University of Edinburgh: Unequal fertility services access for cancer survivors

A national survey reveals significant discrepancies in the delivery and funding of fertility preservation services for child cancer patients across the UK.

Now researchers are calling for NHS funding to ensure equality of access to services that enable young people to save eggs, sperm or reproductive tissue until later life.

Scottish services
In Scotland, the MRC Centre for Reproductive Health at the University of Edinburgh is the only centre offering fertility preservation for children at risk of infertility following cancer treatment.

Since 2016, ovarian tissue has been stored for 85 girls and testicular tissue for 20 boys, but researchers say more children could benefit from this.

Some 1,800 children up to the age of 14 are diagnosed with cancer each year in the UK. For as many as one in five, the disease or its treatment causes significant damage to their reproductive organs. National guidelines say treatment should be offered, if appropriate.

Fertility preservation
A team of researchers from around the UK – including the University of Edinburgh – analysed questionnaire responses on the issue from 18 of the UK’s 20 specialist children’s cancer centres.

Each centre was asked about referrals for the different fertility preservation options, how these were funded and how long the funding lasted.

All of the centres had made referrals for collection and storage of sperm and ovarian tissue, 15 had made referrals linked to testicular tissue and six had made referrals for egg collection and storage.

Differences in funding
Funding sources for fertility services were also very unequal, the team says. Funding is currently determined by local clinical commissioning groups, and so varies by region.

The research also showed a wide variation in the length of time that storage for mature sperm and eggs was funded – less than five years in some cases, and indefinitely in others.

All centres in Scotland, Wales and Northern Ireland were able to access NHS or research funding for testicular and ovarian tissue storage.

In England, nine of the 10 centres said no NHS funding was available and they relied on charitable sources to fund this service.

Whilst a cancer diagnosis in childhood is an immensely difficult time, future fertility and its preservation is an important issue for patients and their families. It is important that healthcare professionals are aware of the option of ovarian and testicular tissue storage and that all eligible patients have access to fertility preservation services throughout the UK.

Professor Rod Mitchell
MRC Centre for Reproductive Health
The research has been published in Archives of Disease in Childhood. It was conducted on behalf of the Children’s Cancer and Leukaemia Group – the umbrella body for the specialist centres.