My Lords, I declare an interest as a former chairwoman of the HFEA. When I was approached for the job, I explained that, at my school, we were not even taught what were then called the “facts of life”. It turned out that this did not matter, as the task of the HFEA chairwoman was to explain to the public, in language that everyone could understand, what was happening and the ethical problems. That is the approach that I am taking today.
The UK was a first in pioneering and regulating in vitro fertilisation. As in other fields, being first is something to be proud of, but it risks us falling behind what is required as the years go on—as in our railway system—and not being sufficiently visionary to encompass future developments. This is not to belittle the global achievement of Baroness Warnock and her committee, when they produced the report that laid the ground for the HFEA and its followers in regulation the world over. I hope that we can now once more be leaders in bringing that law up to date, future-proofing it and coming into line with societal changes. I am well aware of the complexities and time commitments involved in reforming the law, and the risk that legislators will pile in with restrictions and other issues that are not in accord with the root needs, but we have done it before, with Acts reforming the original Human Fertilisation and Embryology Act 1990, and we can do it again with a progressive government.
My Lords, I thank the noble Baroness, Lady Deech, for bringing this matter to the House. At present, the HFEA regulations are under a law that is over 35 years old, as identified by the noble Baroness, Lady Deech, and the legislation is unfit for the purpose in many areas. The HFEA has no flexibility to adjust its powers according to regulatory performance; it needs to reduce the regulatory burden for compliant clinics and focus oversight on those not meeting the required regulatory standards.
The noble Baroness, Lady Deech, summed it up when she talked about fining not closing clinics. The HFEA wants to achieve the greatest impact with the most proportionate sanction for the fertility sector as it is today, with many licensed clinics being part of large private equity-backed groups and more than 70% of patients self-funding. Should there be a financial penalty, which HFEA cannot impose at present? This must be better than removing or suspending a licence. The aim must be to improve compliance while not impacting existing patients.
The current regulations are also out of date where patient safety and other areas are concerned, but it has to be said that treatment in a UK-licensed fertility clinic continues to be very safe. However, we should not rest on our laurels. The UK needs to stay ahead of technical advances by reforming the legislation; the current law is inflexible and does not easily allow for scientific and medical innovation in an area where new treatments and extraordinary advances, such as stem cell-derived gametes, are around the corner. The HFEA is still considered globally the gold standard in fertility regulation, and the UK must not lose that reputation.
My Lords, I would like to come down to earth a little bit. First of all, I suggest that infertility is not a disease; it is actually a symptom of something wrong, and that is the basic problem here. What we are doing here with in vitro fertilisation is using a medical treatment for a symptom without actually making a diagnosis. That is almost universal; it is not only in this country but in every other country. In my view, that is something that neither the Human Fertilisation and Embryology Authority nor NICE have done. In fact, they have made it very difficult to investigate patients to find out what is wrong.
There are at least 100 causes of infertility, some of which are extremely serious and end up with people being childless. They could be treated far more cheaply in all sorts of ways but are not, because in vitro fertilisation is seen, as we have just heard, as the gold standard. Believe me, it is not the gold standard. Indeed, it is not well regulated, for reasons I will explain, and cannot be in this situation.
One issues we have to think about is whether we should really be doing some kind of special regulation for one small treatment in the whole medical spectrum. In my sense, that no longer works. The HFEA was an important body in its time, when there was public unrest about the human embryo and it was very clear that in vitro fertilisation was going to be a new treatment. It is now absolutely essential that IVF is normalised. That will be very complicated, but it is something that this Government could do; they could regulate it far more effectively with the vast things at their arm.
My Lords, it is a privilege to follow the noble Lord, Lord Winston. We live in an increasingly digital world. We entrust apps with our fitness data and menstrual cycle, and healthcare providers frequently offer virtual consultations. It is no surprise, therefore, that many people entrust fertility treatment to the number of concierge-style online providers that have emerged in recent years. Yet our law has not kept pace. These online providers operate entirely outside the remit of the HFEA. The authority regulates licensed fertility clinics and the treatments that take place in them, but the digital-first fertility businesses that sit alongside those physical clinics and play a central role in patients’ treatment journeys face no equivalent oversight. This major gap in our fertility law became painfully clear with the closure of Apricity Fertility, which had called itself
“the UK’s top virtual IVF clinic”.
I am very grateful to the noble Baroness, Lady Deech, for tabling this debate to highlight where the law desperately needs to be updated. Apricity provided patients with online access to qualified medical professionals and a network of clinical services across the country, scheduling appointments, providing expert advice to couples at a vulnerable and emotionally taxing time and offering flexibility for those unable to consistently access the same location. This can be particularly helpful for patients managing treatment around work, caring responsibilities or long journeys to clinics.
My Lords, I recognise the depth of expertise in this Chamber and that my background is not a scientific one. However, it is incumbent on us all to engage in these crucial issues, which hold wide significance and implication. I approach this debate in the knowledge of what it is to long deeply for children. I am profoundly grateful for the gift of my own three children following the experience of difficult and intrusive treatment over many years, including miscarriages and several cycles of IVF. Indeed, if I may be personal, I was for a number of years a patient under the care of the noble Lord, Lord Winston, for whom I have both affection and great admiration and to whose speech I listened very carefully indeed.
I want to recognise the highly complex and agonising experiences of infertility that many go through, and what it is like to have an unfulfilled longing for a child. This debate takes place in a profoundly challenging scientific, moral, legal and emotional context. I recognise that the lives of my children are the result of extraordinary scientific and medical advances, but, ultimately, like any child, they are a remarkable gift from God. Throughout the treatment, I was always aware that they were never a right of mine to be claimed. Good legislation, thoughtful limits and sober weighing of the implications of those limits are vital if we are to continue responsibly in this work with clarity for all. Indeed, I know personally the importance of those limits for tempering what can be a very human dimension, which, if unchecked, can lead to desperation and a willingness to do anything to have a child.
My Lords, it is a great pleasure to follow the right reverend Prelate. That was very moving, and I am very pleased that her three children are in this world thanks to the noble Lord, Lord Winston. That is amazing. Like the noble Baroness, Lady Deech, I confess my inner Mary Whitehouse is hovering at the moment too, so I agree with her. I am going to slightly change the topic, because we cannot talk about fertility policy without talking about prevention. I have personal family experience of IVF, although not for myself. It is a wild west—it is horrible. The chequebook was extremely strained. The result was great but, my God, that was difficult. And all I see in young people I know is that this problem is getting worse.
I buy into the argument that women want children later, women work, and then there is the cost of living—but there is something else going on, and that something is plastics. They are not just a waste problem; they are a chemical problem. The public treats plastic as litter, but plastics are a very complex chemical exposure. They migrate from packaging, consumer goods and medical products into us through what we wear, through the dust, through our skin. There are 16,000 different chemicals in everyday plastics, and right now we only know about 6,000 of them. Reproductive development is particularly sensitive to hormone disruption, which is caused by chemicals. Fertility, as we know, is governed by hormones; they tell organs when to grow, when to develop and when to reproduce. If these messages are disturbed during pregnancy, infancy or puberty, the consequences can last for decades. This is why endocrine-disrupting chemicals deserve particular attention in a fertility debate.
My Lords, it is a pleasure to follow the noble Baroness, Lady Boycott. I thank the noble Baroness, Lady Deech, for securing this very important debate. I declare an interest as a board member of the Human Fertilisation and Embryology Authority and as someone who previously led IVF and fertility units for over three decades. The debate is rooted in my long-standing and strong commitment to promoting the health and safety of women and the belief that fertility treatment has raised the standard in the UK.
I have been proud to serve in the fertility sector for most of my career. I have seen IVF move from a pioneering treatment to a routine service in our healthcare, with around one in every 32 births in the UK—that is one child in every classroom—now resulting from IVF. I have also seen the important role that the regulation has played in maintaining public trust and improving standards of care.
It is true that the UK’s regulatory framework, the first in the world, is considered a gold standard across the world, and it has been a genuine success. Some examples include the collaborative work that the HFEA has done to reduce multiple births from IVF treatment from 30% in the 1990s to 3% now. It has also used data to publish outcomes, including trends, and highlight inequalities in access and outcomes from IVF treatment for Black and Asian patients. In addition, the HFEA provides robust, impartial and accurate data to help with commissioning for NHS patients and patients in general.
My Lords, I pay tribute to the noble Baroness, Lady Deech, for securing this important debate. Before I start, I will just clarify one issue: about 98% of abortion treatment is carried out in the not-for-profit sector, funded around 98% by the NHS. NHS hospitals do not make a profit from abortion care. In my experience, infertility clinics that were run through the NHS used to take both co-payments—that is, self-payment and not-for-payment—and it cross-fertilised and cross-funded so that women who are more deprived could get either NHS treatment or cheap treatment.
I have spent decades looking after women and helping them navigate a fertility system that too often fails them. At the root of that failure lies a simple truth—this outdated law governing fertility treatment. As the noble Baroness, Lady Deech, and others have already said, the regulatory framework, which was set up in the 1990s, was ground-breaking and was the first of its kind. As a young GP at the time, I welcomed it.
But, as we have heard, the law was enacted before the promotion of unnecessary and non-essential add-ons—they just did not exist—such as pre-implantation genetic screening for aneuploidy, which is an abnormal number of chromosomes; endometrial scratches, which, exactly as it sounds, means scratching the uterus in order to create a scar; or the adjunctive use of quite a dangerous growth hormone in the belief that it creates ovarian stimulation and increases chances of conception. This was all before the rise of virtual clinics or of AI embryonic selection. The HFEA itself, the architect of this law, has told us that it is no longer fit for purpose and that the law has not kept pace with the reality of modern care and has left a legislative vacuum. This House should listen to the HFEA.
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Many of the patients are desperate, and the clinicians are competitive. This is where the dangers of statistics become apparent. More important than generalities, the basic elements in statistics have to be the age of the woman being treated and the age at which her eggs were frozen. Clinics offer extras in treatment, for which the patient pays more, and it is suspected that they are not sufficiently improving to be worth it. These so-called add-ons need to be reported to the HFEA, which they are not at the moment. Another issue of concern is that the NHS does too little of the work. It is a postcode lottery. IVF is private, eye-wateringly expensive and commercialised. Of course, one understands that fertility treatment is regarded as of less urgency in the struggle for funding compared with life-threatening diseases, but it is a painful situation.
Since 1990, the fertility sector has transformed beyond recognition, with new technologies, new family structures, new ethical questions and new challenges for patients. When I started as chairwoman, the burning question was whether treatment should be offered only to married couples. Now, of course, same-sex and single people are provided for by statute. The HFEA itself acknowledges that, while much of the 1990 Act remains fit for purpose, it has been updated by statute only once, in 2008, and now contains significant technical gaps, outdated consent rules and insufficient regulatory powers. The HFEA has made proposals for modernisation.
At the same time, the law governing surrogacy, the Surrogacy Arrangements Act 1985, was drafted for a world in which surrogacy was rare, poorly understood and feared. Today, surrogacy no longer raises eyebrows, with the number of children born that way increasing fourfold over the last decade. However, with increased use comes the increased danger of exploitation of poor women and risk to their health and their babies’ welfare. Families are left uncertain in that situation. Clinics are constrained, judges strain the legislation to make it workable, and the UK risks falling behind in welfare protection. However, reforming surrogacy, and the very concept itself, is hotly contested.
Comprehensive reform of both areas is on the table, and we have before us two reform proposals—first, the HFEA’s 2023 proposals to modernise the law, and, secondly, the Law Commission’s 2023 recommendations for a new surrogacy framework. The HFEA proposals tend to an innovative, ethical, patient-centred system of reproductive law. The Law Commission’s proposals about surrogacy are different. As I have looked into this recently, I am less certain than I was that surrogacy and reproductive law can be resolved—certainly not in one statute. Parliament needs to take the lead in scrutiny.
The HFEA’s case is clear: the fertility sector has outgrown the 1990 Act; it has expanded dramatically in size, complexity and commercialisation. Clinics now operate in hybrid, online and in-person models; donor-conceived people have new rights to information; and scientific developments, from mitochondrial donation to embryo research, have outpaced the statutory framework.
Yet the HFEA’s regulatory powers remain narrow, limiting its ability to enforce patient safety and good practice. The consequences are inconsistent clinic standards, complex consent rules, legal uncertainty around parenthood—especially in cases of relationship breakdown and posthumous conception—and a regulatory regime that cannot keep pace with innovation.
Surrogacy law is far more controversial. The Law Commission’s review found consensus that the current law is outdated and unclear. The surrogate remains the legal parent at birth, even in gestational surrogacy where she has no genetic link to the child. Intended parents must apply for a parental order, a process that can take six months, during which they cannot make legal or medical decisions for the child; the child’s status is uncertain and so is that of the parents. But the interests of the surrogate are not fully considered, not least in that she may be burdened with unwanted legal responsibility or even left literally holding the baby.
Meanwhile, cross-border surrogacy is increasing, often involving commercial arrangements that UK law neither permits nor adequately regulates. We have all read concerning stories about poor women, often abroad—for example in Nigeria or Ukraine—delivering in war zones, with uncertain future steps to safeguard the baby. I have great respect for the Law Commission and its logic is impeccable, but its plans to reform surrogacy would reduce the time a surrogate mother has to change her mind. They would reduce the oversight by the family court and Cafcass for domestic arrangements. They would transfer rights to the baby at birth, taking away fresh consent from the surrogate, and they would relax other requirements and safeguards.
Children’s rights and mothers’ rights would suffer if the law tilted too much towards the commissioning parents and away from the surrogate mother. Although the commissions do not propose major changes for cross-border arrangements, they recommend improvements to immigration processes and the recognition of intended fathers for nationality purposes. One wishes that these international transactions could be more controlled or even prevented, but that seems to be impractical.
As I get older, my inner Mary Whitehouse has real concern about single male parent surrogacy and the exploitation of women. Surrogacy welfare checks must be made as stringent as they are for adoption. When I started to research this speech, I thought that surrogacy law and a reformed HFEA law could be combined in one. I am still convinced that there are urgent needs for HFEA reforms—even limited, such as statutory instrument provision for the possible extension of a 14-day embryo limit and protection for new types of gametes. But surrogacy still needs more wariness and consultation, not least because the HFEA seems unwilling to take on surrogacy regulation.
Public attitudes and family structures have changed. The 1990 HFE Act was drafted for a world in which heterosexual couples were the assumed norm. The 2008 amendments widened access for same-sex couples, but the underlying structure remains in assumptions that no longer reflect modern family life. So the HFEA’s 2023 recommendations focus on four key areas. The first is strengthening patient safety and regulatory power. They propose expanded inspection and enforcement powers to ensure that clinics meet high standards of care. The regulator must have flexible tools to protect patients—for example, fining rather than closing clinics.
We need improved access to donor information. Donor-conceived individuals can now access identifying information at age 18. The HFEA proposes going further: removing anonymity from birth for all future donations, with appropriate counselling and support. This reflects a growing consensus that identity matters and that donor-conceived people have a right to know their origins. It was once feared that the removal of anonymity would reduce the willingness to donate but, as it has become more acceptable, that fear is diminishing. Moreover, there are genetic search engines online, enabling people to find their parents without official interference. Frankly, there is no point in keeping the current identity rules, and donors and patients should be warned that it is unlikely that they can remain unknown.
We need to clarify the consent rules. The current regime has led to difficult litigation, especially in cases of relationship breakdown or posthumous use of gametes. The HFEA calls for clearer statutory definitions to protect all parties and reduce judicial uncertainty. Posthumous taking of gametes by violating a corpse is certainly not the way forward—not without consent. There should be automatic record sharing between clinics and the NHS central records system. This fits with the record-sharing provision in the NHS modernisation Bill and could be an amendment to it. There should be more reminders to patients that they can donate unused embryos to research. There is even a suggestion of a national embryo research bank.
We have to prepare for scientific innovation. As I said, I am no scientist and I will leave the details to the distinguished experts who are speaking in this debate. But there are three areas that impinge importantly on the foresight needed in regulation. They are the keeping of embryos beyond the 14-day limit, stem cell-based embryo models and in vitro-derived gametes. The extension of the 14-day rule is linked to the research capability required for the latter. It is being reviewed by the Nuffield Council on Bioethics, which is consulting with the public. In vitro-derived gametes are created by reprogramming other cells—for example, skin. Under current law, they could be used for research but not reproduction. The advantages are that they would eliminate the need for gamete donation, but they will need separate definition in the HFE Act, fresh consideration of the definition of parenthood and, of course, much more research.
The frameworks of regulation must deal with anticipated developments here and their ethics. There are also stem cell-based embryo models, which are lab-grown models made from human stem cells that mimic early stages of human embryonic development. They may verge on becoming real human embryos, and the voluntary code of practice developed in Cambridge needs to be embedded, with a view to developing a distinct method of regulating them—not bad for someone with no biology O-level.
What must Parliament do? It must modernise the Human Fertilisation and Embryology Act. Parliament should plan by setting up a Select Committee to examine the HFEA’s proposals to expand regulatory powers, simplify consent rules, modernise donor information provisions and create a flexible framework for future scientific developments. A Select Committee also needs to look at the Law Commission’s surrogacy reforms as a second-order issue. As I said, I am not at all sure about integrating fertility and surrogacy law into a whole.
The noble Baroness, Lady Merron, has said that the Government are deciding how to take this forward, and there was a Bill about this in the Commons last year. Let us start by updating our fertility law, in keeping with the UK’s history of an ethically cautious and scientifically informed approach, which has made us a global leader. Will the Minister move forward with a Select Committee and pre-legislative scrutiny of a draft Bill to reform the HFEA? I beg to move.
The UK fertility laws were enacted in 1990 and only partially reviewed in the HFE Act 2008. After over 35 years, it must be time for a new review of aspects of the legislation. Is the Minister able to give any hope that this sensible change can happen?
It is also very ironic that it is difficult for many patients to access publicly funded fertility treatment in the very country where IVF was originally pioneered.
The noble Baroness, Lady Deech, said she was not this and not that, but spoke with great eloquence. She said there would be many distinguished speakers speaking at length. I do not count myself among them and will listen with eagerness to what they have to say.
In vitro fertilisation is of course increasingly expensive, as the noble Baroness, Lady Deech, pointed out, because it is largely in private practice. It is in the National Health Service a bit, but the National Health Service is making a profit out of in vitro fertilisation. One president of the College of Obstetricians and Gynaecologists said to me, “Don’t say too much about NHS IVF: we need it because it is currently, together with abortion, paying for maternal care”. That was what he said privately as a president of the college. How we fund the health service is a real issue to think about.
At the moment, private clinics are making vast sums of money. Clinics are being sold for several hundred million pounds at a time; the equipment in them is probably worth about £15 million at best. There is very little understanding and regulation of that, nor is the inspections situation sufficient. In my own laboratory, I remember one year we had a fantastic review saying it was the best lab they had ever visited. We were not then treating patients; we were simply doing research, with some patients being involved in that research. The following year, having changed nothing that was praised, we got a terrible review—for no reason other than the fact there was a different set of examiners, some of whom were in private practice and were jealous of what we were doing. That is a real issue.
That resulted in my closest colleague, Kate Hardy, who was one of the best embryologists in Europe, finally saying she did not want to do embryo research any more—she was in tears—and she never did. She was actually so depressed by that review that she gave up and ended up doing other work on the ovary, which did not involve in vitro fertilisation. We lost one of the best scientists we could have had in that field. She had papers in Nature and many other journals. We had worked together, for example, as the first people to do pre-implantation diagnosis, to look at genes in the embryo, and she was one of the four authors of that paper. She gave it up because of what the HFEA had done to her mentally. She really suffered.
I want to make it clear that we need to do something much more serious about this. As much as I respect the noble Baroness, Lady Deech, we cannot say that it is the envy of the world: it is not. As a so-called expert in in vitro fertilisation—whatever that means—I have visited virtually every civilised country where in vitro fertilisation is done. They laugh at the idea of the HFEA. It does not matter where you are: they do not think that our regulations are fit for purpose.
One of the issues is the way we understand the results of in vitro fertilisation. I mentioned this in the King’s Speech debate the other day, when I pointed out that one area of in vitro fertilisation that is hopelessly accounted for is egg freezing. I showed the data: there are something like a quarter of a million eggs recorded as available which have been frozen. So far, some 34,000 of those have been unfrozen in the past year for the purposes of treatment. Of that number, 2,000 embryos were produced, and only 900 pregnancies were produced. We do not even know the number of live births. People do not want to have an embryo transfer; they want to have a baby. That is why they come.
The problem is that, right from the beginning, we ignore the fact that the treatment is a long process. It starts with an assessment of what is wrong, which should mean a diagnosis, wherever possible. Secondly, we have to look at the hormonal control of ovulation. Particularly, we have to understand that the eggs must be matured properly before they can be treated with sperm, otherwise you do not get normal embryos. When that is done, we have the problem, in some cases, of finally getting embryos. But before we do that, we have to understand male infertility, which is very poorly served and really not dealt with at all by the HFEA, even though it is an integral part of infertility. We need to have far more expertise in dealing with male fertility. We have just ignored it completely, quite unnecessarily. All sorts of research could be employed—but we do need more research.
Once we have an egg that seems to be fertilised, we culture it. It spends up to five days in a dark medium, the constituents of which we do not know, because the constituents of the media that are available commercially are secret. We have been doing extensive work on this to find out what the ingredients are. One of my colleagues, Sheba Jarvis, has looked with spectroscopy and we found 302 different proteins which we did not know were in one particular medium. That is really quite serious, because some of these proteins may be bioactive and could have an effect on the outcome of the culture. After that black box is opened and the embryo is taken out, if it has produced an embryo—which it does in some cases—we hopefully end up with an implantation.
All those stages carry a failure rate, which is not recorded properly in the statistics. In fact, when I recently asked the HFEA to write to the Minister, I was told that we do not know how many eggs are being frozen, how many end up fertilised, how many become embryos or what happens to those embryos—we only know the number of embryos transferred to uteruses and the number of pregnancies. We do not even really know the number of miscarriages, which seems to be at about 15%. That is not satisfactory.
In conclusion, I would argue that the HFEA was a great organisation to start with, but it is now no longer fit for purpose. We need to bring it back in to make in vitro fertilisation a proper treatment that is recognised, so that it ceases to be something that is managed by private practitioners at huge advantage to their pockets. That should not be allowed to happen.
Two of its clients, Rosie and her husband Andy, had been undergoing IVF treatment through Apricity when, just a few days before Christmas 2024, they received a mass email informing them that the company would be closing on 1 January. By that point, they had already invested months in treatment and were waiting for their embryo transfer. Instead of looking forward to the next stage of their journey, they spent the Christmas period uncertain whether the treatment would continue and what would happen to their embryo. Rosie told me, “If you’re having trouble conceiving, every single month is important”. She said: “It was stunning to learn that the HFEA had no remit to step in and help us. We were effectively abandoned. When digital-first services close, there are no guarantees for patients, and couples like us are left fighting to protect our embryo, our money and our chance of having a much-wanted child”.
Rosie’s experience is not an isolated one. Many people who had entrusted Apricity with their hopes of having a family were left in fear that they might not receive their money back or be able to afford continuing treatment with another provider. They are unlikely to know that the law as it stands means that the HFEA can regulate only UK-licensed fertility clinics, which are the physical premises where the treatments take place. Patients assume that, when a company is central to the delivery of their fertility treatment, there will be regulatory oversight and protections if that company fails. At present, that assumption is not always correct.
The HFEA itself has recognised this. One of its recommendations in the 2023 report on modernising fertility regulation was that:
“The Act should be revised to accommodate developments in the way fertility services are provided”.
Following Apricity’s closure, the HFEA’s chief executive, Peter Thompson, warned that fertility legislation was more than 30 years old and had failed to keep pace with the way that modern life is organised.
Around the time of Apricity Fertility’s closure in early 2025, I asked the Minister, the noble Baroness, Lady Merron, whether the Government would review the HFEA’s power, to ensure that it was appropriate for a digital age. The Government responded that they would meet the HFEA’s chair and CEO to discuss the regulatory challenges they face, and that they were considering the HFEA’s priorities, should the opportunity for legislative reform arise. In June 2025, I was told in a subsequent Written Answer that the Government were
“considering the HFEA’s priorities … and will decide how to take this forward at the earliest opportunity”.
Seven months later, in January 2026, the Government’s position had moved no further, and they answered that they
“will decide how we might move forward”.
That is not good enough. The gap is clear. The HFEA has set out its recommendations. Patients have been left without protection. The only thing missing is government action. I ask the Minister why, given the clear gap exposed by Apricity’s closure and the HFEA’s own recommendation for reform, the Government have still not set out a timetable for the legislation. Can she now tell the House when the Government intend to bring forward proposals to ensure that digital and concierge-style fertility providers are brought within an appropriate regulatory framework? Our fertility laws are not fit for the digital age, and women and couples hoping for a family deserve so much better.
I turn to the HFEA’s proposed changes to the law in its 2023 report. The Church of England’s policy team responded to the consultation about the recommendations put forward at the time, which I am also drawing on. They and I recognise the important issues highlighted and the need for a regulatory update, especially around patient safety, licensing and the HFEA’s ability to incentivise compliance within fertility clinics. With the development of the online world, the landscape for people accessing information and selecting their options is changing significantly. There is much misleading advertising on social media, including claims about the guaranteed success of IVF treatment. On such a highly emotional and charged issue, this is deeply troubling and there is a clear case to be made for ensuring stricter regulation of services. The moves towards patient safety and the HFEA having sufficient powers to take action where patient safety is at risk also seem clear to me.
However, some of the proposals in the HFEA report must be considered with more caution. First, it highlights the 14-day limit on embryo experimentation as something that could be changed in the light of scientific developments. In 2003, the General Synod of the Church of England affirmed
“the sanctity of the human embryo and therefore the need to treat it with profound respect”.
Though I recognise the possibility for research into the development of embryos between 14 and 28 days, and, from that, the possibility of therapeutic benefit, it remains the case that individuation and identity are significant to moral status, so I believe that the 14-day limit should not be overstepped.
Secondly, the report proposes changes to the way consent is obtained. In order to prioritise patient safety and access to the best possible care, it seems vital that information can be shared with other healthcare providers. My caution is around the proposals related to changing the consent approach to one which is package-based. Anyone undergoing or considering fertility treatment and having a conversation with a specialist is likely to be experiencing intense stress and possible feelings of overwhelm. That is precisely why it is essential they understand absolutely what they are proceeding with. Each part of the process is weighty and should be considered carefully, according to the conscience of the individual or couple concerned. It is right, proper and honouring of them to ensure that this weighing-up is enabled and facilitated.
Similarly, with the proposed change to the consent regime for research on embryos, if a decision has been made to donate embryos to scientific research, there is likely to be a variety of preferences and approaches. Though some may be content for their embryos to be used for any available research, this will not be the case for everyone. Maintaining the requirement for consent to each named project will be important for some and so should not be overlooked.
I have touched on just a handful of issues for consideration in this complex and important debate. What is clear is that, if legislation is to be brought, it must be preceded by full consultation which facilitates public understanding and engagement. These are matters not only of personal importance, though I understand that dimension all too well, but of societal importance, and any proposals to change the law must be treated with both compassion and great care.
Declining sperm quality is not just a private medical concern; it may be an early warning signal. Relevant research of 185 studies found a 52% decline in sperm concentration and a 59% decline in total sperm count among a completely cross group of men from North Africa, Europe, Australia and New Zealand between 1973 and 2011. This was updated in 2023, and the same sort of decline was found: a 51% decline in sperm concentration and a 62% decline in the total sperm count between 1973 and 2018, with the evidence that this is accelerated.
Phthalates are a priority, because their impact on reproductive evidence is particularly strong. They are used to make plastic fibres; they are present in products that touch food, bodies and babies, and they are the clearest evidence of reproductive concern. Many studies—and I can supply any noble Lord with huge research details; it has been very difficult trying to chop this down to seven minutes—have shown that prenatal phthalate exposure at environmental levels is associated with altered male reproductive development, particularly if measured through the anogenital distance. For people undergoing fertility treatment, chemical exposure is not an abstract issue. It is not just men who are affected. In a Singapore preconception cohort, higher PFAS exposures were associated with decreased fertility in women. Another 2024 report from the Endocrine Society summarises evidence that phthalates are linked with reduced egg quality and other aspects of egg viability.
Fertility does not end with conception. A fertility policy that ignores miscarriage, preterm birth, placental health and early development is incomplete. The first 1,000 days from conception to age two is the period when plastic-associated chemicals will do their most harm. One global estimate says that 1.97 million preterm births in 2018 were due to phthalate exposure. In tiny babies and tiny bodies, a tiny amount makes a big difference. It might not make a big difference to me or you, but it makes a difference to that foetus. We are not talking here about an industrial accident: this is every day in our kitchens and supermarkets. We cannot expect women and men to understand what chemicals are in saucepans and milk bottles. For instance, all 20 brands of baby bottles and 13 brands of sippy cups tested released BPA and BPS under test conditions. Polypropylene infant feeding bottles release microplastics at levels of up to 16.2 million particles per litre. Ironically and very sadly, sterilisation and high temperatures actually increase the way that plastic chemicals are released into whatever product is around it. The saddest point is if you give your baby those tiny yoghurt pots, that food has had more exposure to plastic than if you bought a large family-sized pot.
We cannot regulate one chemical at a time. It is not a case of saying, “This chemical is no good; replace it with another one”. The Government should now move from reassurance to regulation of the whole lot. The average person cannot inspect the chemistry of a can lining, so the rules have to be set upstream. The European Chemicals Agency is considering a broad restriction of all these chemicals, moving entirely beyond a substance-by-substance individual plan. Will the Government commit to a government review of plastic-associated chemicals and reproductive health as part of any wider review of fertility treatment and regulation, develop a UK plan on endocrine-disrupting chemicals, fertility and pregnancy, including all the related chemicals, and strengthen UK REACH restrictions? If we are serious about fertility, we cannot only fund the treatment after the harm has happened. This is rising and it is real. Chemicals are made by fossil fuel industries; at the moment 25% of fossil fuels goes into plastics. This number is rising while fossil fuels going into industrial combustion engines is falling.
I leave you with one small anecdote. I went to see the lovely NHS doctor here the other day because I have had a tick and I did not know if I needed antibiotics. I was chatting to him and I said, “What do you do when you are not here?” He said, “I run a men’s clinic”. I said, “What do you do in your men’s clinic”? He said, “It’s for men from 18 to 32. It is very strange; all they want is HRT”. I said, “What?” He said, “Yes, they want testosterone”. That is because their bodies are lacking testosterone and, if you do not have testosterone, your sperm are not as mobile or healthy, and your sex drive is not as good. He said they were depressed, but they perked up after that. We have a problem that is ours to fix and ours not to continue.
Infertility is a disease, as stated by the World Health Organization, and IVF is an essential treatment for many. We must celebrate the success of our regulatory framework, and it is time to modernise it to better protect patients in a changing fertility sector. The HFEA has set out three practical areas for reform: stronger patient protection, regulation that reflects the changing fertility sector and more proportionate sanctions. I support all three proposals. I want to view them through the lens of something that I have argued for for many years: that the Human Fertilisation and Embryology Act must recognise not only the welfare of the child but the safety and protection of the woman undergoing treatment.
While fertility treatment creates families, the burden of treatment falls overwhelmingly on women. Women undergo multiple and often invasive investigations, daily hormone injections during the treatment and out-patient surgical procedures. They suffer from side effects, the potential complications of these treatments and the emotional and financial strain that accompany them. Yet, despite carrying so much of the burden, patient protection remains largely absent from the legislation that governs our fertility treatment at the moment. The Act was built around the embryo and the future child. The next generation of reform must explicitly state “safety and protection of the patient” at the heart of the Act.
More than 52,000 patients undergo IVF treatment each year, and 70% pay for it privately, navigating a complex commercial market at a time of considerable vulnerability. The absence of an explicit reference to patient protection limits the regulator’s ability to act when patients are offered and encouraged to pay for treatment add-ons—not only do these lack official evidence of benefit but, for some, there is evidence of harm—or when a small number of clinics maintain persistently high multiple birth rates, despite known risks to mothers and babies.
When the Act was drafted, fertility treatment largely took place within a single licensed clinic. Today, services are increasingly fragmented and delivered across multiple sites, including online. Patients reasonably assume that, if a service presents itself as a fertility provider, it is regulated by the HFEA. However, as the noble Baroness, Lady Owen, mentioned, when one of the prominent online providers closed recently, patients were left with no recourse to the regulator they believed had been protecting them. Protection must follow the patient, not the premises.
Putting patient protection at the heart of the regulation means giving regulators proportionate tools to intervene when things go wrong. At present, the HFEA’s principal sanction is to suspend or remove a clinic’s licence. In many cases, a financial penalty would be a more proportionate and patient-centred response. A licence suspension can disrupt treatment for patients in the middle of their fertility journey. Financial penalties can drive improvement while minimising harm to the very people that the regulator is there to protect.
Women move between fertility services, maternity services and the wider NHS, yet these parts of the system too often operate separately and do not communicate with each other. I have spoken previously in this House about the proportionate opportunities created by the single patient record. If we are serious about protecting patients throughout the entire reproductive journey, we need a more joined-up approach to understanding what is happening. Better linkage between the HFEA and NHS data would improve patient safety and help us understand complications and long-term outcomes and ensure that women are not lost between the systems. We also need the HFEA to have increased information powers. We owe it to women to make sure that the HFEA has more power and is able to protect.
Therefore, there is an urgent need to modernise the HFE Act in order to protect patient safety, ensure the continuity of care and hold clinics using unproven and potentially harmful add-ons to account. The responsibility must be matched with power. The HFEA’s proposals are practical, proportionate and ready. I ask my noble friend the Minister to urge our Government to act on them.
I just want to mention a composite patient, drawn from many years of my clinical experience. Sarah was 38 when she walked into her fertility clinic. She and her partner had spent years trying to conceive: years of hope, disappointment, and quiet grief. By the time she sat down in that consultation room, she had run out of options. What happened next was not illegal; it was not even unusual. Sarah was offered a series of add-ons to her IVF treatment: embryo glue, immune therapies, time-lapse imaging, supplements and acupuncture. Each was presented as something she could have. None was framed as essential, and yet declining them felt impossible because when you are desperate, and someone in a white coat suggests something might help, how can you say no? It is a little bit like testosterone for men who are depressed. The clinic reminded her more than once that time was precious at her age. Every failed cycle brought a new suggestion and another invoice. By the end, Sarah and her partner had spent nearly £30,000 with still no baby. They spent not on treatment, as she reflected later, but on hope—hope that had been carefully packaged and endlessly sold.
Sarah’s story is not rare. In many clinics, it is routine. Individuals such as Sarah, who are desperate to have a child, are extremely vulnerable, and many find that they are prepared to do anything and to pay for anything to realise their dream of becoming parents. When given a shopping list of costly add-ons, some harmless but many invasive and time-consuming, most patients—and according to HFEA, 73% of patients—go to extraordinary lengths to raise the necessary funds, only to find that their hopes are never realised. Many of these are pure marketing, and, clinically speaking, to quote a professor at UCL, “nonsense”.
In 2023, the HFEA introduced a new five-point rating scheme for add-ons, which was well received, but it remains a regulatory sticking plaster on a structural legislative wound. The HFEA, as we have heard, has limited powers to intervene and no explicit statutory principle of patient protection within the 1990 Act. Without legislative backing, it lacks enforcement power.
Across modern healthcare regulation, the needs and interests of the patient sit at the centre of that regulation, but fertility law has not kept pace. That must change. Patients must be told clearly before they pay when a treatment is not evidence-based. Informed consent is not a courtesy; it is a right, and it is a legal and ethical obligation.
So why are so many women in the private system in the first place? It is because the NHS system has collapsed. The proportion of NHS-funded IVF cycles has fallen to just under 30%, the lowest level since 2008. Of the very few integrated care boards that provide NICE-approved IVF, that number has decreased as well. Even when they do provide it, it is usually only one cycle. In my own borough in Lambeth, it excludes couples who have had a child by a previous relationship, irrespective of how old that child is or where that child resides. Imagine that you have had a child in an abusive relationship way back when. That child is now living with the father or the mother, and you have no access to that child and may not have had for 20 years, but you are excluded from IVF. That does not sound like fairness.
We have heard about the digital revolution and the fact that the law has not kept up with that. In 2023, HFEA published Modernising Fertility Law and its proposals centre on three clear areas, which I commend to this House: patient protection as an explicit principle of the Act, regulation of online and virtual fertility services, and power to levy financial penalties.
The HFEA has already done much of the analytical work. What is needed now is a Government willing to move from consideration to commitment, and a timetable that women and their partners can hold on to. Women and their partners navigating fertility treatment are not seeking special treatment. They are seeking honest information, equitable access, and a legal framework that reflects the world that we currently live in. This is the least that this Government should be willing to deliver.