HFEA response to the Men’s Health Strategy

Understanding and identifying areas where we can improve support for healthier behaviours

Fertility problems can have a considerable impact on the health and wellbeing of all those affected by it. It is important that young men have access to appropriate reproductive health information. This could encourage healthier behaviours in men to address fertility problems that could be related to lifestyle factors, increase their understanding of the causes of infertility, and identify more quickly when it might be necessary to seek specialist support.

Improving outcomes for health conditions that typically, disproportionately or differently affect men

We are the independent regulator of fertility treatment and human embryo research in the UK. The HFEA holds one of the world’s longest running Registers of fertility treatment where we hold a record of all treatments, partners, patients and children born as a result in the UK since 1991.

We support the government’s aim of improving health outcomes for men, tackling health inequalities and developing a clearer, more tailored approach to health. As outlined in the HFEA’s response to the Government’s 10-year plan, the HFEA would like to see a cross-disciplinary approach to fertility across the health service, from primary care to treatment in specialist fertility services, to maternity care and beyond. This would improve access to treatment and improved outcomes for both men and women affected by infertility.

Improving fertility treatment outcomes

Infertility affects around 1 in 6 people. Many do not require treatments such as IVF but referrals to specialist service at an early stage. With more people delaying starting a family, the speed of referral is crucial.

Men are just as likely to experience difficulty with their fertility as women. For around half of heterosexual couples who are having problems conceiving, the cause of infertility is sperm-related. ICSI is the most common and successful treatment for male infertility.

The earlier the diagnosis of sperm related infertility, the sooner specialist support can be sought or a referral to a fertility clinic can be made. Earlier referral for anyone seeking fertility treatment is crucial to success. If referral is delayed, then the likelihood of successful treatment is reduced and there is a greater cost to the public purse.

There are long term benefits to society of ensuring those who may need to access fertility services are able to access services as soon as possible to ensure treatment has the best chance of success.

To effectively enable men and women to access treatment earlier and therefore provide more cost-effective fertility treatment when needed, we need informed primary care services who can refer them for specialist screening, diagnostics and treatment. Given the pressures on general practice, this may be best performed in health hubs or neighbourhood centres. Having fertility services situated within a specialist centre can often lead to more streamlined experiences where they can be seen by the right specialist at right time, sometimes avoiding the need for more costly and invasive IVF all together. We welcome the Government’s recent announcement in its 10-Year Health Plan for England for a Neighbourhood health service to provide continuous, accessible and integrated care.

Access to fertility preservation

Men may also access fertility services in order to preserve their fertility. Preserving male fertility involves freezing sperm, embryos or reproductive tissue so that a person can hopefully have a biological family in the future.

Sperm freezing is the most effective form of fertility preservation for men. It may be used by men undergoing certain types of cancer treatment, such as chemotherapy, men in the British Armed Forces who might choose to freeze their sperm before deployment to preserve their fertility in case of injury, or used by a transgender or non-binary person who is starting hormone therapy or planning to have reconstructive surgery and wishes to preserve their fertility.

The HFEA supports timely access to fertility preservation techniques to preserve a man’s fertility so he can try and have a child(ren) at a later date. Currently sperm freezing in the most successful method for preserving a man’s fertility however there is research underway on experimental techniques, such as the cryopreservation of pre-pubertal testicular tissue and/or cells prior to gonadotoxic treatment for children at risk of infertility due to cancer treatment.

It is important that GPs and other relevant medical professionals are aware of fertility preservation techniques before any treatment that could damage fertility is carried out (such as some cancer treatments). There must be streamlined services between the relevant medical professions (such as oncologists) and fertility clinics to ensure that potential fertility preservation can be accessed as soon as possible to allow for their medical treatment to begin.

Improving men’s access, engagement and experience of the health service

We suggest that the Men’s Health Strategy incorporate improving men’s access, engagement and experience of fertility health care. A focus should be on raising awareness of fertility, and the need for education, wider and earlier access to General Practitioners (GPs) that will lead to earlier access to fertility treatment.

Fertility treatment is a unique area of healthcare in the UK where the majority of treatment is privately funded. The HFEA regulates NHS and private IVF clinics and provides information to fertility patients on our website, many patients experiencing fertility problems approach their GP as their first point of information. Therefore, it is crucial that a GP has the relevant knowledge to be able to advise men and women on where to go for further specialist information. We encourage the creation of new information flows to support and engage GPs, practice nurses and patients and promoting fertility education materials to support people in making decisions as early as possible about treatment, donation, and surrogacy, ideally at the pre-treatment stage.

Improve engagement and recognition of the partners’ importance in the care process

In terms of improving men’s engagement in the health services, we would like to see a greater recognition of the important role male partners’ (who are also patients in the process) have in the fertility treatment process.

The small number of male respondents to our most recent National Patient Survey indicated a slightly lower level of overall satisfaction with treatment overall and less satisfied with the coordination/administration of their treatment, the availability of clinic to answer any questions they had, and the level of care received from clinic staff.

We would encourage medical professionals to consider the needs and experience of men as well as women seeking fertility treatment. Fertility clinics should think about their communication methods, ensuring that they are involving men in the process and that men receive the same high quality level of care as their partners.