It is estimated that one in seven couples in the UK have difficulty conceiving. Pharmacists can add value to professional conversations with prospective parents by considering the following points.
Do:
- Access the facts. The Human Fertilisation and Embryology Authority (HFEA) is the UK government’s fertility regulator. It offers impartial and accurate information about IVF, clinics, and other fertility treatments.
- Understand national policy. NICE outlines the NHS pathway and required quality standards. The original guidance (CG11 Fertility: assessment and treatment for people with fertility problems) was published in 2004 and sections have been updated since: NICE CG156 Fertility problems: assessment and treatment in 2017, and more recently NG73 – Endometriosis: diagnosis and management in April 2024. A substantial update of CG156 is expected in May 2025. The CPPE module Women’s health: Pregnancy includes content on the problems associated with fertility.
- Understand local policy. NHS funding follows strict criteria set by local commissioners, and so geographical variation prevails. Having the local policy to hand will help to manage patient expectations.
- Understand The Human Rights Act 1988. Article 8.1 decrees the right to respect private and family life, and Article 8.2 indicates where a public authority may intervene. Parenting does not fit any single model, and discrimination is unlawful.
- Know the basics. The approach taken by the NHS follows protocol and can be lengthy. Private healthcare will fast track the necessary investigations, but at a price.
- Be sensitive to circumstances. Anyone accessing a fertility clinic will already have been through an exhaustive mental journey, and may be tired of offering explanations and the judgements of others. Unless specifically asked, avoid attempting to problem-solve.
- Put yourself in the position of the individual. Every decision seems rational to the person making it, and patients are not obliged to justify themselves. Whilst it is important to adopt a healthy lifestyle, advice must be sensitive.
- Recognise the commercial drivers. The private treatment of infertility is big business. Anything outside of NICE CG156 might not be considered cost-effective by the NHS, or may have a statistically low success rate, or be unsafe.
- Update your statistical skills. Impartial statistical data can be found on the HFEA website. Be prepared to assist with interpretation if asked.
- Respect time. Be aware of how time-critical procedures are, particularly if involved in the supply of hormonal treatments. Keeping patients informed of stock shortages in real time will allow a plan B to be enacted, potentially saving a precious month.
- Anticipate social risks. Planned insemination with a live sperm donor comes with moral hazard; women may be vulnerable to physical exploitation.
- Accept life’s inequalities. There is no correlation between procreation capability with the ability to parent, and cases of appalling child negligence occur all too often. This will feel particularly unjust to anyone wanting a family.
Don’t:
- Underestimate what prospective parents have already invested before they approach you. Active, non-judgmental listening is recommended. Have you been approached for a solution or to act as an informed listening ear?
- Over-extend the opportunity for health promotion. Women intent on conception are often well-informed and will require little direction to the female health section.
- Dash hope. Unpick the statistics for the patient if asked, but let the numbers speak for themselves.
- Suggest alternatives such as surrogacy, fostering, or adoption. Potential parents will know that these options exist.
- Surrogacy. The Surrogacy Arrangements Act 1985 makes UK surrogacy agreements unenforceable as the child’s gestational mother (and spouse, if married) are the legal parents until a post-birth parental order application is granted. Surrogacy is not NHS funded; in practice, informal or unregulated arrangements are made through social networks. Trade in human life comes with serious ethical considerations, and sits well outside of our professional remit.
- Adoption. Although the approval process for adoption is now condensed to six months, it is still robust, and applicants should expect their lives to be fully exposed and judged by strangers. Babies under the age of one are rarely available, historical trauma is common, and financial assistance to a parent is limited.
- Fostering. This is a transitional arrangement and unlikely to suit anyone easily attached to children, or unable to manage rapid enforced change.
- Judge. Although assisted conception techniques can be successful, it is not guaranteed. Desperation and hope keep potential parents going – it is not our job to disillusion. Allow patients to decide where to draw the line for themselves.
By Mona Sood, MRPharmS
Get Involved
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Learn more
- NICE – Infertility
- NHS – Treatment for infertility
- Explore fertility treatments
- NAWP members open up about fertility problems and pregnancy loss
- See “It doesn’t make it any easier” – A queer pharmacist’s account of miscarriage: Intersection Update – May 2023
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