Commissioning Policy for the Provision of NHS
funded Gamete Retrieval and Cryopreservation
1
DOCUMENT CONTROL
Reference Number
Version
Status
{lead in specific policy 2
area to provide once
policy ratified)
Final
Sponsor(s)/Author(s)
Head of Medicines Quality
Date
Amendments
By whom
Intended Recipients:
Group/Persons Consulted:
CCG staff
Saba Rai
IFR team
Rachel Loveless
Commissioned providers
Chief Officer (Quality)
Dr G Solomon
Monitoring Arrangements and Indicators:
IFR database
Training/Resource Implications: None
Ensure equity in access for all patients
CCGValue:
Approving Body: Commissioning
Business Planning Group
and
Date Approved:
10th June 2014
Date of Issue
Review Date
June 2016
2
Contact for Review
Head of Medicines Quality
Policy Location:
Intranet, SWB CCG Website
Summary
Patients undergoing treatments such as chemotherapy for cancer or radical surgery
may be made sterile by such treatments. Where there is a significant likelihood of
making a patient permanently infertile as an unwanted effect of any NHS funded
treatment, this policy determines the criteria for NHS funded gamete retrieval and
storage for Sandwell and West Birmingham CCG
Contents
Number
Section
Page No.
1.0
Introduction
4
2.0
Timescales for Funding Storage of Gametes
4
3.0
Criteria for NHS Funded Cryopreservation
5
4.0
NHS Funded Assisted Conception Services
6
3
Commissioning Policy for the Provision of NHS funded Gamete Retrieval and
Cryopreservation
1.0
Introduction
Patients undergoing treatments such as chemotherapy for cancer or radical surgery may be
made sterile by such treatments. Where there is a significant likelihood of making a patient
permanently infertile as an unwanted effect of any NHS funded treatment, those patients
will be eligible for NHS funded gamete retrieval and cryopreservation, provided they meet
the criteria described below. This may be done by banking gametes (eggs or sperm), or
embryos prior to treatment. Following the completion of treatment these may be used to
assist conception.
2.0
Timescales for Funding Storage of Gametes
Where the following eligibility criteria are met, NHS funding will be available for an initial
period of 12 months storage from the date of completion of their treatment. Applications
may be submitted to the CCG to extend funding for a single further period of up to 5 years if
the gametes have not been used within that time. There must be confirmed infertility
resulting from the treatment where this is possible e.g analysis of sperm samples.
Under 18s – Funding for gamete storage will be approved until the patient’s 19th birthday
i.e. up to the age of legal adulthood plus an initial period of 12 months. An application may
then be made to extend funding for a further period of 5 years.
Funding renewals will be considered in line with the ages specified in the IVF policy in place
at the time of application.
Patients may choose to self-fund storage once NHS funding ceases within the terms of the
Human Fertility and Embryology Act 1990.
3.0 Criteria for NHS Funded Cryopreservation
Restricted to individuals permanently registered with a Sandwell and West Birmingham
GP practice.
Restricted to individuals with no living children.
The aim of this criterion is to give priority to individuals with no existing living children. An
adopted child has the same status as an individual’s biological child.
This will be applied in line with the criteria IVF funding policy in place at the time of
application
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Age: Upper age restrictions for both men and women will be in line with those patients
funded for fertility services under the IVF policy in place at the time of the funding
request.
There is clinical evidence which demonstrates that a women’s fertility falls with age
significantly dropping after the age of 40 years. Chromosomal abnormality increases with
age in men and increases significantly after the age of 55 years. Gamete retrieval will be
offered to all women aged under 40 years and all men aged 55 years or younger at the date
of the procedure.
There is no lower age limit applied in this policy however all patients including those aged
under 16 years must be able to understand the procedure being carried out and considered
competent to give informed consent.
Patients must be undergoing NHS funded treatment which is likely to lead to permanent
infertility
The funding application must be supported by the NHS consultant providing their care.
Previous sterilisation
Gamete retrieval and cryopreservation will not be funded where the patient has previously
been sterilised.
Previous Assisted Conception
Access to NHS funded Cryopreservation will not be affected by previous attempts at
Assisted Conception. However funding for further assisted conception attempts will be
subject to the criteria stated in the IVF policy at the time of any funding application.
Human Embryo and Fertility Act 1990
Cryopreservation of gametes or embryo’s must meet the current legislative standards.
The provider of the service must ensure the patient receives appropriate counselling and
provides full consent. The patient and their partner must be made aware of the legal
position on embryo ownership should one partner remove consent to their ongoing storage
or use.
The provider of the service must ensure patients are aware of legal issues on posthumous
use of gametes and embryo’s should they wish a partner to be able to use these should
their treatment not be successful.
Patients will need to provide annual consent for continued storage. The patient will be
responsible for ensuring the storage provider has up to date contact details. Failure to
provide on-going consent may result in the destruction of stored materials.
The provider must ensure appropriate consent to storage is in place and that the patient
understands the need for on-going consent
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Transgender patients
Cryopreservation will be funded for patients on a transgender pathway provided the criteria
above are met.
4.0 NHS Funded Assisted Conception Services
Once an individual is fit and able to proceed with Assisted Conception using their frozen
gametes or embryo, they must then meet the Eligibility Criteria for Assisted Conception in
force at that time if they wish to access NHS funding.
The funding of gamete retrieval and cryopreservation does not commit the CCG to funding
for Assisted Conception services. Applications for funding of these services will be
considered on the same merits as any other application. Patients should be made aware of
the CCG policy for funding assisted contraception in force at the time of gamete retrieval.
The patient’s supporting consultant must ensure that the patient has a realistic expectation
as to the likelihood of future funding for these services and does not unreasonably raise
expectations.
6