, does not have a biological child. For these purposes:

• where a child has been born to a same-sex couple, both partners in a same-sex couple will be treated as the biological parents of a child, even if they are separated. (For example, if A and B, both women, have a child together and A is the biological parent but then they separate, B would still be treated as having a biological child and would not be eligible for fertility preservation, unless B had a new partner (C) who did not have a biological child)^[5]
• a child born through surrogacy or egg/sperm donation will not be treated as a biological child of the surrogate or egg/sperm donor but would be treated as a biological child of the intended parent(s)
• an adopted child is not treated as a biological child

7. As NHS-funded IVF is available where one partner has children and one does not, clinicians will have to take this into consideration where the individual is part of a couple. This may be a circumstance where storing embryos may be preferable to storing oocytes.

8. Previous sterilisation will preclude access.

9. Smoking would not preclude access to storage; however, where there is time, patients should be strongly encouraged to stop smoking.

10. Being in a stable relationship is not a relevant criterion for access (or ongoing storage).

11. Welfare of the child considerations are not relevant for storage for fertility preservation, although they will be at the time of subsequent use of stored materials.

12. See also specific issues regarding treatment groups.

It is essential that patients recognise that full NHS access criteria will apply when it comes to using stored material for fertility treatment in an NHS setting, including for NHS-funded IVF/ICSI.

Issues specific to the separate groups of patients to be considered for NHS fertility preservation are set out below.