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I still remember the first couple I helped conceive through IVF; the anxious wait, the cautious hope, and finally, the overwhelming joy when the pregnancy test turned positive. Since then, I’ve supported thousands more. But what hasn't changed is the emotional toll of infertility. I’ve seen people spend tens of thousands of pounds on private treatment, only to face repeated failure or miscarriage. The hardest part of my job is witnessing those who long for a child being told by their GP: not here, not you, not now. The door is closed. Stop knocking.

A Lifelong Commitment to Inclusive Fertility Care

As a consultant gynaecologist and fertility specialist, I’ve spent over forty years supporting people on their journey to parenthood and worked with patients from all walks of life; heterosexual couples, single women, same-sex couples, trans and non-binary individuals and those living with life-changing medical conditions. What they all share is the same longing: that hope to build a family either now or perhaps in the future.

Early in my career, I helped establish the UK’s first programme for people living with HIV to become parents safely. That experience shaped my commitment to ensuring everyone, regardless of identity, relationship status, or background, has access to the care they need.

When I moved to Sussex 19 years ago and founded the Agora Clinic, I built that commitment into the heart of our work by developing inclusive fertility pathways for same-sex couples, single parents by choice, and transgender individuals, because no one should be excluded from family-building because of who they are or who they love.

That belief, that everyone deserves the chance to become a parent, is why I am so honoured to have been asked to join Fertility Action as a founding Trustee. This charity is wholly aligned with my values and no more so than its commitment to ensure no one is denied NHS-funded fertility treatment based on their postcode, income, gender identity or family structure.

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Dead sea, Israel

Photo Credit: Image by Kim Shaftner  on Pixabay

The Reality of Fertility Inequality

We don’t talk enough about how unfair fertility care is across the UK. In one area, you may receive three full NHS-funded IVF cycles. In the next county, you may get nothing. Even in areas with inclusive policies, LGBTQ+ people are often told to self-fund multiple donor insemination cycles before qualifying for IVF. That’s not equitable, and it’s certainly not ethical.

In Sussex, we’ve shown there’s a better way. Thanks to a collaborative effort with the local Integrated Care Board (ICB), we now offer one of the most inclusive and generous funding packages in the UK. Heterosexual couples, same-sex couples, single women, and even cancer patients and transgender individuals needing fertility preservation are all considered, with support deeply rooted in clinical evidence and compassion.

But Sussex is the exception. When I spoke in Parliament earlier this year on behalf of Fertility Action, to help educate and inform ministers and push for national reform, I left them with a bold but true message: Fertility doesn’t discriminate. Our NHS health system does.

This is personal for me. Not just as a doctor, but as a human being who has witnessed how much infertility takes from people – emotionally, physically and financially. I don’t want to see another patient walk through my door who has been let down by a postcode and a policy.

The Broken Promise of the NHS

The NHS Constitution is clear: the NHS belongs to all of us. It's meant to be there for our health and wellbeing, in times of need, applying the best of science and compassion. So why doesn’t that promise extend equally to those experiencing infertility?

Medical infertility affects 1 in 6 people in heterosexual relationships and social infertility affects far more, including those who are gay, lesbian, trans, single, or part of a blended family. It cuts across all demographics. And for many, IVF is the only effective treatment. Yet too often, patients come to me after years of being bounced between GPs and under-resourced NHS departments, only to be told they’re not eligible for help, often because they’ve “run out of time” and are beyond the age or fertility test eligibility criteria.

I’ve seen women wait eight, even ten years to be referred for proper investigations. By the time they're finally seen, their chance of successful IVF has dropped. The system has failed them – not their bodies.

Why Fertility Equality Matters

This inequality is unacceptable. Fertility care is not a luxury. It is not cosmetic. It is a medical need with a scientifically proven solution, most often IVF. And it should be funded accordingly.

That’s why I’ve been campaigning for a national standard for NHS fertility funding, one that reflects the National Institute for Health and Care Excellence (NICE) guidelines. These guidelines are evidence-based and recommend up to three full cycles of IVF for women under 40, with adjustments based on clinical circumstances. Yet in most parts of England, those standards are ignored.

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Caption: What is IVF: In Vitro Fertilisation?

A Different Way: What We’ve Built in Sussex

Sussex shows what’s possible when compassion, clinical evidence, and progressive policy come together. In 2021, I was invited to work with the Sussex Integrated Care Board (ICB) along with other local experts to overhaul our local fertility funding policy. We didn’t just tweak it, we redesigned it around NICE guidance, equity, and inclusivity. It became one of the most generous and equitable fertility funding policies in the country.

Here’s what we achieved:

• For heterosexual couples with medical infertility who meet clinical criteria, Sussex funds three full cycles of IVF. In addition to each fresh cycle, up to three frozen embryo transfers are also funded. Embryos can be stored under the policy for up to five years;
• For single women and same-sex female couples, Sussex ICB funds six cycles of donor sperm insemination. If these aren’t successful, they are eligible for a full IVF cycle using donor sperm;
• For patients with severe male factor infertility requiring donor sperm, the same pathway applies;
• For individuals facing cancer treatment or undergoing cross-hormone therapy for gender reassignment, Sussex funds egg and sperm cryopreservation before treatment;
• For women with premature ovarian insufficiency, Sussex offers a fully funded cycle of egg donation.

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Caption: IVF vs ICSI: What is the Difference?

Eligibility criteria are not ideal but clinically reasonable and based on maximizing success rates for the funding investment: BMI under 30kg/m², non-smoking status, and adequate ovarian reserve (AMH > 5.4 pmol/l). Heterosexual couples need to have tried to conceive for over a year; single women and same-sex couples need to self-fund six cycles of home or clinic insemination.

This policy doesn’t just talk about inclusivity. It delivers it. It aligns with the evidence base, the science. And it’s cost-effective, delivering life-changing treatment for a fraction of what delayed or repeated private care would cost.

But it’s not perfect. Same-sex couples and single women still have to self-fund six rounds of insemination before being considered and gay men or those needing surrogacy for medical reasons are not funded to create embryos that could be used in a surrogacy arrangement. Worst, those who suffer a miscarriage are sent back to the back of the queue and asked to try for another full year before being considered for fertility treatment. So, there’s still a lot of work to be done to change policy.

The Agora Clinic's Role in NHS Fertility Care

As the founder, CEO and Group Medical Director of the Agora, I am proud that our clinics have been at the forefront of this shift. Over two thirds of our IVF cycles are fully funded through the NHS, with no waiting times. Patients can access high-quality care, emotional support, and a treatment pathway tailored to their needs without the crushing burden of private costs. And there is no difference to the level of support or care we offer our NHS patients compared to our private patients. This is in stark contrast to far too many private IVF clinics who still elect to only offer privately funded treatments, even when local policy offers NHS funding.

Our clinics in Brighton, Eastbourne, and Worthing are built around inclusivity. Whether our patients are single, in same-sex relationships, or navigating complex medical histories, we ensure their journeys are met with dignity, respect, and expert care. That’s what modern fertility care should look like.

The National Picture and the Urgent Need for Reform

Unfortunately, when it comes to equitable NHS funding, Sussex is the exception. Across the UK, policies remain patchy, discriminatory, and outdated.

• Some ICBs offer no NHS-funded IVF at all;
• Some exclude patients based on previous children in blended families, even if they've never conceived themselves;
• Not all fund cryopreservation for transgender individuals.

This Patchwork of Care is not Just Unfair, It's Unethical

We are long overdue national leadership on this issue. NICE guidelines were published in 2013 and are currently under review for re-release in August. But the recommendations are already there. What we need is political will to enforce them.

What Fertility Action Is Fighting For

This charity is calling for:

1. National adoption of the NICE fertility guidelines – including three funded IVF cycles and inclusive eligibility for all who need treatment;
2. Equal access regardless of geography, sexual orientation, gender identity, or marital status;
3. Timely diagnosis and referral pathways – to prevent avoidable loss of fertility potential;
4. Full NHS funding for fertility preservation for patients undergoing medical or gender-affirming treatments.

The cost of inaction is profound. Not just in missed opportunities for family-building, but in the emotional toll on individuals forced to navigate infertility alone. It's not just about people trying to conceive, it’s about justice, dignity, and equality in healthcare.

Final Thoughts

Fertility does not discriminate, but the NHS still does. That has to change.

The Sussex model proves what’s possible when ICBs address the need for inclusive NHS care and speak to local experts to become educated and empowered to make more informed decisions. It’s time the rest of the country woke up and caught up.

Those of us involved with Fertility Action, will keep pushing until every person in the UK has a fair chance at building a family, no matter where they live or who they are.

Because everyone deserves the chance to become a parent, if that’s what they choose.