NHS told: give trans patients equal access to fertility service

Bowl mentioned on this, and I'm also really curious as to how most of them see this working out. It may be a stupid question but in which scenarios is this going to be a real possibility?

I know there have been so-called pregnant men, but as I understood it these people hadn't had surgery and had to lay off hormones (which in any case caused complications). So a FtM who had undergone a full transition would, presumably have to either find a surrogate or get a female partner to carry the child. Unless the female partner was infertile herself, why would they complicate matters and make success harder?

I suppose it's a bit more straightforward for transwomen with a female partner. But for others we're back at the surrogacy issue.

And aren't we supposed to believe that all this is triggering? How can they reconcile this?

I've c&p so capitals are from text.
Campaign launched last year by Becki McGuiness 'Cancer & Fertility UK':

"Thankfully I have now been in remission for 8 years but have to live with life long side effects. Early menopause is a hard one to deal with especially as the Gynecologist I had to see for HRT (Hormone Replacement Therapy) said they could have helped me, if only I had been originally sent to see her.

If only the hospital had a holistic approach for cancer patients.

I am officially launching a campaign for the awareness on #Cancer and #Fertility for all cancer patients called “The Vicious Cycle Campaign” and I’m also using the hashtag 💔 #HiddenHeartache 💔 because it’s something painful that’s hidden in society especially if you’re young and infertile. I want to raise awareness so women know the options available (as it takes longer to save women’s eggs and men usually get their fertility preserved, as it’s quicker) and asking to see a fertility specialist. I would prefer if all oncologists brought up the subject with every patient because for some patients it’s so traumatic finding out they have cancer that they might not even be thinking clearly enough or may forget to even ask about fertility and that’s why I believe they shouldn’t be putting this pressure on the patient to ask because they have so much to worry about already

This is something I am really passionate about. I know it can vary throughout the UK for different women and I want my campaign to make sure there’s equal opportunities for all women and men regardless who their doctor is or area they live in.

I want the protocol to be the same for everyone in the UK rather than being hit and miss for patients or a postcode lottery."

"A STUDY BY ST MARY’S HOSPITAL IN MANCHESTER SAYS AROUND HALF OF FEMALE CANCER PATIENTS AGED 15 TO 39 — ROUGHLY 4,000 A YEAR — ARE INFERTILE AFTER THEIR TREATMENT.
RESEARCHERS ESTIMATE THAT AROUND HALF WOULD VOLUNTARILY CHOOSE NOT TO USE FERTILITY PRESERVATION AND HALF WOULD WANT IT.

FREEZING EGGS, OVARIAN TISSUE OR AN EMBRYO CREATED WITH A PARTNER’S SPERM ACTS AS AN INSURANCE POLICY WHICH MAY GIVE THEM THE CHANCE TO START A FAMILY LATER USING IVF.
BUT IN 2014 ONLY 154 WOMEN HAD THEIR EGGS FROZEN — LESS THAN 4 PER CENT OF THE 4,000 WHO WERE LEFT INFERTILE.
AND A FURTHER SURVEY FOUND THAT ONLY A THIRD OF THE WOMEN WHO DID HAVE TREATMENT GOT IT ON THE NHS.
THE REST ARE LIKELY TO HAVE PAID THOUSANDS OF POUNDS PRIVATELY FOR THE CHANCE TO BE A MOTHER.
STUDY AUTHOR DR YAZAN ABDALLAH OF THE DEPARTMENT OF REPRODUCTIVE MEDICINE AT ST MARY’S SAID: ‘GETTING CANCER IS A MISFORTUNE, NOT A CHOICE, AND SO FERTILITY PRESERVATION MUST BE AVAILABLE ON THE NHS. THERE IS A BIG OPPORTUNITY TO INFORM AND EMPOWER WOMEN — NOT ASK THEM TO PAY... continues

THE RESEARCH, PRESENTED TO A BRITISH FERTILITY SOCIETY CONFERENCE IN EDINBURGH LAST WEEK AND DUE TO BE PUBLISHED IN THE JOURNAL HUMAN FERTILITY, SAYS THAT 77 PER CENT OF NHS FERTILITY CENTRES JUDGE CANCER PATIENTS ON THE STANDARD CRITERIA, DESPITE NICE’S GUIDANCE.
IT SAYS ANOTHER FACTOR IS THAT SOME PATIENTS OR THEIR DOCTORS MAY BE NERVOUS ABOUT DELAYING THE START OF CANCER TREATMENT UNTIL EGGS CAN BE HARVESTED. BUT THE AUTHORS SAY THIS CAN TAKE AS LITTLE AS 12 DAYS IF HORMONES ARE INJECTED TO STIMULATE OVULATION.
THE RESEARCH, WHICH HAS BEEN SUPPORTED BY CONSULTANT DR RAJ MATHUR, ALSO SHOWS A POSSIBLE POSTCODE LOTTERY FOR FUNDING, WITH LONDON AND THE NORTH-WEST OVER-REPRESENTED AMONG THE 154 WHO HAD TREATMENT.
DR CHERYL FITZGERALD, CONSULTANT IN REPRODUCTIVE MEDICINE AT ST MARY’S, SAID: ‘THERE IS A HUGE INEQUITY. MEN HAVING FERTILITY-DAMAGING TREATMENT ARE AUTOMATICALLY REFERRED TO SPERM BANKING.
‘FOR WOMEN, BECAUSE EGG FREEZING USED TO BE LESS SUCCESSFUL AND BECAUSE IT’S A MORE INVASIVE AND TIME-CONSUMING PROCESS, IT’S NOT AUTOMATIC.
‘THE EMPHASIS HAS OBVIOUSLY BEEN ON CURING CANCER, BUT WITH SO MANY PEOPLE SURVIVING CANCER, WE NEED TO LOOK AT IMPROVING THE QUALITY OF LIFE AFTER TREATMENT, INCLUDING THE CHANCE TO HAVE A FAMILY.’ ”

cancerandfertility.co.uk/about/

(not that I need IVF. but if I did, I couldn't on the NHS).

I am confused. What is the case for threats and special treatment of trans patients here?

The NHS is already refusing to fund basic IVF in many areas because of budget cuts/cost pressures not keeping pace with funding (or both at the same time). Ditto fertility preservation for adult people (including children) with cancer. This will add more demand so will create further disadvantage to them.

GMC (the regulator of doctors) guidance:

Trans healthcare

Trans and non-binary people experience the same health problems as everyone else and have very few differing needs. If a health problem’s unrelated to gender dysphoria or its treatment, trans patients should be referred to the same hospital or specialist services as everyone else.

www.gmc-uk.org/ethical-guidance/ethical-hub/trans-healthcare

I also think it is deeply unethical that children (anyone under age 18) should take any step -hormonal, medical or surgical- that would permanently compromise their future fertility for gender identity/dysphoria reasons. The NHS should not be stepping in to facilitate this with fertility preservation which is a very scarce resource already and is a real last resort because it can not guarantee a pregnancy or baby for anyone.

This professional guidance from RCN details the fertility preservation process:

www.rcn.org.uk/-/media/royal-college-of-nursing/documents/publications/2017/april/pub-005986.pdf

I can not get IVF in my area.

Equal access to services therefore equals the sum total of fuck all.

I wish WOMEN could get equal fertility treatment.

This is preferential treatment.

I'm not sure this is such a bad news story if it will mean infertility is properly discussed prior to puberty blockers being prescribed. It may mean fewer families take that step. It may lessen the pressure on parents to agree to their child going down this 'totally reversible' route.

I have also had this thought/hope.

I am also concerned that just as many young people who are transgender state confidently 'I will adopt' without much awareness of the reality of this process, they may also believe that in storing eggs, they will easily have children through IVF.

There does seem some tension with simultaneous lobbying (one presumes from the same sources) for both prompter medical treatment by way of blockers and cross-sex hormones and also fertility saving treatments for young people.

What is clear though is that of all of the patient-led lobby groups seeking parity or improved medical treatments, the transgender lobby stands head and shoulders above all others in terms of effectiveness.

I think 5% (could be totally wrong on that but it’s a few percent) risk of ovarian hyperstimulation syndrome which is potentially fatal too.

In the guardian article the usual line of ‘potentially life saving’ gender affirmation treatment is trotted out. How anyone can justify putting a child through egg harvesting unless they’re facing a life threatening illness treatment is beyond me.

Where the hell are the ethics committees in this?

www.healthline.com/health-news/donate-egg-become-infertile#2

Egg donation is a really serious business - some quotes from the link above:

I felt fully recovered within days of retrieval
Yes, it's a procedure that takes days to recover from (and that's just the retrieval, not even hormones in the lead up to it)

then:

The first sign that something was wrong came when my period just stopped. Months went by with no sign of my cycle. Then when it did return, it was with excruciating pain.

I began running fevers every time I got my period, doubling over in such pain that I couldn’t walk and often vomited because I was hurting so badly. That pain began to extend into my day-to-day life, even when I wasn’t on my period.

It turned out that she had stage 4 endometriosis, likely she had it before without knowing, but the hormones from the egg donation aggravated it to unmanageable levels, and left her infertile. The clinic that took her eggs stopped responding to her calls, leaving her to pay for all of this herself.

No research has been done on this - women are told it's a rare sideeffect, but mislead regarding the safety of egg donation.

On the scales of balance, it seems to me that putting a child through this so they can go on hormones doesn't actually balance. Just like to me, putting them on hormones for this alleged risk of suicide (also un-researched) doesn't balance.

R0wantrees

how Will this tie in with:

Push for demedicalisation if adults? As noted above this will apply for treatment for gender dysphoria - the very condition adults are trying to have removed from the books.

How will it work with our current (very strict, thank goodness) surrogacy laws?

In short - who is going to actually bear these children? Someone who has not undergone puberty and been on blockers and cross sex hormones will have significant atrophy of the Reproductive system. For a male who has had sperm harvested things are easier IF they have a fertile female partner.

How is this supposed to work?

Children who trans as early as mermaids want will not have nature sperm or ova to be able to be banked.

I was just thinking that, Bowlofbabelfish.

I'm not sure this is such a bad news story if it will mean infertility is properly discussed prior to puberty blockers being prescribed. It may mean fewer families take that step. It may lessen the pressure on parents to agree to their child going down this 'totally reversible' route.

Even when gametes can be successfully stored, or donor gametes used, young people and their parents need to be told honestly what 'equal access' to fertility treatment looks like - 0 - 3 rounds of IVF depending on your postcode. I believe there are numerous age and health related restrictions as well. They will need to be told honestly what the chances of success are too.

Surrogacy is (quite rightly) not something available on the NHS. Any suggestions it should be available for trans patients will need countering strongly.

There is currently a government consultation on the equality act which focuses on the role of EHRC. One of the items they want evidence on is:

Whether changes are needed to the Commission’s approach to using its enforcement powers as set out in its policies (such as the strategic litigation policy and compliance and enforcement policy) or as implemented in practice, and the way it identifies and selects legal cases to lead or support;

The other reason EHRC has been in the news over the last couple of days is their report to CEDAW detailing the sorry state of women's rights in the UK. I don't know whether they are doing much with their statutory powers or strategic litigation to counter sex inequality. I intend to find out.

EHRC are one of the organisations that have been found to be using 'gender' instead of 'sex', which is quite shocking given their legal role. They released a statement this week, saying To avoid any ambiguity, we are reviewing our use of language across our website and publications to ensure clarity and consistency.

That video that Rowan posted

"I can officially say that I have 10 children in the freezer"

... errr that's not how it works, at all. They'd need to be fertilised, transplanted and gestated (surrogate?), you're probably going to loose some along the way. So they maybe have 1 or 2 children potentially?

Also, how come you can't voluntarily be sterilise when you're young (20s&30s) but old enough to know what you're doing but you can if you just say I'm the opposite sex??

It's not a comparable situation in so many ways.

If (& it is a big if) a person diagnosed with cancer has a referral to fertility services, for females, there is often a critical time issue. Starting a process of egg harvesting may require delay of treatment. Also for some cancers, starting the required hormone treatments requires a consideration of risk. Some cancers are hormone receptive. The person diagnosed is also in a state of trauma about their future.
The consequences of all of these factors will likely mean that though there is a protocol and pssiblity for egg harvesting and storage, it would likely be a small percentage of females diagnosed with cancer who go ahead.
Similarly, one has to consider the future reality for those diagnosed with cancer who have stored eggs in terms of whether they choose or are able to go ahead in the future with attempts to then have a child whether through IVF or surrogacy.

There are many differences to the circumstances.

Surely one possible result of this is that the NHS says 'we can't provide fertility treatment so we can't provide hormone treatment'? So effectively the option to transition will be cut off? Or are the so terrified of the TRA lobby that they'd rather sink the NHS first?

I’m also very concerned about how it is being sold to them. Does a young girl who goes through the brutal process of having her eggs harvested think this will pretty much mean she’ll be a biological parent? Because it really, really doesn’t
I’m also concerned about the possible roll back of surrogacy laws

Watching some of the YouTube videos of young female born transgender people discussing egg harvesting increases these concerns.

Article in the Times highlights the contrast between this and cancer patients at risk of reduced fertility ‘now not automatically being offereed the option to freeze their reproductive cells.’ Am finding this a bit shocking - especially in contrast to the nhs being told it must make this offer as standard to trans patients.

As others have said the nhs is having to make very hard choices these days, and having to make priorities. Here we have the trans lobby yet again wanting themselves front of the queue - ahead of cancer patients and others. . Not going to play well with the general public.

ROwan

From the BBC article:

The equality watchdog sent a pre-action letter to NHS England on Friday, which it said was the first step towards a judicial review, and asked them to make gamete extraction and storage available to anyone having treatment for gender dysphoria.

All the more reason for the government to support self-ID.

Isn't it strange that the ECHR has never stepped in to decide that the postcode lottery of IVF and cancer treatments (plus many others lke joint replacement) are unfair and discriminatory.

I can also testify that the protocols for those diagnosed with cancer being referred for fertility guidance and possible treatment is also a postcode lottery.

I have experienced all three. IVF options were very poor relative to other areas. I was then fortunate in that both cancer treatments and fertility protocols were amongst the better postcodes.

I was aware that the lobby might be pushing for parity with regards fertility options for those diagnosed with cancer.

Its incredibly difficult to even begin to talk about this having both been affected and knowing many others who have had cancer diagnosis.

I think the leverage for this comes from the NHS report published earlier this year about transgender healthcare.

This wasn't the only area where equality of treatments was been sought.

Bowl, so essentially, this action wouldn't have any effect on retaining the fertility of children being processed into the blockers/hormones route anyway? It's entirely for the benefit of adult transitioners?

It’ll depend on the age of the child. If they’ve started puberty or just gone through it there’s a possibility of mature gametes. If they’re been given blockers pre puberty or at pubertal onset they will not have mature gametes to save.
So the primary population who will benefit are adults. A child put on the blockers/hormones route as puberty starts is going to be sterile. Full stop.

I’m sure I don’t need to tell anyone on the thread this, but I’ll say it for anyone lurking - harvesting sperm is pretty easy but harvesting eggs is a very unpleasant process for a woman - and also has health risks of its own.

YY Bowl, and I found this quote from the article very poignant, from the parent of a trans child

it isn’t realistic to expect a child to want to be able to have their own children

It isn’t realistic to expect children to have any understanding of how they will feel about having their fertility compromised, no.

I do support preservation of fertility because I don’t think that option should be closed off for children who aren’t capable of understanding the magnitude of their decision. However, that also applies to the removal of their fertility.

I’m also very concerned about how it is being sold to them. Does a young girl who goes through the brutal process of having her eggs harvested think this will pretty much mean she’ll be a biological parent? Because it really, really doesn’t.

I’m also concerned about the possible roll back of surrogacy laws. You can bet the TRAs will be pushing for this.

We are told that being transgender isn't a mental illness .The NHS is being stretched to its limits (and beyond) so why on earth should it fund this? The NHS cannot afford it, simple.

Bowl, so essentially, this action wouldn't have any effect on retaining the fertility of children being processed into the blockers/hormones route anyway? It's entirely for the benefit of adult transitioners?

The good news is that the more publicity this sort of stuff gets, the more the general public will start to say wtf, especially those who perceive that they themselves will be affected, in this case people struggling with infertility.