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Lack of NHS funding forces IVF patients into private care, says study

Research reveals a complex and overlapping system that contributes to inequalities in treatment experience

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The privatisation of UK healthcare services is creating unequal access to fertility treatment, researchers have said, leaving many people unable to afford the care they need.

The study, conducted by Queen Mary University of London, has shown that long NHS waiting lists along with the cost of living crisis are stopping people from starting families.

Only a fifth of the aspiring parents involved in the research could afford private fertility care, while 40 per cent said it would be just about possible with substantial financial planning. The remaining 40 per cent could not afford the treatment.

More than 50,000 people have fertility treatment every year in the UK, some as NHS patients but most paying privately, at prices from £3-5,000 for a standard IVF cycle to more than £20,000 with certain add-ons.

Although it is generally assumed that people struggling to conceive use NHS or private services, researchers have said this new study reveals a complex and overlapping system, where an initial round of IVF on the NHS often still leads patients into paying privately.

The findings have shown that while hopeful their treatment would work, participants knew that each round of IVF might not lead to a baby, and it was generally accepted by both patients and professionals that multiple attempts would probably need to be undertaken.

For many, the possibility that they might become private patients in the future involved substantial financial planning, coupled with worry about financial trauma.

One participant described how she was prepared for her funded IVF cycles not to be successful and started to save money, saying: “I thought, it’s going to cost us 16 grand in total to get two [private cycles of IVF]… I just needed that in my head, so I thought I could start saving, and so I’d be ready if it didn’t work.”

Dr Manuela Perrotta, study author and reader in technology and organisation at Queen Mary University of London, said: “Participants in our study went into fertility treatment expecting they may need to pay thousands of pounds for it, even if they were having NHS care.

“People know there is limited public funding for IVF, and each cycle has quite a low success rate which decreases further over time – so even if NHS care is available, it may not be enough.”

Many participants reported not being able to afford the costs of private IVF, and a lack of other options led some to make significant life changes in pursuit of the care they need.

One patient in the research moved 50 miles to be in a different catchment area with more supportive funding policies.

“I found out that if I lived in certain areas I would have had three rounds funded, so we moved [to another city] within about three weeks of finding that out and got the funding.”

The National Institute for Health and Care Excellence (NICE) recommends three cycles of IVF for women under 40, but access to treatment in the UK is determined by a patient’s home address and registered general practice, which can leave some unable to get help on the NHS.

This has led to an uneven provision of IVF treatment across different regions in the UK, with more funded cycles available in Scotland than in London and the east of England.

Paying for fertility treatment does not necessarily involve moving to a private clinic, the study has also suggested.

One patient described her first experience of private treatment being with the same consultant and at the same clinic as her previous NHS treatment.

Researchers have found that movement between NHS and private fertility care was often challenging for patients, with treatment options varying significantly from place to place.

Dr Josie Hamper, study author and post-doctoral researcher at Queen Mary University of London, said: “Our research shows that the boundaries between NHS and privately provided IVF are not as neat as they seem, and the hybrid public/private infertility landscape has had profound consequences for all IVF patients.

“The representation of a public/private divide contributes to inequalities in treatment experience, and does not reflect patients’ experiences of IVF in the UK.”

Menopause

High street bakery chain Gail’s reveals menopause plan

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Gail’s has unveiled a menopause action plan offering new workplace support to thousands of staff ahead of legal reforms due in 2027.

The high street bakery chain will offer new benefits including 24/7 digital GP access and a new employee assistance programme, according to The Times.

It will also explore new online training for staff, including specific training for management.

Gail’s people director Miranda Burgum told The Times: “All we’re trying to do is talk freely and for it not to be a forbidden subject. It’s helping our managers and teams understand that this isn’t a taboo.”

“We’re going to develop the education with our managers, so it will be threaded through all our policies

“It will look at induction training, it will look at the types of people we need to make sure that we make reasonable adjustments for.

“And if somebody needs some sort of risk assessment, we’re going to be looking at [that].”

The move comes ahead of reforms due to be introduced in spring 2027 under the Employment Rights Act.

UK employers with 250 or more employees will be legally required to publish and update official menopause action plans.

The plans are intended to support employers to take effective action to improve workplace gender equality and support employees experiencing menopause.

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Fertility

Paracetamol use may impact future fertility, studies suggest

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Paracetamol use in pregnancy was not linked to autism or ADHD, while separate research found reproductive differences in girls exposed before birth.

One study analysed health records from more than 120,000 children and found no increased risk of autism following prenatal paracetamol exposure.

A separate analysis of nearly 100,000 children also found no increased risk of ADHD among those born to mothers who used the painkiller during pregnancy.

Researchers from the Hong Kong Hospital Authority examined electronic health records covering pregnancies between January 2001 and December 2023.

The autism analysis included 124,333 children, who were nine years old on average and split almost evenly between males and females. There were 3,445 autism diagnoses, representing 2.8 per cent of the group.

The ADHD analysis involved 97,285 children, who were seven years old on average and also split evenly between males and females. There were 5,168 ADHD diagnoses, representing 5.3 per cent.

Women prescribed paracetamol during pregnancy were more likely to be older and have pre-existing conditions including psychiatric disorders, as well as reasons for taking the drug such as infection, fever or chronic pain.

No association was found between prenatal paracetamol exposure and either autism or ADHD.

The findings did not differ according to the trimester in which paracetamol was taken or whether use was intermittent or daily. Advanced maternal age, defined as pregnancy in women over 35, did not alter the findings.

The researchers wrote: “Paracetamol remains a safe and essential analgesic [pain reliever] and antipyretic [fever reducer] during pregnancy, whereas alternatives, such as NSAIDs and opioids carry well-documented risks.

“Unwarranted reluctance to use paracetamol could lead to undertreatment of pain and fever, or the use of more harmful alternatives, both posing risks to the pregnancy and developing fetus.”

The authors said women should assess paracetamol use with guidance from their doctor.

A separate study involving 685 pregnant women without pre-existing conditions and 302 infant daughters found associations between prenatal paracetamol exposure and differences in reproductive organs and hormone levels.

Researchers from Copenhagen University Hospital enrolled the women during their first trimester and assessed them during the first trimester, third trimester and again when their babies were three months old.

At around three months, infants experience a temporary rise in reproductive hormones sometimes called mini-puberty.

Pregnant participants completed questionnaires every two weeks about their use of pain medicines including paracetamol. Infant girls underwent ultrasound scans of their reproductive organs and blood tests to measure hormone levels.

Researchers also examined a separate group of 1,210 girls followed from infancy to adolescence whose mothers reported paracetamol use during the third trimester.

Three-month-old girls exposed to paracetamol before birth had an average 40 per cent smaller ovarian volume, 13 per cent smaller uterine volume and 23 per cent fewer ovarian follicles.

Girls exposed during the first trimester also had lower levels of Anti-Müllerian hormone, a marker of ovarian function.

Among the older girls, those exposed before birth were more likely to have smaller uteruses at puberty and smaller ovaries during their teenage years.

Dr Margit Bistrup Fischer, lead study author and postdoctoral researcher in the Department of Growth and Reproduction at Rigshospitalet hospital in Denmark, said: “Animal studies have demonstrated that impaired formation of ovarian follicles can lead to reduced fertility and earlier reproductive aging.

“Whether the differences observed in our study have implications for fertility and age at menopause in humans remains unknown and will require long-term follow-up of the girls in our cohort.”

She cautioned that women who had used paracetamol during pregnancy “should not be alarmed by our findings”, as the study found associations rather than direct causation and outcomes for individual women and children are unclear.

“Importantly, our study does not evaluate whether [acetaminophen] causes reproductive problems, nor does it provide evidence that prenatal exposure affects future fertility or age at menopause,” she said.

“Although we observed similar associations in an independent cohort, long-term follow-up is needed to determine whether these early-life differences have any clinical significance later in life.”

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Insight

Research uncovers potential new target for breast cancer therapy

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Targeting CD1d altered immune cells slowed tumour growth and improved immunotherapy responses in mouse models of breast cancer, researchers found.

The findings suggest blocking the molecule could make the environment around breast tumours more favourable to anti-cancer immune responses.

Further work is needed to understand how these immune changes occur and how the approach could be safely used in patients.

Researchers from King’s College London, the Francis Crick Institute and University College London investigated how immune cells inside breast tumours influence cancer growth.

They focused on myeloid cells, a group of immune cells found in large numbers within tumours that can either support an immune attack against cancer or contribute to tumour growth and immune evasion.

The team examined CD1d, a molecule found on the surface of myeloid and other immune and tissue cells that helps regulate immune responses.

When CD1d was genetically removed from cells in a mouse model of breast cancer, the mice were more resistant to tumour growth. Researchers also saw changes in myeloid cell populations, including increased activity among cells that can help attack cancer.

The team then blocked CD1d using an antibody and again observed changes in myeloid cells and slower tumour growth. Blocking CD1d also improved responses to immunotherapy in the mouse model.

Researchers used single-cell RNA sequencing, a technique that examines gene activity in individual cells, to investigate the immune changes in more detail.

They identified a population of myeloid cells called monocytes that expressed genes associated with inflammation, an important part of the immune response. These cells were particularly important in restricting tumour growth in the mouse models.

A similar pattern of gene activity was identified in data from human breast cancer tumours. Its presence in myeloid cells was associated with positive responses to immunotherapy in breast cancer patients.

However, the findings in people were based on gene expression data and did not test CD1d-targeting treatment in patients.

Professor Patricia Barral, professor of immunobiology at King’s College London and senior author of the study, said: “Many breast cancers do not respond well to current immunotherapies.

“Our findings reveal a previously unrecognised mechanism by which immune cells within tumours are regulated.

“While CD1d is best known for helping immune cells recognise lipid molecules, we found that it also plays a role in shaping the behaviour of myeloid cells within tumours.

“These findings suggest that targeting the immune cells that surround and support tumours could boost anti-cancer immunity and potentially improve treatment responses in the future.”

Researchers now plan to investigate how the immune changes occur and how they can be safely harnessed in patients.

They also want to examine whether targeting CD1d could enhance existing treatments and influence treatment responses in different cancer types.

The work was supported by UKRI BBSRC, Breast Cancer Now and the Cancer Research UK City of London Centre.

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