NHS-FUNDED IVF treatment has decreased most for Black heterosexual couples, a UK regulator has found.

The Human Fertilisation and Embryology Authority (HFEA) found NHS-funded IVF cycles among patients under 40 in heterosexual relationships decreased across all ethnic groups.

However, for Black couples the funding decreased the most, down from 60% in 2019 to 41% in 2021.

Patients of other ethnic background were more likely to receive NHS-funded treatment (63%), followed by patients of White (53%), Asian (49%) and Mixed (47%) background.

The UK regulator published the Ethnic Diversity in Fertility Treatment 2021 report in December 2023, which highlighted stark disparities in use and outcomes of fertility treatment in the UK by ethnic group between 2017-21.

Professor Geeta Nargund, member of the Human Fertilisation and Embryology Authority, said: “There is no room for the health inequalities that exist within fertility treatment,

“While it is good news that multiple birth rates in all groups have dropped, this new HFEA report highlights the health inequalities that still exist within fertility treatment.

“It shows that there is a need for meaningful changes so that Black, Asian and ethnic minority fertility patients and their partners are not left behind in access to and experience of fertility treatment.”

Lowest birth rates

The HFEA report also found for single Black and Asian patients, they started fertility treatment much older at 38-39 years, compared to 36.2 years for White single patients in 2017-21.

Black patients in heterosexual relationships also started fertility treatment about a year later than other ethnic groups at 36, and this matters as age is a key factor in the success of treatment.

This group had the lowest birth rates but continued to have the highest high-risk multiple birth rates of all ethnic groups in 2020-21. Multiple births are a high risk to both patients and babies.

The report shows that Black patients continued to have the highest multiple birth rates at 9%, compared to 7% for White patients in 2017-21.

Over half of sperm used in treatment from donors of Mixed, Other and Black backgrounds in 2017-21 was imported from abroad.

HFEA data shows significant differences by ethnic group in the use and outcomes of fertility treatment.

The average IVF birth rate per embryo transferred has increased across all groups, but Black and Asian patients aged 18-37 had the lowest birth rates (23% and 24% respectively) compared to White patients (32%) in 2020-21.

Decreases in funding

The decreases in funding among Black patients could be related to the findings HFEA has found in their Fertility Trends 2021 report, which showed the number of NHS-funded IVF cycles reduced the most in London, from 23% in 2019 to 17% in 2021.

ONS data showed 49% of the Black population in England and Wales lived in London in 2021.

The UK regulator also noted that the decline in NHS-funded IVF cycles from 2019-2020 that were observed across all ethnicities may also be partly attributed to difficulties in accessing treatment, tests, or surgeries prior to starting treatment as a result of the COVID-19 pandemic.

Call for action

The HFEA, the Royal College of Obstetricians and Gynaecologists, the British Fertility Society and Fertility Network UK are calling for action to ensure that Black, Asian, and ethnic minority patients and their partners are not left behind in access to and experience of fertility treatment.

Professor Geeta Nargund added: “We know that fertility declines with age, and we are concerned the data shows that Black, Asian and ethnic-minority patients are left behind.

“A shared focus of all members within the sector is equalising treatment and hearing from the impacted groups to inform robust policy-making.

“Increasing information awareness, addressing high-risk factors, and further investigating health conditions such as endometriosis or fibroids, start the right conversations to begin to eradicate the disparities.

“The HFEA is committed to working together with other key bodies and healthcare professionals to ensure patients across all groups have better access to fertility treatment.”

The UK regulator says the reasons for these variations are complex but may relate to other differences across ethnicities, including underlying general health conditions, cultural, social, economic and structural factors, including stigma experienced by ethnic minority patients and other factors.

In 2017-2021, IVF was most used by White patients (77%), with Black IVF patients accounting for 3% of IVF patients compared to 4% of the age-matched population.