Although nursing is not easy, it is also extraordinary, dynamic and rewarding – and no more so than in fertility nursing. I joined the specialty in 1986 as a research nurse when in vitro fertilisation (IVF) was still considered research.
The Warnock report had established principles and limits for UK patients to access safe, licensed fertility treatment (Department of Health and Social Security, 1984). However, challenges remained. Technology wasn’t finely tuned or tailored to women’s health, and models of care centred on male-female partnerships, making parenthood for most single, same-sex or transgender people out of reach.
Science, research and attitudes move at pace in fertility, creating an excitement that means I’m still a fertility nurse 40 years on. Covid-19 has been our latest big challenge, but the ever-changing nature of our specialty helped equip fertility nurses for all that came with it. This adaptability, coupled with the resilience that runs through our DNA, also drove the fertility sector’s recovery.
“Science, research and attitudes move at pace in fertility, creating an excitement that means I’m still a fertility nurse”
Fertility was one of the first elective health services to reopen. Clinics quickly adapted and introduced new ways of delivering safe care, with some patients resuming treatment after a few weeks. This meant delays were less than initially feared, with only a small drop in NHS-funded IVF treatments, from 35% in 2019 to 28% in 2020 (Human Fertilisation and Embryology Authority (HFEA) (2022a).
At the same time, only one third of NHS clinics reopened in May 2020 (the earliest they could apply) compared with 83% of private clinics, probably due to NHS staff redeployment and the need to reduce hospitals’ footfall. Similarly, 2019 to 2020 saw a 35% decrease in NHS-funded IVF treatment cycles compared with 13% for the private sector.
Nonetheless, by the end of October 2020, 95% of NHS clinics had reopened compared with 97% of privately run clinics. Covid-19 related measures meant patients who could restart treatment often had appointments remotely, with in-person visits restricted to just the patient attending. This, and supporting patients physically and emotionally through treatment without a loved one by their side, was challenging.
A year on from clinics reopening, fertility treatments are almost back to pre-pandemic levels, but the aftershocks are still being felt. One in ten patients who had fertility treatment in 2020-21 reported delays in speaking to their GP because of Covid-19 (HFEA, 2022b). And from February 2020 to December 2021, gynaecology waiting lists grew by 59% to over 570,000 (Royal College of Obstetricians and Gynaecologists, 2022). This is higher than all other specialisms with women approaching 42 years no longer able to access fertility treatment in some areas of the UK.
As advocates for fertility patients, we must prepare, support and inform patients and their partners as early as possible, and throughout, their treatment. The Westminster Government’s Women’s Heath Strategy has a key role here, having the power to transform access to treatment and care and ensure high-quality patient information to inform decision-making for UK women (Department of Health and Social Care (DHSC), 2022).
We particularly welcome the aims of the Women’s Health Strategy in addressing the geographical divide, providing fairer funding for same-sex couples and ending the non-clinical criteria preventing patients accessing NHS treatment if they have a child from a previous relationship. This, along with a review of HFEA regulatory powers (now 30 years’ old), paves the way for more inclusive and accessible services.
As I reflect on the last two years, my enthusiasm and love for the speciality has not wavered. I look forward to landmark moments: a chance to modernise fertility-related legislation, with HFEA proposals to the DHSC due at the start of 2023; and seeing the Women’s Health Strategy commitments realised. Most of all, I look forward to working alongside my dedicated, resilient and agile colleagues to see how innovative new practices directly improve patient care.
Alison McTavish is Human Fertilisation and Embryology Authority member, and manager at Aberdeen Centre Reproductive Medicine
Department of Health and Social Care (2022) Women’s Health Strategy for England. DHSC.
Department of Health and Social Security (1984) Report of the Committee of Inquiry into Human Fertilisation and Embryology (The Warnock report). The Stationery Office.
Human Fertilisation and Embryology Authority (2022a) Impact of Covid-19 on fertility treatment 2020. Hfea.gov.uk. May (accessed 1 December 2022).
Human Fertilisation and Embryology Authority (2022b) National patient survey 2021. Hfea.gov.uk, April (accessed 1 December 2022).
Royal College of Obstetricians and Gynaecologists (2022) Left for too long: understanding the scale and impact of gynaecology waiting lists. Rcog.shorhandstories.com (accessed 1 December 2022).