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Fertility Services a 'Geographical Lottery'

Geographic access to IVF and other fertility services is significantly higher in the richest parts of Britain, a new study shows. Researchers from the University of Exeter warned that "the current locations of clinics is likely reducing opportunities for those living in more deprived parts of the country to get fertility treatment".

"Large numbers of people are affected by infertility in their lifetime," said the World Health Organisation (WHO) in their latest report on infertility, published yesterday. Around 17.5% of the adult population – roughly 1 in 6 worldwide – experiences infertility, the WHO highlighted, which it said demonstrated the "urgent need" to increase access to affordable, high-quality fertility care for those in need.

The National Institute for Health and Care Excellence (NICE) said that in the UK an estimated 1 in 7 couples – approximately 3.5 million people – have difficulty conceiving. 

For the study, published in the journal Human Fertility, the researchers used publicly available data on fertility clinics, combined with official statistics for 315 local authorities in England, to create a standardised measure of geographic accessibility to fertility services. They used information from a cornucopia of data sources – collected in June 2020 and that included the Human Fertilisation and Embryology Authority (HFEA) and the Office for National Statistics (ONS) to compile fertility clinics and their location, together with sociodemographic information at the local authority level.

London and South East Rich in Provision

Although referral criteria may vary among health authorities, NICE guidance recommends that for women younger than 36 years with normal history, examination, and investigations in both partners, referral should usually be considered if the couple have not conceived after 1 year, with earlier referral a consideration for women older than 35 years, or if the history, examination, and investigations of either partner suggest an underlying cause.

In 2020, when the researchers carried out their research, there were 92 main fertility clinics and 52 satellite clinics in England, with 87 that offered IVF services. 

Overall, nearly a third of local authorities, with a total population of more than 2.8 million women of reproductive age, did not have available clinics offering IVF treatment in their area, found the researchers – these figures did not include any male partners affected by infertility, the authors pointed out.

Most local authorities with limited access to these services were in the North, including the Yorkshire and Humberside region, and in the South West, they said.

The largest concentration of clinics providing IVF services was found in London (37 clinics), followed by the South East (24 clinics). Fertility clinics were more "sparse" in the South West (19 clinics), East of England (15), North West (13), West Midlands (12), East Midlands (10), Yorkshire and the Humber (7), and in the North East (7).

The researchers revealed that, within London, most fertility clinics were located in central London, with the largest concentration of clinics found in Westminster (17).

"We found that geographic accessibility to assisted reproduction is significantly higher in the most advantaged local authorities in terms of average household income and level of deprivation," reported the authors. 

No Nearby Services

The researchers identified that in 2020 nearly a fifth of local authorities did not have fertility clinics within a radius of 25 km. This, they emphasised, meant that 1.6 million women of reproductive age had "no assisted fertility services nearby". In addition to that, just over two million women aged 18-50 live in local authorities with only one clinic within 25 km that provides IVF. 

"Restricted geographic accessibility to fertility treatment may pose a substantial barrier, as it entails additional expenses, including travel costs and time off work and may also lead to longer waiting times," the authors explained.

The number of women of reproductive age with limited access to NHS-funded IVF treatment was somewhat higher, highlighted the authors, with nearly three million living in local authorities with no proximity to clinics providing IVF to NHS funded patients, and further 2.4 million women with access to only one clinic within 25 km. This results in around 5.4 million women who are living in areas with no or limited availability of clinics providing NHS-funded IVF services, the authors said.

Professor Mountford-Zimdars, School of Education, University of Exeter, and co-author, said: "Given the limited provision of publicly funded IVF treatment in England, reduced geographic accessibility to fertility clinics is likely to exacerbate existing inequalities in access to medically assisted reproduction."

Better Fertility Treatment Access in Wealthier Areas

In London, there were two or more clinics per 10,000 eligible women within a radius of 25 km. The South East and the Midlands had a relatively high concentration of clinics while the North of England and the South West had the lowest rates of clinics available per population of women of reproductive ages.

After controlling for population size, region, and degree of urbanisation, "the wealthier areas – mainly in terms of household income and level of deprivation – have higher geographic accessibility to fertility treatment across England", the authors said.

Dr Peri-Rotem, senior lecturer in sociology, philosophy and anthropology at the University of Exeter and co-author, said: "We have found that the accessibility of fertility clinics is strongly linked with area-level measures of economic wealth. Accessibility to fertility treatment is significantly higher in local authorities with greater average household income. In addition, the clinics rate in more deprived local authorities is lower by around 30 per cent than that in the least deprived areas."

Asked to comment for Medscape News UK, the Human Fertilisation and Embryology Authority's (HFEA) Director of Compliance and Information, Rachel Cutting, said the that the study findings were "concerning", since the study showed how access to fertility treatment may be "lower in more deprived areas".

"The lower clinics rate in more deprived local authorities may further hinder the likelihood of seeking medical help and usage of assisted reproduction technologies among those living in these areas," Dr Peri-Rotem warned.

Prof Mountford-Zimdars urged that a more "strategic approach "for setting the location of fertility services providers would contribute to improved accessibility and to reducing existing barriers to assisted reproduction. "Extending the provision of funded fertility treatment across England, in accordance with the recommendations of the National Institute for Health and Care Excellence will also increase access, particularly for more deprived groups," she said.

This study received no outside funding, and the authors declared no conflicts of interests.