Fertility treatment is two-tier system, and single women are paying the price

Emma’s fertility story began, counterintuitively, with a breakup. “At 32, I’d reached the age where most of my friends were coupled up and many were having babies. I began to worry that my biological clock was ticking forward faster than my love life could catch up. So I paid for a fertility MOT for future-proofing.” The results weren’t good; Emma’s egg count was low (below the 10th percentile) and time was suddenly of the essence if she wanted to have children of her own.

Egg freezing was the obvious option. But Emma’s low egg count would have required her to go through multiple rounds to garner enough eggs to give her the best possible chance of having a baby: an expensive and exhausting process. “I also considered how I might feel if I waited years to go back to use my frozen eggs, either with a partner or donor, and found none were viable,” she says. The best option was to pursue IVF with donor sperm to “bank embryos for the future”.

It sounded simple enough. And it might have been had Emma not been a single woman. But what followed was two years of medical complexities, financial struggles, pregnancy followed by miscarriage, and being repeatedly turned away by the NHS – all because of her relationship status. “The system is stacked against us,” she says. “Policy-making reflects ingrained patriarchal social attitudes towards women who do not conform to social scripts. Being single or gay currently means being a second-class citizen as far as NHS funding goes. I know of women resorting to bringing a male friend or random stranger (found online) to pose as their partner to access NHS care.”

The number of single women undergoing fertility treatment in the UK has more than trebled in the last decade, according to a new report by the Human Fertilisation and Embryology Authority (HFEA). And yet reproductive healthcare remains rooted in the past, meaning single women like Emma are consistently being failed in their pursuit of fertility treatments. The result is a relentless cycle of physical and psychological turmoil.

According to the National Institute for Health and Care Excellence (NICE), women aged under 40 should be entitled to three cycles of IVF treatment on the NHS if they’ve been trying to get pregnant through regular unprotected sex for two years, or if they’ve not been able to get pregnant after 12 cycles of artificial insemination, with at least six of the cycles using a method called intrauterine insemination (IUI). This is a system that disproportionately affects single women, who would need to opt for the latter route. It typically means paying privately for IUI, costing upwards of £1,500 per round, given that it’s not routinely offered on the NHS. Then there’s the cost of donor sperm – around £1,630 per vial – as well as clinic fees, all of which add up astonishingly fast.

“It costs women over £20,000 going down this route,” says Catherine Hill at Fertility Network UK, the nation’s leading patient-focused fertility charity. “The current system means single women have to ‘prove’ their infertility and it’s too much of a financial hurdle for many people, which is why they often wind up going private, or they travel abroad, both of which come with their own financial and logistical complications. The reality is that fertility treatment for single women just isn’t very accessible.”

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Subsequently, some find dangerous ways to cut costs, seeking unregulated practitioners and donors found in online groups as opposed to going via a sperm bank. “I briefly joined one of those groups but I was bombarded by creepy messages from men offering to ‘naturally inseminate’ me,” says Emma.

To make things even trickier, very few single women can even access NHS-funded IVF in the first place. In Scotland, it’s not available at all for single women, though Scottish ministers were considering proposals to change this in July. And in England and Wales, access differs depending on your region. This is due to individual NHS integrated care boards (ICBs) having the final call on who can have NHS-funded IVF in their local area, creating a postcode lottery. Over half of ICBs don’t include single women in their policies.

In 2019, it was revealed that one set of clinics in southeast London had banned single women from accessing IVF entirely because they “exert less control on their children” and “place a greater burden on society in general”. That ban has since been lifted.

All this perpetuates an insidious ideology: that women cannot raise children alone. It’s one felt around the world, too; single women and same-sex couples are banned from accessing IVF treatment in Italy, Hungary, Poland and Switzerland.

“Many policies around fertility were created in a time when traditional family structures were more prevalent, and there hasn’t always been the political will to update these frameworks to reflect the diverse realities of modern family-building,” says Rachel Close, clinic manager at Concept Fertility in London. “The idea that a family should consist of a mother and father is still prevalent and this can create barriers for single women, same-sex couples, and other non-traditional family units.”

Given the NHS barriers, the majority of single women seeking fertility treatment do so privately. In the UK, prices vary depending on where you live. Costs range from £3,735 to £13,408 for an advertised IVF package, according to data collated by Fertility Mapper, a website dedicated to showcasing the experiences of the UK’s private clinics. But for many that’s a mere starting point – particularly if you’re going to go through more than one round of IVF, or you have a low egg count that renders your case more complex.

“Any financial stability I have built over years of working has been quickly wiped out,” says Emma. “During my first round of sperm donor IVF I discovered uterine infertility issues. I was referred by my fertility clinic to the NHS for a hysteroscopy [a test to look inside a woman’s womb using a small camera] but was denied a referral to the fertility pathway due to my relationship status.”

Emma ended up self-funding the hysteroscopy and was later diagnosed with Asherman’s Syndrome, a rare gynaecological condition that causes scar tissue to form in the uterus. After undergoing surgery in Hamburg, Germany and later enrolling in a clinical trial in Spain for Asherman’s as a way of accessing more fertility care, Emma became pregnant but miscarried. She returned to London and, due to her litany of complications, came close to receiving NHS-funded support. “But after one face-to-face appointment, I was promptly notified that upon further conversations with the clinic manager, I did not qualify for NHS funding due to being single and also having already self-funded my own IVF,” she says. “I raised a complaint about this but have yet to hear back.”

Nicola’s story is similar. “I got to 39 and found myself single during Covid with more time to think about my future, so contacted a fertility clinic and had a fertility MOT,” she recalls. Like Emma, her egg count was low. Her doctor advised IUI; she completed six rounds using donor sperm, one of which resulted in pregnancy but ended in miscarriage.

The good news was that Nicola then qualified for NHS-funded IVF at her local ICB. “They wouldn’t do IVF with my own eggs as they didn’t expect it to work so encouraged me to use donor eggs,” she says. “I said I wasn’t ready to do that without attempting IVF with my own eggs. They allowed me to have three more IUIs on the NHS that didn’t work.” Nicola ended up paying privately for one cycle of IVF using her own eggs with money she’d been saving for a deposit on a house. She got pregnant but tragically this, too, ended in miscarriage.

Nicola returned to the NHS for IVF using donor eggs from her 31-year-old sister. “I have had three embryos transferred so far and none of them have worked,” she says. “I’ve got three left.” Since the last failed transfer at the end of August, her consultant has recommended that she takes a break until the new year “as the disappointment and failure was affecting my mental health”.

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Increasingly, single British women have started travelling abroad in search of more affordable fertility treatments, with many going as far as Turkey and Greece. Diers Klinic in Denmark, which specialises in IUI using donor sperm, has noticed a pronounced uptick in the last two years. “We frequently hear from the British women we treat that they have felt pressured into choosing more invasive IVF treatments, which involve hormone stimulation from the beginning, at clinics in the UK,” says Liza Diers, founder of the clinic, where 40 per cent of clients are single women. “They are often exceptionally well-prepared for the role of solo motherhood,” Diers adds. “They have carefully considered their decision and usually have a strong support network backing them every step of the way.”

Finances and hormones aside, the psychological impact of being turned away and rejected due to your relationship status can be monumental. “Practically and emotionally, I’ve been forced to grapple with a life different than expected, with what has often felt like half the resources and double the burden of a couple to pursue the dream of having a child,” says Emma. “What should have been a modest house deposit was instead a £15,000 miscarriage,” she adds. “I have been flushing money down the toilet. I feel angry that I’ve had to fight so hard to advocate for access to a system I pay into, and disappointed that in modern-day Britain, where almost half of pregnancies are unplanned and nearly one in two marriages end in divorce, NHS fertility policies remain so punitive towards alternative family structures.”

Given all the time and energy required to go through the process of fertility treatment, it also hinders one’s prospects of finding a romantic partner. “I’m lucky that I have very good family and friends but I still feel lonely,” says Nicola, who hasn’t dated at all while undergoing fertility treatments. “I think it’s too complicated and I’ve not felt great about myself. I used to be such a positive, confident and happy person. But this has worn me down so much; it has been a rollercoaster of emotions.”

There are minimal mental health provisions for single women undergoing IVF. In order to access NHS fertility counselling or support groups, you need to be accepted as an NHS fertility patient. Four in 10 fertility patients have experienced suicidal feelings, according to a survey of 1,300 people conducted last year by Fertility Network UK. Most respondents said they wanted counselling but had to fund some or all of it themselves.

“When each attempt at pregnancy costs so much you also live with the likelihood that you may well be priced out of parenthood,” says Emma. “And, when society doesn’t recognise your desire to have a child as valid or views your family composition as less deserving of support, you experience disenfranchised grief. It’s very othering.”

When approached for comment by The Independent, an NHS spokesperson said: “These clinical services are commissioned by integrated care boards (ICBs) for their area based on the needs of the local population and prioritisation of resources available. All ICBs have a responsibility to ensure services are provided fairly and are accessible by different population groups.”

All this acquires new poignancy in light of the current birthrate, which has declined worldwide and this year fell to its lowest rate on record in England and Wales. Surely now is the time to encourage, not deter, prospective parents? Better support is imperative across the board for everyone – regardless of their relationship status.