Fertility preservation provision in the NHS in Scotland: guidance

Duration of gamete/embryo storage

The upper age limit for NHS IVF treatment in Scotland is a female age of 42 (after 40 women will only receive one cycle of NHS IVF). Eggs or embryos in storage after that age cannot be used for NHS IVF treatment. Patients with cancer may be advised to avoid pregnancy for approx. two years after treatment to ensure full recovery and identify early relapse.

1. Patients should have an initial follow up at a maximum of five years from the date of storage and at five-yearly intervals thereafter. These should be initiated by the fertility clinic that provided storage for discussion and assessment of the patient, and whether it is appropriate to continue NHS-funded storage. This process is separate to the consent process and an updated consent is only required every 10 years.

2. Not being in a stable relationship is not a relevant criterion in the context of storage.

3. Young patients may need to store gametes for a very long time. However, timely follow ups are important as young people have articulated how important their fertility is to them.

4. If at the follow up review the patient is no longer eligible for NHS storage, e.g. now has children or is age 43 for oocyte/embryo storage or 55 for sperm storage, then ongoing NHS-funded storage will not be provided. A review appointment offers the opportunity for discussion/assessment (potentially also with an appointment with the fertility clinic counsellor) concerning ongoing storage and what the patient wishes for their gametes/embryos going forward. If patients are no longer eligible for NHS-funded storage then the patient should be advised that they would be charged for storage if they wish it to continue.

5. Normal semen analysis indicates likely fertility and certainly shows the presence of sperm which could potentially be used in fertility treatment. If at the five-year appointment or thereafter the patient is shown to have a normal semen analysis, disposal of stored sperm should be discussed with them; and they should be advised that they will be charged for further storage. If, however, the sperm count is found to be low then ongoing NHS-funded storage will be provided. If the patient does not provide a semen sample, further NHS-funded storage will not be provided, and the stored samples will be disposed of or the patient will be charged for further storage. This should be handled sensitively and consideration given for those patients who are not able to provide a semen sample.

6. Issues regarding the limited ovarian lifespan and potential for it to be shortened after cancer treatment mean that regular menstrual cycles or biochemical tests of ovarian function should not be used as grounds for disposal or charging for ongoing storage, where other criteria for access to NHS treatment are still met.

7. Where sperm are stored during NHS IVF treatment as a ‘back up’ in case of no fresh sperm being available on the day of oocyte recovery, these samples will not be considered to be stored for fertility preservation reasons. The duration of NHS-funded storage in these cases may be limited if the couple achieve a live birth or have completed their allocation of NHS-funded treatment. Under those circumstances, further storage will need to be self-funded.

8. A patient contract is considered the best way of combining these aspects of duration of storage, the need to reassess eligibility, and self-funding of further storage once a patient is no longer eligible for NHS treatment. This needs to be completed at the time of storage. Storage protocols have been developed for other aspects of fertility storage, and a protocol will now be developed for fertility preservation storage.

Data Collection

It is important that information regarding use of NHS resources is collected, to inform future service development. Information to be collected includes:

1. Number and source of referrals.

2. Number of patients proceeding to fertility preservation; their characteristics (e.g. age, diagnosis) and fertility preservation results (e.g. number of eggs).

In the future we aim to collect data on usage/other outcomes.

Public Health Scotland (PHS) have developed a data capture form which is in use by the four NHS Assisted Conception Units. All data collected will be anonymised and personal information will not be retained for these purposes. The Units send completed forms to PHS each quarter where the data is then collated. Centralised storage by SNBTS in future will allow collection of this data as samples are stored.