Experts calling for more inclusive guidelines and equitable access to fertility treatment for LGBTQ+ and single people

Social infertility refers to prospective parents who do not have the ability to conceive or have children due to social, relational, or environmental circumstances rather than purely physiological causes.

The NICE guideline focuses on people with health-related fertility problems – people with a medical cause of infertility or who are unable to achieve pregnancy after 12 months or more of regular, unprotected penile-vaginal intercourse or after six cycles of artificial insemination.

Researchers from four universities and a lived-experience panel from the Online Sperm Donation Project welcome the publication of the updated NICE guideline but think it could go further.

Dr Rhys Turner-Moore is a Reader in Psychology at Leeds Beckett University and leads the Economic & Social Research Council-funded Online Sperm Donation Project, which brings together researchers from Leeds Beckett, University of West Scotland, University of Manchester, Pillowfort Productions and the University of Sussex. Dr Turner-Moore said:

“While it’s positive that NICE has updated its guidelines around fertility treatment, by only focusing on people with health-related fertility problems they are missing a large number of people who want children but are unable to conceive without help.

“We’re calling on NICE to develop assessment and treatment guidelines that include all people who can’t conceive without assistance because of social or relational circumstances. This includes individuals who are single or in same-sex relationships (LGBTQ+) and want children.

“We think it’s vital that these people have a voice and they are able to get fair access to the treatment they need as well.”

Same-sex couples of single individuals often have to pay for up to twelve cycles of donor insemination themselves before being able to access NHS treatment. This creates another financial barrier on top of the existing postcode lottery in the UK, which sees the amount of state-funded fertility treatment cycles varying across nations, and for England, across regions, depending on local policy.

As part of the Online Sperm Donation Project, Dr Turner-Moore and his team have conducted research with recipients, partners, donors and platform owners involved in online sperm donation. In the final action research phase, people with lived experience reviewed the findings and worked with researchers to imagine and begin shaping an ideal future for online sperm donation.

The donor action research group has produced a report calling for changes to regulated donor insemination, highlighting inequitable access for those experiencing social infertility and the high costs of clinical treatment. They argue that people should have genuine choice between clinical and informal online routes, but current barriers limit the clinical option for many. As one donor in the research action group explains, the costs associated with fertility treatment in clinics “reinforced for me why many intended parents look for alternative routes, and why accessibility matters”.

Fertility Action leads the Fertility Access campaign and is a national charity focused on driving equity, improving support and increasing education in fertility care. Katie Rollings, Founder and CEO of Fertility Action, said:

“This update from NICE marks an important moment - but it also underscores how far we still have to go. Fertility care must evolve to reflect the realities of modern families. At Fertility Action, we work alongside patients every day and see the real-world impact of these policies. What people are asking for is not preferential treatment, but a system that treats them fairly.

“This is a pivotal opportunity to reset the framework - by removing non-clinical barriers, introducing national consistency, and building a system that is inclusive, transparent and centred on those who need care. Because equitable access to fertility treatment is not aspirational - it should be the standard.”

The Progress Educational Trust (PET) is a charity which aims to improve choices for people affected by infertility and genetic conditions. Sarah Norcross, Director of the Progress Educational Trust (PET), said:

“The NICE Fertility Guideline should deliver for everyone, not just people in heterosexual relationships, and the new update to the Guideline is a missed opportunity to ensure that this is the case. Four years ago, the Women's Health Strategy for England stated that the Government would work to ensure that "Female same-sex couples are able to access NHS-funded fertility services in a more equitable way". Neither the present Labour Government nor its Conservative predecessor has made any progress toward achieving this.”

PET maintains the PET NHS Fertility Funding Tracker – a regularly updated resource that enables patients, professionals and researchers to check what level of IVF treatment is funded by each of England's Integrated Care Boards.