East Midlands Fertility Policy Review: Insights from Nottingham and Nottinghamshire citizens

Background

In July 2022, the ICB inherited a number of clinical commissioning policies from the former NHS Bassetlaw Clinical Commissioning Group (CCG) and NHS Nottingham and Nottinghamshire CCG. Much work has been done since July 2022 to ensure these policies are aligned across the ICB’s geographical footprint. The remaining policy requiring additional work is the Fertility Policy, which requires updates to modernise and standardise the offer.

NHS Nottingham and Nottinghamshire ICB has been working with other ICBs in the East Midlands to develop a new Fertility Policy which is consistent across the whole geographic area and is also up to date with modern expectations in society.

The overarching aim of the engagement was to gather the perspectives of both citizens and stakeholders in relation to the proposed fertility policy, specifically those who are affected by the proposed changes.

Across the East Midlands a total of 2046 surveys were completed, of these 427 citizens/stakeholders indicated that they lived in Nottingham and Nottinghamshire with 33 responses specifically for Bassetlaw. There may be citizens from Nottingham and Nottinghamshire included in the 2046 responses but who did not indicate where they lived. This report covers the local feedback from Nottingham and Nottinghamshire citizens and should be read alongside the overall East Midlands report.

Our listening exercise began on 11^th November 2024 and concluded on 10^th January 2025 (60 days). A range of different methods were used to listen to citizens and stakeholders, to understand their views. In addition to the survey, we heard from people by attending a public meeting or providing a response to the promotion of the engagement on social media, therefore in total we heard from over 500 local people. The feedback from this listening exercise will be considered and fed into ongoing discussions regarding the development of the fertility policy, prior to approval by the Board of the ICB.

Key findings

The themes from the survey highlight the variety and complexity of experiences with fertility services, ranging from emotional distress, inequality, positive support and financial challenges. 

Regional and national standardisation:

• Respondents highlighted disparities in access to fertility treatments and there was support for regional standardisation to ensure equal access.
• Calls were made for a national policy to ensure fairness across the UK.
• 49% of those surveyed agreed with the proposal to standardise IVF treatment across the entire East Midlands region by offering one cycle of IVF for all areas. However, many advocated for increasing the number of NHS-funded IVF cycles from one to two or three to align with success rates and NICE guidelines.

Fairness and equality:

• 77% of respondents agreed with the proposal that same sex female couples will be recognised as requiring fertility support and get a referral for fertility treatment if they meet all other criteria. 65% agreed that the same should apply for single women and trans men.
• A recurring theme was the need for fairness and inclusivity in fertility treatment access, including for same-sex couples, single women and trans men. Many pointed out that this is aligned to ethical and legal considerations within modern societal values and equality laws.

Mental health impact:

• Fertility treatments were described as emotionally taxing, with significant distress exacerbated by financial strain and restrictive eligibility criteria.
• There was a strong demand for improved mental health support throughout the fertility journey, including support after unsuccessful treatments.

Fair and individualised assessments:

• A flexible, case-by-case approach to eligibility for fertility treatments was strongly supported, with emphasis on considering individual medical histories such as longer gamete storage for cancer patients, and opposition to service restrictions on BMI, age and existing children.

Financial impact on patients:

• The financial burden of fertility treatments was highlighted, with many respondents arguing for increased NHS funding and reduced private treatment costs, especially for same-sex couples and individuals without access to financial support.

NHS Financial Resources:

• Some respondents questioned whether infertility treatment should be prioritised by the NHS, suggesting that funds could be better allocated to other medical conditions.
• Concerns were raised about the allocation of NHS resources for fertility treatments for non-medical cases like single women or trans men.
• Many based their opinions for example on IUI whether the service would be financially viable and efficient given the current economic climate and budget restrictions on the NHS.

Clinical Evidence and Best Practices:

• Support for evidence-based decision-making in fertility policies, including adherence to NICE guidelines, was emphasised.
• Lifestyle factors such as smoking cessation and maintaining a healthy weight were viewed as crucial for improving fertility success rates.

Fertility care among GPs and clinical staff:

• Respondents expressed concerns about the lack of fertility knowledge among GPs and other healthcare professionals, leading to delays and inadequate support.
• Calls for better GP training in fertility issues, including emotional challenges, were made to improve the overall patient experience.

IUI/DI (Intrauterine Insemination/Donor Insemination):

• Many respondents prefer IUI/DI as a gentler, less invasive alternative to IVF, especially as a first step, particularly for those without known fertility issues. 59% of survey respondents agreed with the proposal to offer IUI/DI before considering IVF.
• While some considered IUI/DI a more affordable option, some questioned whether the low success rates made it a financially viable option.
• Patient choice was emphasised with empowering patients to choose between IUI/DI and IVF based on personal circumstances, with many believing IUI/DI should not be a prerequisite for IVF.

BMI (Body Mass Index)

• There was a strong argument that BMI is an outdated and often inaccurate measure of health, particularly for women, and does not account for muscle mass, racial diversity, body composition, or conditions like PCOS.

Age:

• While many respondents acknowledged age’s significant role in fertility, some suggested increasing age limits to reflect modern health standards and trends in delayed childbirth, advocating for more inclusive age policies.

Current children:

• The majority of those surveyed (65%) disagreed with the policy proposal that those wishing to become pregnant and/or their partner must not have a living child from their current or previous relationship. Respondents argued that the policy fails to reflect modern family structures, including blended families, and discriminates against individuals seeking to have a child with a partner who has children from a previous relationship.

Gamete storage:

• Gamete storage was viewed as essential for patients undergoing treatments (e.g., chemotherapy) that could impact fertility with 94% of people agreeing with this proposal. Respondents emphasised the importance of ensuring everyone has the opportunity to start a family, regardless of medical circumstances and financial situation.
• 70% of respondents agreed with the proposal that the NHS funds storage of gametes or embryos for up to three years however many would like to see a tailored approach to this.

Smoking:

• 90% of respondents emphasised the importance of quitting smoking or vaping for improving fertility and ensuring optimal pregnancy conditions.

Sterilisation:

• The majority of respondents (64%) felt sterilisation was a personal choice, with those who undergo sterilisation voluntarily accepting responsibility. However, others argued that life circumstances can change, and individuals should not be penalised for past decisions if they later wish to have children.

Next Steps

The findings from this listening exercise will be used by Nottingham and Nottinghamshire ICB, alongside clinical and financial considerations, to develop a final Fertility Policy.   

Conclusion 1: There is strong support for a consistent, fair, and equitable fertility policy to eliminate regional disparities (‘postcode lottery’).

Recommendation 1: Implement a Standardised Regional Fertility Policy that includes same-sex couples, single women and trans-men to ensure equal and inclusive access across all areas of the East Midlands.

Conclusion 2: Many called for tailored approaches for conditions like PCOS, endometriosis, and post-chemotherapy fertility preservation.

Recommendation 2: Revise Eligibility Criteria to allow for more flexible and individualised assessments based on medical and social needs.

Conclusion 3: Fertility treatment takes a significant emotional toll, necessitating increased mental health support, particularly for those facing unsuccessful treatments. There is a clear demand for comprehensive counselling, weight loss support, smoking cessation assistance, and better communication between NHS and private services.

Recommendation 3: Enhance support services including weight loss programmes, smoking cessation assistance and fertility guidance.

Recommendation 4: Expand mental health support with structured counselling, emotional support for unsuccessful treatments, and increased awareness of fertility-related distress.

Conclusion 4: Delays in fertility services and poor communication from healthcare providers cause frustration and distress. Improved transparency and streamlined referral processes are needed.

Recommendation 5: Improve communication and transparency in fertility pathways, ensuring clear guidance, reduced wait times, and better coordination between NHS and private services.

Recommendation 6: Enhance GP and professional training to improve fertility knowledge, ensure compassionate care, and streamline the referral process.

Conclusion 5: Many respondents believe the number of NHS-funded IVF cycles should increase and align with NICE guidelines to improve success rates and reduce stress.

Recommendation 7: Consider the number of NHS-funded IVF cycles, and if not possible to increase, ensure that there is a clear rationale to citizens as to why.

Conclusion 6: Calls for individualised assessments highlight the need to consider medical history, family circumstances, and alternative health indicators beyond BMI and age limits.

Recommendation 8: Revise the policy to consider individual parental status rather than automatically excluding those whose partners have children.

Recommendation 9: Incorporate a more holistic health evaluation for fairer access to fertility services.

Conclusion 7: The cost of non-NHS fertility treatment remains a significant burden.

Conclusion 8: IUI/DI is valued for being less invasive but has lower success rates, leading some to favour IVF as a more effective option. Patient choice is crucial and access to IVF should not be contingent on first attempting IUI/DI.

Recommendation 10: Ensure patients can choose between IUI/DI and IVF based on personal circumstances rather than mandating IUI before accessing IVF.

Context

In July 2022, Nottingham and Nottinghamshire Integrated Care Board (ICB) inherited a number of clinical commissioning policies from the legacy organisations of Bassetlaw Clinical Commissioning Group (CCG) and Nottingham and Nottinghamshire CCG (which excluded the geographical area of Bassetlaw). Clinical commissioning policies describe what health services are funded and typically the thresholds for people to access those services. This means that only the most clinically suitable treatments, as recommended by expert doctors and nurses are available. It also means that the offer to people is consistent across the whole ICB area.

Since July 2022, the majority of these policies have been reviewed and aligned, either by levelling up or down, or merging where the offer was very similar or clinically identical. The fertility policy is the one remaining policy which requires further work.

Current fertility policy

Fertility refers to the ability to conceive a child. Infertility is the difficulty or inability to reproduce a child naturally, where formal investigation is justified and possible treatment implemented. The current fertility policies include a range of treatments and procedures to support people struggling to conceive, including access to In Vitro Fertilisation (IVF). The National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summary on infertility[1] states: “Infertility is a disease of the reproductive system in men or women”.

The legacy policies that are in place were written at least a decade ago and do not offer the same levels of access to all ICB residents.

This inconsistency is also present across the East Midlands. Nottingham and Nottinghamshire ICB has been working with other ICBs across the region (Derby and Derbyshire; Leicester, Leicestershire and Rutland; Northamptonshire; and Lincolnshire) and alongside expert doctors and nurses to develop a new policy which is consistent across the whole geographic area and is also up to date with modern expectations in society. This means that the proposed policy will:

• Be inclusive of modern relationships and identities, including supporting same sex female couples and transgender men.
• Align the number of cycles of IVF available.

A new fertility policy is therefore proposed to ensure consistency across the East Midlands, reflecting all those aspects of modern society and also aligning the number of cycles of IVF available in the East Midlands.

Proposed East Midland Fertility Policy

An overview of the proposed changes is below:

• Offer one IVF cycle only across the whole of the East Midlands region.
• Offer three cycles of unstimulated intrauterine insemination (IUI)/ donor sperm insemination (DI) for those couples / individuals where vaginal intercourse is not possible or appropriate prior to considering IVF.
• Single women or transgender men with no known fertility issues (must have regular ovulation, and patent tubes[2]) will also be offered for up to three cycles of unstimulated DI where the donor has a normal sperm count.
• Offer access to services around BMI and Age in line with the clinical criteria set out in the NICE guidance[3].
• Include the requirement for all parties involved in the treatment to be non-smoking/vaping or have quit smoking/vaping.
• The person wishing to become pregnant and/or their partner must not have a living child from their current relationship or any previous relationship.
• Not provide fertility treatment for couples where their infertility arises wholly or partly from sterilisation of either partners.
• Same sex couples are considered to have a known fertility issue and are therefore eligible for treatment if all other criteria are met.
• Single women and transgender men are considered to have a known fertility issue and are therefore eligible for treatment if all other criteria are met.
• Include access to storage of gametes[4] if the patient is due to commence a medical or surgical treatment likely to permanently affect their fertility.

To summarise, in the Bassetlaw area, there will be one cycle of IVF offered, rather than the three cycles currently available. In all other areas of Nottingham and Nottinghamshire there will continue to be one cycle offered. For people in Nottingham and Nottinghamshire, including Bassetlaw, the proposed policy will improve access to fertility treatment by aligning the approach with the latest clinical thinking and also removing criteria that restricts access to people who are in same-sex relationships or who are transgender men.

Our statutory duties around public involvement

Nottingham and Nottinghamshire ICB have a legal responsibility – under the NHS Act 2006 (as amended), section 14Z45 – for involving and consulting the public in developing and considering proposals for changes in commissioning arrangements:

“The ICB must make arrangements to ensure that individuals to whom the services are being or may be provided, and their carers and representatives (if any), are involved (whether by being consulted or provided with information or in other ways):

• (a) in the planning of the commissioning arrangements by the integrated care board

• (b) in the development and consideration of proposals by the integrated care board for changes in the commissioning arrangements where the implementation of the proposals would have an impact on

• (i) the manner in which the services are delivered to the individuals (at the point when the service is received by them), or

(ii) the range of health services available to them, and (c) in decisions of the integrated care board affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact.

The substantial change provisions arise under separate legislation, the Local Authority (Public Health, Health & Wellbeing Boards and Health Scrutiny) Regulations 2013. Where these apply, the obligation is to consult with the Local Authority, and they are the body that can then require a public consultation, if the proposals reach the relevant threshold.

NHS providers have equivalent public involvement and consultation duties under section 242 of the NHS Act.

Aims and objectives

The overarching aim of the listening exercise was to gather the perspectives of both citizens and stakeholders in relation to the proposed fertility policy, specifically those who may be affected by the proposed changes. This can be broken down into the following objectives:

• Understand the views of citizens and stakeholders on the proposed policy, in particular, areas that are supported and those that are not.
• Listen to the experiences of those who have accessed or are accessing fertility services to better understand the potential impacts of the proposed policy.
• Prioritise hearing from people and communities that would be most impacted by the proposed policy:
  • Citizens living in Bassetlaw
  • Single women
  • Same-sex female couples
  • Trans men
• Ensure that the ICB meets its statutory duty to involve the people affected in the development of plans for service changes.
• Ensure the ICB meets its statutory duty to involve the Local Authority/Authorities in any development of proposals for substantial variation to services.
• Ensure that our engagement is transparent and meets statutory requirements and best practice guidelines.

Principles

All engagement activity was undertaken in line with our statutory duties and with The Gunning Principles[5], which are:

• That engagement and consultation must be a time when proposals are still at a formative stage. 
• That the proposer must give enough reasons for any proposal to permit intelligent consideration and response.
• That adequate time is given for consideration and response.
• That the product of engagement and consultation is conscientiously taken into account when finalising the decision.

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[1] Definition | Background information | Infertility | CKS | NICE

[2] Tubal patency refers to the openness and lack of blockage in the fallopian tubes. 

[3] Fertility problems: assessment and treatment

[4] Gametes are the reproductive cells involved in making a baby. They carry half of the genetic material needed to create a baby. In humans, egg are the female gametes and sperm are the male gametes.

[5] The Gunning Principles.pdf (local.gov.uk)

The listening exercise began on 11^th November 2024 and concluded on 10^th January 2025 (60 days).

A range of different methods were used to listen to citizens and stakeholders, to understand their views. In total, over 500 individuals living in Nottingham and Nottinghamshire participated by either responding to the survey (427 respondents), attending a public meeting or community group meeting or providing a response to the promotion of the engagement on social media.

During the listening exercise several emails and letters providing additional feedback outside of the main survey were received. The responses were from various different groups reflecting the high level of engagement across the region. Feedback was received by:

• LGBT Mummies
• Fertility Action (registered charity 1212260)
• Teenage Cancer Trust
• East Midland Teenage and Young Adult Integrated Cancer Service
• NUH Life
• Fertility Alliance
• Health and Overview Scrutiny Committees
• Various ICB working groups, Clinicians, members of the public and patients.

(For more information, please see the East Midlands engagement report)

To ensure consistent messaging across all methods utilised, a narrative describing the proposals was developed. This formed the basis for all content in the engagement materials, including the Case for Change, stakeholder presentations, events and media briefings.

Alternative versions and formats of the public engagement document, including in languages other than English, were available upon request. 

Our approach

To ensure meaningful engagement with patients and the public, we:

• Tailored our methods and approaches to specific audiences as required.
• Identified and used the best ways of reaching the largest amount of people and provide opportunities for underserved groups to participate.
• Provided accessible documentation suitable for the needs of our audiences.
• Offered accessible formats, including translated versions relevant to the audiences we wanted to engage with.
• Undertook equality monitoring of participants to review the representativeness of participants and adapted activity as required.
• Used different virtual/digital methods or direct and 1-1 telephone activity to reach certain communities where we become aware of any under-representation.   
• Arranged our engagement activities so that they covered the local geographical areas that make up Nottingham and Nottinghamshire.

Elected member briefings

Two one-on-one briefings with MPs were carried out by ICB representatives, providing information about the proposals, methods of engagement, and requesting any support in dissemination to constituents as well as gathering initial feedback from the MPs. 

In November 2024, the Nottinghamshire Health Scrutiny Committee (HSC) received a briefing on the Fertility Policy Review. Background information as well as the proposed policy was outlined. The engagement approach and methods were introduced including the targeted outreach to affected groups such as residents of Bassetlaw, single women, and LGBTQ+ individuals. The HSC was invited to review the briefing, contribute to discussions, suggest community groups for outreach, help disseminate engagement details and determine how they wished to stay informed on the policy’s development.

Public meetings

Three virtual public meetings were arranged for members of the public to give feedback about the proposals and to ask any questions they had to ICB representatives.  These meetings were arranged at times suitable for the working age population given the age profile of those who typically access fertility treatments. 

In each public meeting, ICB spokespeople described why there were different fertility policies in Nottingham and Nottinghamshire, the process underway to align these across the East Midlands and what criteria would be included in the proposed policy. Attendees were then given the opportunity to ask questions or provide any comments they had which were responded to live. For any questions that were not answered, a commitment was made to provide a response on our website. No such questions were raised.

Recordings of the online public meetings were made available on the ICB YouTube channel[1], and within the landing page for the fertility listening exercise on the ICB website[2] for people who were unable to join the live event.

In total, 9 individuals attended either of the public meetings.  

Attendance at these public meetings was lower than anticipated despite the extensive promotional activities and outreach work as detailed in Appendix 1. This was consistent with the experience of other ICBs in the East Midlands.  It is surmised that given the personal and emotional response that discussions about fertility often generate that citizens did not want to participate in public discissions and instead preferred to complete the online survey. 

Community group events and meetings

Local community group events and meetings were found through online research and utilising the knowledge and experience of external colleagues and resources. This included visits to local health community hubs, where a stand with information on the listening exercise was hosted. At that event the team spoke to 30 members of the public. Information was also shared at the local asylum seeker and refugee multi-agency forum, for information to be further distributed.

Community group meetings

Key groups and communities were identified through an extensive stakeholder mapping database undertaken by the ICB.  An invitation was sent to 2000 stakeholders (including Healthwatch, local Voluntary Community Social Enterprise (VCSE) groups, LGBTQ+ groups, Women’s groups and Bassetlaw place groups), offering members of the ICB Engagement Team to attend community/groups meetings, provide presentations and obtain feedback. This offer was also shared at the public and community events attended as above. The ICB did not receive any invitations to attend group meetings.

Leaflet Drops

Key community hubs were selected to improve the LGBTQ+ engagement. ICB colleagues attended these locations to drop off A5 leaflets describing the proposed policy change and how the public could share their voice, including a QR code linking to the survey. A total of 100 leaflets were dropped off across Nottingham and Nottinghamshire.                                          

Survey

Citizens and stakeholders were invited to complete an online survey about the proposals (see Appendix 2). The survey was circulated electronically to individuals and groups whose details were held on our stakeholder database.

Paper surveys were also available which contained the same questions as the online survey. There were no requests for other languages or formats.

The survey comprised a number of questions, where responses could be made via rating scales or through free text. In total, 427 individuals of the 2,046 who provided a response to the survey were from Nottinghamshire, with 33 of those being from Bassetlaw specifically. It was acknowledged that not all those who completed the survey disclosed their locality, and therefore this number may be even higher.

Data analysis and reporting

All written notes taken during the public meetings, community group meetings, and qualitative responses from the survey were thematically analysed. Quantitative data was analysed to produce descriptive statistics.

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^[1] A recording of the online fertility session is available on YouTube here

^[2] The recording of the online fertility session is also available for viewing on the ICB website

In total, 427 people responded to the survey from Nottingham and Nottinghamshire. The demographic information for this cohort is summarised below, with a full breakdown available in Appendix 3

33 (8%) responses were received from residents in Bassetlaw.

85% of the respondents were female (n = 355) whilst 10% (n = 42) were male, 3% (n = 13) would prefer not to say, 1% (n = 4) identified as Other, 1% (n = 3) identified as Trans Non-binary and 0.2% (n = 1) were inter-sex.

Nearly all respondents indicated that their gender matched their sex registered at birth (95%; n = 400). The highest number of responses to the survey were completed by the 35-44 year age group (34%; n = 143), followed closely by the 25-34 year age group (33%; n = 140).

The highest number of responses to the survey (87%; n = 362) were completed by the White – English/Welsh/Scottish/Northern Irish/British ethnic group. 

The majority were heterosexual/straight (86%; n = 361) whilst 4% (n = 18) would prefer not to say, 4% (n = 17) were bisexual, 4% (n = 16) were gay women/lesbian, 2% (n = 6) identified as pansexual, 0.5% (n = 2) were gay men and 0.2% (n = 1) were asexual.

96 people (23%) indicated that they had a long-standing health condition and/or physical/mental impairments that limit their ability to carry out day to day activities. 89 indicated that they had caring responsibilities (22%). 55% (n = 230) stated that they did not have a religion and 36% (n = 150) were Christian.

Results from the quantitative survey questions

Who is affected by this policy?

419 respondents answered this question with 8 individuals opting to skip the question.

Answer	Number	Percentage
It affects me	128	31%
It affects someone I know	89	21%
It affects both me and someone I know	47	11%
It affected me in the past	68	16%
It affected someone I know in the past	36	9%
It does not affect me or anyone I know	51	12%

Participants were asked to specify how long ago they underwent treatment, if applicable, and 251 responded. Many were currently receiving treatment, had recently started, were waiting to begin soon, or anticipated needing fertility support in the future. A considerable portion had undergone treatment within the past five years (2019–2024), while others reported receiving treatment 5–10 years ago (2014–2018). Some had experiences dating back over a decade (pre-2014). A smaller group referenced treatments from more than 25 years ago, with responses reaching as far back as 1993 and even 1984.

Question	Yes	No	Don’t know/ unsure	Total
Do you agree with the proposal to standardise IVF treatment across the entire East Midlands region by offering one cycle of IVF for all areas?	206 (49%)	183 (43%)	35 (8%)	424
Do you agree with the proposal to offer up to three cycles of unstimulated IUI/DI for eligible couples or individuals before considering IVF?	252 (59%)	99 (23%)	75 (18%)	426
Do you agree with this proposal to offer fertility services in line with the clinical criteria for age and BMI set out in the NICE guidance?	245 (58%)	147 (35%)	33 (8%)	425
Do you agree with the proposal to require all individuals involved in fertility treatment to be non-smokers or have quit smoking/vaping?	384 (90%)	20 (5%)	22 (5%)	426
Do you agree with the proposal to continue the policy that individuals wishing to become pregnant and/or their partner must not have a living child from their current or any previous relationship?	94 (22%)	277 (65%)	55 (13%)	426
Do you agree with the proposal to not provide fertility treatment where infertility is caused, either wholly, or partly by the Sterilisation of the individual or partner?	274 (64%)	75 (18%)	77 (18%)	426
Do you agree with the proposal that same sex female couples will be recognised as requiring fertility support and get a referral for fertility treatment if they meet all other criteria?	329 (77%)	61 (14%)	36 (9%)	426
Do you agree with the proposal that single women and trans men are recognised as requiring fertility support and get a referral for fertility treatment if they meet all other criteria?	275 (65%)	98 (23%)	53  (12%)	426
Do you agree that patients should have access to gamete storage if they are about to undergo medical or surgical treatment that is likely to permanently affect their fertility?	399 (94%)	13 (3%)	14 (3%)	426
Do you agree with the proposal that the NHS funds storage of gametes or embryos for up to three years?	298 (70%)	73 (17%)	55 (13%)	426

Overarching qualitative themes

Regional and national standardisation

Many respondents appreciated the opportunity to express their views on the policy review as they have concerns on the disparities between areas in accessing fertility treatments and referred to ‘postcode lotteries’. They highlighted the need for a consistent and fair policy that ensures equal access to fertility treatments regardless of location and stressed the importance of thorough consideration and implementation of any changes to the policy.

“I am pleased this is happening to provide equity across the region. The postcode lottery needs to stop!”

The support for the regional standardisation of the fertility proposal was cited due to equality reasons and that it was fairer than the current policy, particularly with regards to same sex couples.

Comments were made to increase the number of NHS-funded IVF cycles to match the current provision in Bassetlaw rather than all have one round.

Respondents also made the case for a national policy so that it is fairer across the country.

“This needs to be standardised across the UK.”

Specific medical considerations 

Responses also showed that many people see infertility as a medical condition and a human need rather than a want.

There were calls for the policy to address specific medical conditions such as Polycystic Ovary Syndrome (PCOS) and endometriosis.

Others highlighted the specific requirements of people undergoing treatments like chemotherapy for example with the need for long-term storage of eggs. 

Some respondents expressed concerns about the medical and social implications of offering fertility support to single women and trans men, questioning whether they should take priority over couples facing medical infertility. Many emphasised that medical and clinical criteria should be the primary basis for fertility treatment, arguing that it should be reserved for those with a clear medical need.

Counselling and additional support services

The need for comprehensive counselling and support services was another significant theme. Respondents felt that these services should be readily available to all individuals undergoing fertility treatments.

Some respondents suggested additional services and support that could be beneficial. This includes genetic testing, support for those with long-term health conditions, and better communication between private and NHS services.

Many respondents highlighted the lack of support available for women needing to lose weight to access fertility treatment and argued that if strict BMI criteria are in place, there should be accessible medical support, including weight loss programmes and medications, to give women a fair chance at improving their health and fertility.

Respondents also reasoned that while it is important to encourage individuals to quit smoking, it is equally important to provide them with the necessary support to do so. 

“I think they should as part of the treatment be offered assistance to stop as undoubtedly, they will want the best chance at a successful pregnancy.”

Fairness and Equality

A recurring theme among respondents was the need for fairness and inclusivity in accessing fertility services. There was strong support for policies that promote fairness, prevent discrimination, and uphold the right of all individuals to build a family. Many emphasised the importance of equal treatment for all individuals, including same-sex couples, single women, trans men, individuals with stepchildren, and those with disabilities. 

“Everyone should have an equal opportunity to have fertility treatments.”

“It is wildly unfair. I am a single woman, trying for a child with donor sperm as a solo mum by choice. I have just as much right to try for a family as someone in a more ‘traditional’ family set up and should be supported in the same way as hetero couples are. I have to fund all of my treatment myself, purely because I am single. It is wildly discriminatory.”

“It needs to be fair and inclusive. The mental health of women is overlooked when it comes to fertility. The pressures that it puts on couples and your own health is incredibly stressful. There needs to be more support, fertility issues should be spoken about more in the media etc. “

Barriers to fertility treatment, particularly restrictive eligibility criteria, were a major concern. Respondents called for policies that ensure accessibility for everyone seeking treatment, regardless of relationship status or gender identity. 

“Everybody has the right to have a child, regardless of sexual orientation.”

“It’s about equality and people being able to live their lives and fulfil their dreams with the person they love.”

“Again, it’s about applying the rules consistently and equitably. Loving families come in all shapes and sizes,”

Ethical and legal considerations were also raised, with many stressing that fertility policies should align with modern societal values and equality laws. Some specifically argued that denying treatment to same-sex female couples would be discriminatory. 

“Equality for all people is so important. The knowledge that you’re not going to be discriminated against for your identity either directly or indirectly is key.”

Some respondents discussed practical considerations related to fertility treatment for same-sex female couples. They mentioned the need for clear criteria and guidelines to ensure fair access.

“If they meet the usual criteria they should not be treated differently than a heterosexual woman”.

Waiting times, communication and information

Concerns about long wait times and limited accessibility were frequently raised. Many respondents emphasised the need to shorten wait times and ensure services are more readily available, including expanding locations to reduce travel burdens. 

Frustration over inadequate communication from healthcare providers was a common theme, leaving patients feeling unsupported and uncertain about their treatment journey. Some reported waiting years for fertility services, leading to emotional distress, repeated testing, and the need to actively chase appointments. 

“Improved waiting times, increased counselling sessions.”

Beyond delays, respondents felt let down by poor communication and a lack of knowledge among healthcare professionals, particularly GPs and referral services. Many highlighted that doctors were often uninformed about fertility treatment pathways, resulting in conflicting advice, unanswered questions, and further delays. 

“Better communication, sensitivity training and an easy process.”

The absence of clear guidance and timely care not only prolonged their fertility journey but also heightened stress and frustration, making an already difficult process even more overwhelming. Respondents stressed the need for better communication and clearer information about the treatment process to help manage expectations and reduce anxiety.

There were calls for greater transparency and better information dissemination. Respondents wanted clear guidelines and information about the processes and criteria involved in fertility treatments.

“A clear process should be established for individuals or couples who conceive naturally but were close to proceeding with IVF.”

Respondents emphasised the need for greater empathy, timely referrals, and clearer guidance on available resources.

Number of IVF Cycles

Several respondents felt that the number of IVF cycles offered should be increased and standardised. They highlighted that one cycle of NHS-funded IVF is not sufficient for the needs of the population and that the areas should be increased to two or three, some elaborate that it should be increased due to success rates, compliance with NICE guidance, cost implications for patients and the impact on people’s mental health and stress. Some noted the declining birth rate as a factor in their opinion.

“As per NICE guidance, 3 fertility cycles should be available for all patients in the Mmidlands region. Unexplained (or otherwise) or inability to afford expensive private treatment should not stop eligible people accessing appropriate fertility care on the NHS.”

Mental health impact

A key theme across the responses was the profound physical and emotional toll of fertility treatment. Many respondents described experiencing significant distress and anxiety throughout their journey, exacerbated by financial burdens and strict eligibility criteria, such as BMI restrictions.

“Anxious, sleep deprived, frustrated at delays and mixed communications, like living in a nightmare.”

The requirement to lose weight to meet BMI thresholds was a particular source of stress, negatively impacting mental health for those already struggling with infertility. Additionally, several respondents highlighted the emotional strain of policies that deny treatment based on a partner’s existing children, describing feelings of helplessness and frustration.

“Strongly disagree, my husband is a fantastic stepfather to my one child, but I see his heartbreak every time he wishes that he could have those moments with his own too. In fact, it’s difficult for our marriage because we can’t afford IVF privately… yet if he left me to be with a woman without children, he would be given the chance on the NHS to have IVF. I carry a huge amount of guilt around… there’s absolutely nothing I can do to ease this for any of us…”.

There was a strong call for improved mental health support. Many felt that current provisions were inadequate and did not sufficiently address the emotional challenges of fertility treatment. Respondents advocated for consistent, accessible counselling and regular mental health check-ins throughout the process, with some emphasising the need for flexible support options.

“More support required for those who are not successful, there is nothing out there for those who will never go on to have a family. Something that has ruined my own life and impacted on my mental health ever since. There is no support out there.”

Many also felt that healthcare professionals did not fully recognise or address the psychological impact of infertility. Fertility treatment was described as an isolating and distressing experience with limited psychological support. Respondents suggested better resources for those facing miscarriages or failed treatments, including preparation for these possibilities and structured emotional support when they occur.

Fair and individualised assessments

Many respondents advocated for a more flexible approach to eligibility criteria for fertility treatment, emphasising the need for case-by-case assessments. They highlighted factors such as medical history (including conditions like endometriosis, PCOS, or cancer), blended family dynamics, and financial circumstances as important considerations.

“What I think you’re missing is the humanity in all of this. There is no one size fits all system, each case is totally different to the next and should be judged as so… giving a flat rule for everyone in every circumstance is just wrong and will cause so much distress and worry for people like myself who are struggling with fertility.”

A recurring theme was opposition to a rigid, one-size-fits-all policy. Respondents argued that strict adherence to criteria such as BMI, age, or existing children fails to account for the diverse factors influencing fertility and access to treatment. Instead, they called for evaluations based on individual merits, considering alternative health indicators and the nature of relationships, particularly in cases involving stepchildren.

“I understand that there is evidence behind these recommendations and that from a financial perspective/business case there unfortunately is some cuts off that will be enforced. Being in the category of increasing age and increasing BMI I believe there should be more of a health related assessment involved. BMI is not always the most accurate measure of a person or is age. I do understand the science and evidence but not one person’s situation is reflective of the next. I feel this needs to be more fluid and individualised”.

“Individual circumstances are unknown and this blanket policy does not take into account whether the individual or person has any contact or access to their living child.”

Some respondents raised ethical and medical concerns, particularly for individuals sterilised due to medical necessity or coercion. They asserted that such cases should be treated differently and not result in automatic exclusion from fertility treatment.

Additionally, a number of respondents expressed conditional support, suggesting that single women and trans men should receive fertility support if they meet specific criteria. Others emphasised that assessments should prioritise the ability to provide a stable, loving environment for a child, ensuring that individual circumstances and needs are carefully considered.

Financial impact on patients

A number of respondents highlighted the financial strain associated with fertility treatments, emphasising that the current policy imposes an unfair burden on those seeking care. Many expressed concerns about the lack of NHS funding, which forces individuals to pursue costly private options, adding to their stress and anxiety. 

“I am a single woman, I had a stillborn baby 3-years ago, I would like to try it again, but I am single and I have no money. It is frustrating.”

Some respondents specifically noted the financial barriers faced by same-sex female couples, pointing out inconsistencies in access across different regions. They argued that these couples should not be disproportionately burdened with private treatment costs. 

Others raised concerns about the financial and resource implications of providing fertility treatments to individuals who have undergone sterilisation. They suggested that NHS resources are limited and should be prioritised for those who did not choose sterilisation. 

Overall, respondents advocated for increased financial support to make fertility treatments more accessible and to alleviate the stress associated with high costs.

NHS financial resources

Some stated that funding of fertility is not a priority as there are more important conditions (some argue that infertility is not a medical concern) and therefore it should not be funded by the NHS, often citing the financial pressures currently faced by the NHS locally and nationally. 

Several respondents expressed concerns about NHS resource allocation, questioning whether fertility treatment for same-sex female couples, single women, and trans men should be prioritised. They argued that NHS funding should be reserved for those with medical fertility issues rather than lifestyle choices. Many emphasised financial considerations, asserting that individuals who choose to be single or transition should bear the cost of their own fertility treatment.

“Single women should self-fund if they wish to have a child alone.”

Clinical evidence, best practices and support for NICE guidelines

Many respondents supported a policy rooted in clinical evidence and best practices, noting the importance of evidence-based decision-making to enhance patient outcomes. There was strong endorsement of NICE guidelines, with respondents highlighting their role in optimising success rates.

Several participants noted the impact of personal health choices, such as maintaining a healthy weight and quitting smoking on fertility outcomes. Many stressed the significant health benefits of smoking cessation for both the individual and the potential child, believing that promoting overall well-being is essential for a successful pregnancy.

Additionally, respondents acknowledged that individuals have control over certain lifestyle factors, such as weight management and smoking habits, and should prioritise their health to improve their chances of success. They argued that adhering to these criteria enables the best possible outcomes for both mother and child.

Fertility care among GPs and clinical staff

A common concern was the lack of fertility knowledge among GPs and other healthcare professionals, leaving many feeling unsupported and misinformed. Respondents reported receiving inconsistent advice, incorrect information, and a general lack of understanding of conditions such as male-factor infertility. This issue extended beyond GPs, with some noting that even fertility clinics lacked expertise in specific conditions.

There was a strong call for improved GP training on fertility issues, including both medical knowledge and the emotional challenges individuals and couples face. Many felt that GPs, particularly male GPs, were not well-informed, leading to delayed referrals and inadequate support.

“Give GPs, male GPs in particular, more information on fertility and women’s health so you’re not spending a year trying to get referred first of all.”

Additionally, participants stressed that GPs should proactively educate patients on what to expect from fertility services and the emotional toll of treatment. Enhanced awareness would ensure individuals receive timely, compassionate, and informed care.

Many respondents described feeling ignored, invalidated, or treated without empathy when discussing infertility with healthcare professionals. Some felt reduced to a number or a burden rather than being met with care and understanding. There was a clear demand for more compassionate, sensitive care, with respondents calling for better training to help healthcare staff support patients emotionally throughout their fertility journey.

Positive experiences

Despite the challenges, some respondents shared positive experiences with fertility services, expressing appreciation for the support and care offered by specific clinics and healthcare professionals.

“For me personally, the whole experience was positive. We started our IVF journey 3-years ago.”

Feedback relating to specific elements of the policy

IUI

Many respondents viewed IUI/DI as a less invasive and physically taxing alternative to IVF, making it a preferable first step for some individuals. However, others felt the priority should be minimising stress and maximising success, rather than focusing solely on less invasive options.

“IVF is brutal. Therefore, if IUI is an option (no known fertility issues) it should be considered.”

Concerns were raised about the stress and emotional toll of IVF, with some advocating for IUI/DI as a gentler initial approach. At the same time, many respondents questioned the low success rates of IUI/DI and its financial viability, arguing that resources might be better allocated to IVF, which offers higher chances of success.

“Low success rates seem to be a waste of money, even in healthy couples it can take over 8 months of trying to get pregnant so 3 cycles of IUI is surely unlikely to be successful.”

Patient choice and empowerment emerged as key themes. Respondents emphasised that individuals should have the freedom to choose between IUI/DI and IVF based on their personal circumstances. While IUI/DI should be available as an option, many felt it should not be a prerequisite for accessing IVF.

Some respondents also highlighted the potential cost-effectiveness of IUI/DI, suggesting that despite its lower success rates, it could reduce the overall need for more expensive IVF treatments.

BMI

Many respondents strongly opposed using BMI as a criterion for fertility services, arguing that it is an outdated and inaccurate measure of health, especially for women. They pointed out that BMI fails to consider muscle mass, body composition, and other key health indicators. 

“BMI is a nonsense scale and I honestly don’t understand why it is still used by the NHS as any sort of scale of health.”

Concerns about discrimination were also prevalent. Many felt the criteria were unfair, particularly for individuals with medical conditions like Polycystic Ovary Syndrome (PCOS), which can affect weight. They argued that BMI-based restrictions could unjustly exclude otherwise healthy individuals capable of carrying a pregnancy. 

“BMI is an outdated and often incorrect way to assess a womens health. Women with a BMI of over 30 conceive naturally ALL of the time. Often those with conditions like PCOS struggle to lose weight but can control the condition with medication which regulates periods and encourages ovulation. Why are we penalising these women and saying they can’t have the chance to be a mother because their BMI is over 30? It’s only one “rating” of a person’s health and means little in isolation”.

Additionally, respondents highlighted racial bias, noting that BMI does not account for diversity in body types. Many called for a reassessment or greater flexibility in BMI and other health-related criteria to ensure fairer access to fertility services.

Age

There was more acceptance of the age criteria, with many respondents acknowledging that age plays a significant role in fertility. However, some suggested that the age limit should be increased to reflect modern health standards and the trend of women having children later in life.

“In this day and age, women are having children older, it would be great to see the age barrier stretched.”

Previous children

Most respondents felt this aspect of the policy was unfair and discriminatory, particularly against individuals without biological children whose partners have children from previous relationships. They strongly expressed that it unjustly penalises people for their partner’s past decisions, which were beyond their control.

“This is a disgraceful policy… my partner has a child who doesn’t live with us and lives in another country… we would make amazing parents, the system is failing people like us… it discriminates against the partner without a child. For some individuals, having a biological child is extremely important to them. It is not fair that just because they wish to have a child with somebody who already has a living child, they are denied from having their own biological child”.

“Having children from a previous relationship should not prevent couples from. Having children together”.

Some respondents partially agreed with the proposal but believed it should apply only when a couple has a living child together, not when children are from prior relationships. A few also highlighted the negative impact of secondary infertility.

“This is a discriminatory proposal. More often than not directly affecting a female in a relationship. A person having a child in a relationship 20 years ago is now not allowed to have a child in their new relationship.”

Many pointed out that modern relationships frequently involve blended families, and the policy fails to reflect this reality. They argued that it should be revised to accommodate the complexities of contemporary family structures.

“I think this is a very old fashioned approach. Lots of different situations that people find themselves in and again 1 in 4 marriages breakdown therefore blended families are much more welcomed and common but you should not be penalised for this”.

Ethical and moral concerns were also raised, with respondents asserting that it is unjust to deny someone the opportunity to have a child based on their partner’s past. They viewed the policy as outdated and misaligned with current societal values.

Additionally, some respondents highlighted perceived inequalities between single women and those in relationships. They argued that if single women are eligible for IVF, it is unfair to exclude women whose only barrier to treatment is their partner’s parental status. Some feared this could lead to relationship breakdowns, while others suggested it might encourage system manipulation to qualify for treatment.

Gamete storage

Many respondents stressed the importance of preserving fertility for patients undergoing medical treatments that could impact their ability to have children. They believed that everyone should have the opportunity to start a family, regardless of their medical condition. Gamete storage was seen as crucial, offering hope and future planning for patients facing treatments like chemotherapy or radiotherapy. Respondents highlighted the necessity of this service, emphasising that life-saving treatments should not preclude the possibility of having children later.

A recurring theme was the emotional and psychological impact of fertility loss due to medical treatments. Respondents noted that access to gamete storage could alleviate some of the distress and mental health challenges associated with such diagnoses. Many felt that offering this service was not just a medical necessity but also an ethical and moral obligation to support individuals facing life-altering conditions. Compassion and fairness were strong motivators, with respondents arguing that patients should not face additional burdens due to their medical circumstances. Respondents also raised concerns about the psychological and social implications of time-limited storage, emphasising the need for adequate recovery time before making significant life decisions.

“Medical treatment such as cancer treatment is hard enough without having to also worry about future fertility and funding this.”

Concerns about equity and accessibility were also prominent. Many believed that all patients, regardless of financial situation, should have access to gamete storage and supported NHS funding for this service. Some respondents raised ethical considerations, suggesting clear guidelines to ensure that only those with a genuine medical need could access it.

“If someone is unfortunate enough to suffer an illness like cancer, we absolutely should try to protect their ability to have a baby.”

A significant number of respondents criticised the proposed three-year storage period, particularly for individuals preserving fertility after a cancer diagnosis. They argued that recovery often takes longer than three years and that many patients may not be ready to make family planning decisions within that timeframe. Younger patients, especially teenagers, were seen as needing more time to consider their future. Many suggested that storage duration should be determined on a case-by-case basis, factoring in the type and length of medical treatment.

“I believe this should be considered on a case by case as if the treatment for cancer is going to take 3-years, then they are prejudiced by a 3-year retention policy.”

“This proposal discriminates against young people who are storing gametes or embryos prior to cancer or other potentially sterilising treatment…”

“Having a life-changing medical treatment shouldn’t mean that you can’t have a child in the future because you don’t have the income to pay for gamete storage.”

There were mixed opinions on the financial implications of extending storage periods. Some felt that individuals should contribute to costs beyond three years, while others believed that continued NHS funding was necessary, particularly for those with severe illnesses. While a few respondents supported the three-year limit as a fair compromise given NHS financial constraints, others felt that alternative options, such as private extensions, should be made available.

Some respondents were unsure about the proposal and felt that more information was needed to make an informed decision. They expressed confusion or uncertainty about the criteria and implications of the proposal. For example, with regards to gamete storage people highlighted a lack of clarity on key factors such as cost, embryo viability after three years, and the number of affected individuals. Many expressed a need for evidence supporting the proposal, as well as a clearer understanding of its legislative and scientific basis. Others felt that the question was misleading, as it did not explicitly state that the change would reduce the current 10-year storage period to three years for cancer and trans patients.

Smoking

A large number of respondents emphasised the health benefits of quitting smoking or vaping for both individuals undergoing fertility treatment and their potential child. Many believed that ensuring optimal health conditions is essential for a successful pregnancy.

“Smoking is harmful to a foetus so people seriously considering fertility treatment to achieve a pregnancy should at least be in the process of attempting to give up smoking in preparation for this.”

However, some expressed concerns that such policies might encourage dishonesty to access treatment. Others questioned whether vaping should be included, as many use it as a tool to quit smoking.

Fairness and support were key considerations for several respondents, while others raised concerns about personal choice and autonomy, arguing that individuals should have the right to make their own decisions regarding smoking and fertility treatment.

“Smoking does not prevent you becoming pregnant or carrying a baby naturally and whilst it is preferable not to smoke or vape, it is an individual’s right to choose.”

“This issue is too nuanced to answer yes or no. There have been natural pregnancies in people who regularly smoke and not.”

A few respondents also highlighted ethical and moral concerns, questioning whether it is justifiable to deny fertility treatment based on smoking habits, especially when other harmful behaviours do not lead to medical treatment denial.

“Why are people with fertility difficulties made to jump through hoops when there are people out there on drugs, drinking excessively etc having pregnancies and children getting taken into care or left to differ abuse.”

Sterilisation

Many respondents believe that sterilisation is a personal choice and that individuals should take responsibility for their decisions. They argue that since sterilisation is often a deliberate and informed decision, those who choose it should not expect NHS-funded fertility treatments if they later change their minds.

A large number of respondents however highlight that life circumstances can change, and people should not be penalised for decisions made in the past. They argue that new relationships, changes in personal situations, or even the loss of a child can lead individuals to reconsider their desire for children.

“Things change, partners change and there may be reasons that this once was needed but it’s not the case anymore. I don’t believe this should apply.”

Belief in traditional family structures

Some respondents emphasised the importance of traditional family structures, asserting that children benefit most from being raised by both a mother and a father. They expressed concerns about the potential impact of single parenting on children’s mental health and overall wellbeing, believing a two-parent household provides greater stability.

A few raised ethical and moral concerns about the proposal, questioning whether fertility treatment should be provided to individuals whose lifestyle choices have affected their fertility.

While there was considerable support for single women receiving fertility treatment, some respondents were hesitant about extending this to trans men. Their concerns largely centred on the perceived complexity and appropriateness of trans men undergoing fertility treatment. Others opposed the proposal altogether, believing that neither single women nor trans men should receive fertility support.

The findings from this listening exercise will be used by Nottingham and Nottinghamshire ICB, alongside clinical and financial considerations, to develop a final Fertility Policy, in partnership with the other ICBs in the East Midlands. The Engagement Team will continue to work with Commissioning and Contracting colleagues to support the financial recovery plan, specifically to:

• Lead involvement work with patients and the public for proposals which have an impact on how patients access or receive services.
• Continue to proactively engage with the Health Scrutiny Committees as the programme develops.

1.1       Appendix 1: Engagement Log

Date	Description	Audience
17 October 2024	Informal meeting: County HSC Chair and Vice Chair	County HSC
22 October 2024	Informal meeting: City HSC Chair	City HSC
28 October 2024	Notification of Engagement exercise	Fertility treatment providers
07 November 2024	Proposed engagement details shared	Engagement Practitioners Forum
11 November 2024	Mansfield Chad	Mansfield Citizens
11 November 2024	Launch e-mail forwarded to Co-production Team	Your Voice Your Choice – Pohwer
11 November 2024	Hucknall Dispatch	Hucknall Citizens
11 November 2024	ICB social media	Citizens
11 November 2024	Worksop Guardian	Worksop Citizens
11 November 2024	Launch e-mail (2,000 contacts)	All stakeholders: Healthwatch Nottingham and Nottinghamshire Media MPs Local Authority Councillors Local Health Scrutiny Committees VCSE Alliance/Local VCSE Keep our NHS Public Community Network Representatives Women’s groups Trans Men’s groups Same sex couples groups Bassetlaw Place Current patients, General Practice and Primary Care ICB social Media NHS Trusts E&D leads for Nottm &Nottinghamshire Babes breastfeeding groups Carers Children’s Centres Family Hubs Community Forums CVS Leads Ethnic Communities Faith Groups ICB LGBTQ+ Fertility groups Local Authority officers
12 November 2024	Shared at Mid Nott’s Health Inequalities Oversight Group	Mid Notts health and care colleagues
14 November 2024	Launch e-mail	Staff LGBTQ+ network
14 November 2024	Launch e-mail	VCSE Alliance Strategy workshop attendees
14 November 2024	Launch e-mail	Circulated to Nottingham Recovery Network Team
15 November 2024	Launch e-mail shared on Bassetlaw Place Facebook page	Bassetlaw residents
15 November 2024	Bassetlaw Place -November News	800 contacts
15 November 2024	Facebook in Bassetlaw (Ran by Rachel Wood)	Bassetlaw residents
15 November 2024	Local groups in Bassetlaw via Rachel Wood	Bassetlaw residents
15 November 2024	Launch e-mail	LMNS SYB and CYP Networks in Bassetlaw
15 November 2024	Launch e-mail	Larwood and Bawtry PCN followers
16 November 2024	Mail online	National public
17 November 2024	GB News	National public
18&19 November 2024	Launch e-mail shared with fertility treatment providers	Fertility treatment providers
18 November 2024	Social media post shared by County Council on Instagram and Facebook and Family Hubs page	Public
18 November 2024	Public Face Newsletter	Public
18 November 2024	Health Innovation East Midlands -Shared with the Senate members requested to respond on an individual basis.	Health Innovation, Senate members
18 November 2024	Health Innovation East Midlands- Shared with Public Contributor List consisting of over 100 people.	Health Innovation Public contributors
18 November 2024	Launch e-mail shared with Women’s Organisations and Networks	Nottingham Women’s Centre visitors
18 November 2024	Shared with ICB and the ICS LGBTQ+ System Voice network who can distribute it to all their organisational LGBTQ+ networks.	Organisational LGBTQ+ networks
18 November 2024	Shared via local networks and raised in meetings. I’ll make people aware you are able to visit and talk to groups.	Organisational LGBTQ+ networks
18 November 2024	2nd E-mail	Family hubs Alliance/CVS (LGBTQ+ Groups running) Libraries Bassetlaw Women’s groups including single women Fertility Endometriosis LGBTQ+ including trans men, same sex couples
18 November 2024	NUH LIFE (States it’s a consultation)	Public
18 November 2024	PET  Published 18 November 2024 posted in Elsewhere and appears in BioNews 1265	Public
18 November 2024	Launch email	Bassetlaw CVS channels and networks
19 November 2024	Informal meeting: City HSC Chair	City HSC
20 November 2024	Nottinghamshire HSC meeting	Nottinghamshire HSC
20 November 2024	Notts tv	Public
20 November 2024	Lincolnshire Focus	Public
21 November 2024	Girls and Women Violence Network Conference – to network and further promote	Professionals
21 November 2024	Healthwatch social media
21 November	West Bridgford Wire	Public
22 November 2024	BCVS	Public
22 November 2024	Meeting with Jo White MP	MP
25 November 2024	Letter to patients promoting engagement NUH Life	Patients
26 November 2024	Nottingham Post	Public
27 November 2024	BBC East Midlands Today -first item
27 November 2024	Meeting with Michelle Welsh MP	MP
27 November 2024	BBC News	Public
28 November 2024	NCVS
28 November 2024	Informal meeting: County HSC Chair and Vice Chair	County HSC
28 November 2024	Online public meeting 6.30pm – 8.00pm (6 people)	Public
03 December 2024	Healthwatch Nottingham & Nottinghamshire December update	Mailing list
03 December 2024	Nurture webinar	Public
04 December 2024	ICB communications Update	Comms stakeholders
05 December 2024	E-mail to Centre Place Service manager (updated contacts)	Georgia Crosslands
10 December 2024	Shared with Active Rushcliffe Health Partnership meeting members	ARHP members
10 December 2024	NUH Life	Leadership Team
11 December 2024	Update e-mail with social media resources (third e-mail)	Full stakeholder list
11 December 2024	Leaflet drop: The Health Shop, Broadway Cinema, Six, Barrels Victoria, The Golden Fleece, The Health Shop, Hockley Transgender clinic, Ashfield Voluntary Action, The Women’s Centre, Café Sobar, Nottingham Central Library, Nottingham Contemporary.	Visitors to these venues
12 December 2024	Leaflet shared by James Naish for Rushcliffe Facebook page
12 December 2024	Shared to Multi Agency Forum Meeting members	MAF (city)
12 December 2024	Shared in Bulwell & Top Valley Integrated Neighbourhood Team Newsletter	Bulwell & Top Valley local organisations and partnerships
12 December 2024	Leaflet drop to The Centre Place in Worksop	Visitors/ beneficiaries
12 December 2024	Online public meeting 6.30pm – 8.00pm (3 attendees)	Public
14 December 2024	Online public meeting 10.00am – 11.30am (Saturday)	Public
16 December 2024	Health Community Hub at The Chase Neighbourhood Centre, St Anns. The Engagement Team attended the Health Community Hub organised by Nottingham City East PCN. These are regular events open to the local community, attended by community organisations including the Police, Social Prescribing link workers, Nottingham Health and Wellbeing Hub, Notts County Football and Thriving Nottingham. A stand with information about the East Midlands Fertility Policy and how to get involved was available. Around 30 people attended the event, two leaflets were taken, one  view expressed  was in strong support of LGBTQ + individuals having equitable access to fertility treatment.	Public
07 January 2025	NUH LIFE response	Engagement Team

Appendix 2: Survey Questions

• Does the fertility policy affect you or someone you know, or has it affected you in the past?
• It affects me
• It affects someone I know
• It affects both me and someone I know
• It affected me in the past
• It affected someone I know in the past
• It does not affect me or anyone I know
• Other (please specify)
• Do you agree with the proposal to standardise IVF treatment across the entire East Midlands region by offering one cycle of IVF for all areas?
• Yes
• No
• Don’t know / Unsure
• We want to understand why you gave the above answer. Please provide your comments below.
• Based on the information provided above, do you agree with the proposal to offer up to three cycles of unstimulated IUI/DI for eligible couples or individuals before considering IVF?
• Yes
• No
• Don’t know / Unsure
• We want to understand why you gave the above answer. Please provide your comments below.
• Do you agree with this proposal to offer fertility services in line with the clinical criteria for age and BMI set out in the NICE guidance?
• Yes
• No
• Don’t know / Unsure
• We want to understand why you gave the above answer. Please provide your comments below.
• Do you agree with the proposal to require all individuals involved in fertility treatment to be non-smokers or have quit smoking/vaping?
• Yes
• No
• Don’t know / Unsure
• We want to understand why you gave the above answer. Please provide your comments below.
• Do you agree with the proposal to continue the policy that individuals wishing to become pregnant and/or their partner must not have a living child from their current or any previous relationship?
• Yes
• No
• Don’t know / Unsure
• We want to understand why you gave the above answer. Please provide your comments below.
• Do you agree with the proposal to not provide fertility treatment where infertility is caused, either wholly or partly, by the sterilisation of the individual or partner?
• Yes
• No
• Don’t know / Unsure
• We want to understand why you gave the above answer. Please provide your comments below.
• Do you agree with the proposal that same-sex female couples will be recognised as requiring fertility support and get a referral for fertility treatment if they meet all other criteria?
• Yes
• No
• Don’t know / Unsure
• We want to understand why you gave the above answer. Please provide your comments below.
• Do you agree with the proposal that single women and trans men are recognised as requiring fertility support and get a referral for fertility treatment if they meet all other criteria?
• Yes
• No
• Don’t know / Unsure
• We want to understand why you gave the above answer. Please provide your comments below.
• Do you agree that patients should have access to gamete storage if they are about to undergo medical or surgical treatment that is likely to permanently affect their fertility?
• Yes
• No
• Don’t know / Unsure
• We want to understand why you gave the above answer. Please provide your comments below.
• Do you agree with the proposal that the NHS funds the storage of gametes or embryos for up to 3 years?
• Yes
• No
• Don’t know / Unsure
• We want to understand why you gave the above answer. Please provide your comments below.
• How did the fertility policy, or your experience accessing fertility services, make you feel during your journey? (Please also indicate how long ago your treatment was, if applicable)
• What changes would you suggest to ensure the policy is more supportive and understanding of the emotional challenges faced by individuals or couples?
• Do you think there is anything that’s been missed that needs to be included in the new East Midlands Fertility Policy?
• Please provide any other comments you may have regarding the East Midlands Fertility Policy review:
• Which area of the East Midlands do you live in?
• Derby and Derbyshire
• Leicester, Leicestershire, and Rutland
• Lincolnshire
• Northamptonshire
• Nottingham and Nottinghamshire
• None of the above
• Do you live in Glossopdale?
• Yes
• No
• Do you live in Bassetlaw?
• Yes
• No
• What is your age group? (optional)
• Under 18
• 18 – 24 years
• 25 – 34 years
• 35 – 44 years
• 45 – 54 years
• 55 – 64 years
• 65 – 74 years
• 75 – 79 years
• 80+ years
• Prefer not to say
• Please choose one option that best describes your relationship status.
• Single
• In a relationship
• Living with partner
• Married / Civil Partnership
• Separated
• Divorced / Dissolved Civil Partnership
• Widowed / Surviving Civil Partner
• Child
• Other
• Prefer not to say
• What is your Gender?
• Male
• Female
• Trans female
• Trans male
• Trans Non-binary
• Inter-sex
• Prefer not to say
• Other
• Have you gone through any part of a process (including thoughts or actions) to change from the sex you were described as at birth to the gender you identify with, or do you intend to? (this could include changing your name, wearing different clothes, taking hormones or having gender reassignment surgery)
• Yes
• No
• Prefer not to say
• Please choose one option that best describes how you think of yourself.
• Heterosexual / Straight
• Gay woman / Lesbian
• Gay man
• Bisexual
• Pansexual
• Asexual
• Prefer not to say
• Prefer to self-describe as… (please specify)
• Are your day-to-day activities limited because of a health condition or illness which has lasted, or is expected to last, at least 12 months? (please select all that apply)
• Vision (such as due to blindness or partial sight)
• Hearing (such as due to deafness or partial hearing)
• Mobility (such as difficulty walking short distances, climbing stairs)
• Dexterity (such as lifting and carrying objects, using a keyboard)
• Ability to comprehend, concentrate, learn or understand
• Memory
• Mental ill-health
• Stamina or breathing difficulty or fatigue
• Neurodiversity (e.g. Autism or Attention Deficit Disorder)
• No
• Prefer not to say
• Any other comments or definition of your condition or illness (please specify)
• Do you look after, or give any help or support to family members, friends, neighbours or others because of any of the following? (select all that apply)
• Long-term physical or mental-ill-health/disability
• Problems related to old age
• No
• I’d prefer not to say
• Other (please specify)
• Please choose one option that best describes your Ethnic Group or Background?
• White – English/Welsh/Scottish/Northern Irish/British
• White – Irish
• White – Gypsy or Irish Traveller
• White – Other
• Mixed/multiple ethnic groups – White and Black Caribbean
• Mixed/multiple ethnic groups – White and Black African
• Mixed/multiple ethnic groups – White and Asian
• Mixed/multiple ethnic groups – Other
• Asian/Asian British – Indian
• Asian/Asian British – Pakistani
• Asian/Asian British – Bangladeshi
• Asian/Asian British – Chinese
• Asian/Asian British – Other
• Black / African / Caribbean / Black British – African
• Black / African / Caribbean / Black British – Caribbean
• Black / African / Caribbean / Black British – Other
• Chinese
• Arab
• Prefer not to say
• Any other ethnic group (please specify)
• Please choose one option that best describes your religious identity.
• No religion
• Christian (including Church of England, Catholic, Protestant and all other Christian denominations)
• Buddhist
• Hindu
• Jewish
• Muslim
• Sikh
• Baha’i
• Jain
• Prefer not to say
• Any other religion (please specify)
• Please choose your preferred language option for communicating and interpreting information.
• English
• Arabic
• Bengali
• BSL (British Sign Language)
• Bulgarian
• Chinese
• Farsi
• Gujarati
• Hindi
• Hungarian
• Latvian
• Lithuanian
• Pashtu
• Polish
• Portuguese
• Punjabi
• Romanian
• Russian
• Slovak
• Somali
• Turkish
• Urdu
• Any other preferred language (please specify)