Experiencing fertility problems can be tough, but Armed Forces couples can face additional challenges, such as time spent apart and moves potentially resulting in a longer wait for fertility treatment. NHS England has an assisted conception policy for Service couples which funds three full cycles of IVF for qualifying women under 40, but not all Forces couples are aware of it and sometimes pay for private treatment unnecessarily. Tim Child, medical director of Oxford Fertility, part of the Fertility Partnership, and Professor at the University of Oxford, told Army&You about his experiences of helping those in the Forces to start their own families…
How many of your patients are Service families?
Based in Oxford, with satellite clinics across the Cotswolds, we’ve been helping couples from bases including Imjin Barracks, RAF Brize Norton, RAF Halton, Benson and Caddington for more than 30 years. At the moment, we have 12 Armed Forces babies due.
What’s your success rate?
Almost half of our patients achieve a pregnancy – 45.7 per cent among those under 35 and 43.8 per cent across all age groups. We have an active research programme and participate in worldwide trials to drive this further.
There are so many factors that influence a person’s fertility, no two couples we see are the same. With that in mind, I would never recommend a person looks at reported success rates and assume they will apply to them. Their combined fertility situation may lead to a higher or lower expected outcome; there are also treatment decisions that can make a significant difference to expected chances of conception. It’s best to undergo fertility tests, so you’re armed with facts on your fertility and your options.
How do you ensure your staff are aware of the NHS England Armed Forces Assisted Conception Commissioning Policy?
We have a brilliant patient services team which works closely with NHS England to keep abreast of the Armed Forces policy and paperwork requirements. The process is quite detailed and if it’s not followed we know it can cause frustration. For example, a full set of blood and semen tests must be carried out and sent with your application form. These must be within a specific time window otherwise they will need to be repeated.
Our team works closely with secondary care fertility clinics and GPs to ensure everything is in place. We also have a patient questionnaire to catch any Forces couples who come to us through their local GP, rather than a military GP, and who may be unaware of the funding available to them.
Why is it important to recognise the unique issues that can affect Service personnel and their partners?
Growing up as part of a Forces family myself, I understand the life involved with being posted every six-to-36 months.
So, when planning a couple’s fertility treatment, it is essential to consider the additional real challenges that are faced by the Armed Forces. This helps us to build a treatment plan that works within this.
We also understand that undergoing IVF can be emotionally tough, especially if you live away from home or a partner is away. Our counsellor can talk you through it and point you to support.
If a couple has a problem with their treatment due to the needs of the Service, how do you help them?
Availability and flexibility tend to be the two main challenges that couples in the Armed Forces face. A partner may need to be on deployment at critical stages of the IVF process, so we need to be flexible in our treatment whilst not compromising their chances of conception.
The only change we, or any other clinic, can’t make, is moving a couple to another clinic mid-IVF cycle. Unfortunately, the cycle must complete at our clinic – this makes us even more mindful of planning for possibilities.
With couples sometimes paying for private treatment unnecessarily, how does your centre help to raise awareness of this policy?
I worked as part of the committee to establish the NICE guidelines, recommending that couples receive three rounds of IVF, and am on the board of Fertility Fairness, a lobbying group for greater NHS IVF funding. I am delighted that the Armed Forces upholds this advice.
To ensure as many couples are aware of the funding policy available to the Armed Forces, we highlight this on our website and follow up with any patients who indicate they are part of the Forces in our patient enrolment forms – we are keen to ensure no one falls through the net.
What is the catchment area for referrals?
Certain clinics are awarded NHS England contracts so in theory can treat Armed Forces couples from across the UK. For us, as treatment involves about ten visits to the clinic, we tend to see couples from across the south.
What’s your advice to any Army family who is seeking support for assisted conception?
Although the most common reason for a decline in fertility is age, the extent varies for each person, and there are also many other factors that cause infertility, such as male factor, ovulatory disorders, blocked fallopian tubes and endometriosis.
My advice is to undergo a relatively straightforward fertility test. This will arm you with the most valuable information – a clear picture of your situation. With these results your consultant will be able to give you an accurate picture of your fertility and if any steps need to be taken to help conception.
It may provide you with the reassurance to continue trying naturally, it may reveal that simple dietary and lifestyle changes are needed to boost your chances of conceiving. However, it may also show that an operation or assisted conception is necessary.
If you do need treatment, ask your IVF clinic or military or civilian GP about the NHS England Armed Forces IVF funding policy to ensure you meet the requirements. This includes age, weight and lifestyle factors and will help you to put changes in place straight away to cut down any waiting time.
The government’s HFEA website has a good picture of the IVF clinics across the UK so this can help you develop a shortlist. Attend open evenings and ask about their experience treating Service couples to ensure they will be able to work with your additional needs. They need to be able to deliver treatment to the right level of flexibility, adaptability and success that the Armed Forces require.
For further information on assisted conception support, including information for those living overseas or in the devolved areas, visit the health pages at aff.org.uk or contact AFF’s Health & Additional Needs Specialist Karen Ross at firstname.lastname@example.org