Fertility treatment for trans

[PerverseConverse]

Just had a nosey at the BBC news page and come across this:

www.bbc.co.uk/news/av/health-46634595/should-the-nhs-pay-for-transgender-fertility-treatment

I'm not sure how I feel by my instinct is that no, infertility treatment should not be available to trans people. But then for the future, all those poor children who had been rendered infertile by their parents allowing doctors to give them hormones that caused the infertility, that throws a different light on it for me.
Then there's the whole children are a privilege not a right train of thought.

I suspect it is just more demands to access women's health care by entitled men in a world where access to infertility treatment is not available to every woman equally. Postcode lottery, age, BMI etc.

I'm sure that those who have knowingly and willingly agreed to treatment that affects fertility should then not be entitled to free treatment.

This stuff really messes with my head!

I can't say I'd support it for people who've taken drugs/had surgery in full knowledge it would negatively affect their fertility. That would be ridiculous.

I don’t think fertility treatment can or should be denied to people solely on the grounds that they are transgender, no. I also think the uptake would be pretty low in any event, so it’s hardly like it’s a problem of epidemic proportions.
The treatment, I presume, would be given to transmen, not transwomen. I don’t think they should be penalised because they took hormones as it is likely that they did this to alleviate symptoms of gender dysphoria.

Do you mean fertility preservation ie freezing eggs/sperm? I can see the argument for offering that as part of the transition process. I can see that there will be an issue around spiralling costs for that given the massive increase in transgender individuals.

When it comes to later on and someone wanting IVF or similar to use their frozen eggs/sperm then I would expect that to be offered to people on the same basis as anyone else seeking fertility treatment on the NHS.

I've nothing against it per se as long as its not at the expense of more serious illnesses. People are free to make their own choices but with the state of the NHS at present I hope they have their priorities in order.

Egg and sperm freezing are currently only offered to a small number of cancer patients on the NHS, everyone else has to pay.

I don't want to be too specific here, but trans people would not be eligible for NHS fertility treatment on the grounds of their sexuality/gender/GRA.

The guidance works a bit like this...

To be eligible for fertility treatment, one half of the couple have to have evidence of medical infertility.

Therefore the NHS don't discriminate against people who are gay / lesbian / trans or just single, but in practice wouldn't fund treatment because they are not medically infertile.

The video talks of freezing sperm from a male to female, and a non-binary person (male). I'm confused as to what they are transitioning to if they do t identify as male or female though
I've been away from the board for a week or so as my brain needed a rest!
Max in the video was sensible in saying that there are already many treatments and support on the nhs (they'd just had a double mastectomy) and they shouldn't get more.

The main point of this that pleases me is that there is recognition of transitioning causing infertility which up to now has been swept under the carpet.

NHS England has said no according to the video.

If one half of a couple has gone through full surgical transition then they would be medically infertile though, or is that excluded?

I agree with assassinated. If someone has been diagnosed and is being treated for dysphoria then it's analogous to other medical conditions.

I'm not sure how great the demand would be. Is there an age limit applied for sperm/egg storage in other circumstances? I fear that girls trying to escape from the reality of their female bodies might vehemently reject this option.

Do you mean fertility preservation ie freezing eggs/sperm? I can see the argument for offering that as part of the transition process.

But a child who goes from puberty blockers to cross sex hormones wouldn't have any viable eggs or sperm to freeze.

Egg-freezing is a bit of a con though isn’t it? It has a pretty low success rate unless the eggs are fertilised at the point of freezing. I don’t think many young trans people will be going for this option. And I think that if they present later in life as wanting IVF that they should be treated as any other infertile person.

It’s more likely that trans people will find out too late about infertility. Ludicrous rumours about transwomen being able to gestate a baby are doing their rounds on the internet and a lot of impressionable people probably believe it. I would think it’s rare for a trans man to want to carry a baby themselves.

With the rate that CCGs are stopping funding IVF treatment, I don't think it will actually be something that has to be considered - before long I would imagine that there will be no funding for anyone.

Yes, freezing egg/sperm would only be relevant for someone who had gone through puberty and had mature eggs/sperm.

I really hope that young people considering full surgical transition are counselled in detail about their fertility, what options are available to them now and in the future and what the success rates are.

I don't think the NHS should just fold and fund this when it is not currently funded for a considerable amount of other health conditions that people have which can impact fertility. Fertility treatment is very restricted already in this country and it would be grossly unfair to improve it for trans people and leave so many others with fertility inhibiting conditions without similar funding. Equally, mental health services are so absolutely dire in this country I really think that's the top area in desperate need of more funding myself. We have too much inequality between CCGs and that needs ironing out. Commissioning decisions need to be focused more heavily on demographic need.

This was on the bbc lunchtime news. It had this quote from the NHS:

"We believe this request is misjudged and potentially unfair to NHS patients, as well as wasting precious NHS resources on legal costs."

The Equality and Human Rights Commission is suing the NHS. So one taxpayer funded body suing another one. Is this really what the NHS should be spending money on?

there has been a legal challenge to the NHS. THreads discussing this (August 2018)

www.mumsnet.com/Talk/womens_rights/3326933-NHS-told-give-trans-patients-equal-access-to-fertility-service

www.mumsnet.com/Talk/womens_rights/3333708-NHS-faces-lawsuit-for-not-funding-fertility-services-for-transgenders-who-want-kids

Well, women freezing eggs and then goofing on T had better decide fast, if they want to carry s pregnancy. Isn’t it the recommendation that within 5 years after starting T a female have a full hysterectomy

It may also be that some seek surrogacy with IVF.

I think it needs to be talked about. I have a friend and I didn’t know her before her transition but it was never suggested she could freeze sperm. She’s now in a relationship where she wishes she’d though about that and would be able to have a child with her own DNa

I wasn't aware of the legal challenge and will watch with interest.

I was involved as a clinician for many years with deciding appeals when people had been turned down for NHS funded treatment. (in England). We regularly sought legal advice to inform our decisions.

There are some broad criteria behind the decision making process.
Nice guidance has to be followed where it exists, with local decision making permitted if it doesn't, however the treatment has to have a reasonable chance of success or the NHS are not allowed to fund. IME the dept health are very heavy handed in requiring CCGs not to set funding precedents.

I can fully believe that CCGs are having to sift through a number of these cases in the current climate and can imagine that some are well supported/funded by pressure groups.

As I said, I am interested to find out what happens with the legal challenge, though I'm no longer involved in this work. I'm struggling to think of a reason to fund treatment as an exception to policy though.

Did they not have any counselling about this as part of the transition process?

Those referred via the NHS usually have counselling yes.

Many seek private treatment though.