What is a gamete?
Gametes are sex cells. The male gametes are sperm, and the female gametes are eggs. Conception (getting pregnant) happens when a man's sperm fertilises a woman's egg.
What is gamete retrieval?
Gamete Retrieval is the extraction of gametes (by surgical or non-surgical methods) which can then be stored for future use.
What is cryopreservation?
Cryopreservation is the process of storing biological material at extremely low temperatures (below zero). At these low temperatures, all biological activity stops, including the biochemical reactions that lead to cell death and DNA degradation.
Why do we need these procedures?
In certain circumstances, a man or a woman’s fertility may be compromised for a number of reasons:
- Certain types of treatment (e.g. cytotoxic therapy) which permanently prevents the individual producing gametes (eggs/sperm), OR
- Certain types of treatment (e.g. cytotoxic therapy) which permanently causes genetic abnormalities in the eggs/sperm
- The ovaries or testes may, in certain clinically required circumstances (e.g. to prevent the spread of disease), need to be surgically removed which results in infertility
- The patient has premature ovarian failure.
Patients undergoing treatments such as chemotherapy for cancer or radical surgery may be made sterile by such treatments. Where there is a significant likelihood of making a patient permanently infertile as an unwanted side-effect of NHS funded treatment (including gender reassignment), those patients will be eligible - under the Birmingham and Solihull CCG commissioned pathway - for gamete retrieval and cryopreservation to preserve fertility, as long as they meet the eligibility criteria.
This may be done by storing gametes (eggs/sperm), prior to treatment. Following the completion of the NHS funded treatment, these gametes may be used to assist conception.
**If the patient requires CCG funding for assisted conception, then the patient will be required to evidence how he/she meets the currently commissioned Assisted Conception Policy.
Patient eligibility criteria
- The patient must be permanently registered with a Birmingham and Solihull CCG GP practice, AND
- The patient must have no living children. The aim of this is to give priority to individuals with no existing living children. An adopted child has the same status as an individual’s biological child. However, self-funding for gamete retrieval and storage is still possible, AND
- Upper age restrictions for both men and women will be in line with those patients funded for fertility services under the Assisted Conception policy in place at the time of the funding request (currently a woman must be under the age of 40 and a man must be under the age of 55 years. There is no lower age limit).
AND the patient must meet ONE of the following clinical criteria:
- The patient must be undergoing NHS funded treatment which is likely to render the patient permanently infertile e.g. cytotoxic therapy, OR
- The patient is at immediate risk of premature ovarian failure, OR
- The patient has a diagnosed chromosomal abnormality which is likely to render the patient permanently infertile, OR
- The patient’s ovaries/testes are going to be removed as part of NHS funded treatment, AND
- The funding application must be supported by the NHS consultant providing their care, AND
- The patient has NOT undergone a previous sterilisation or reversal of sterilisation procedure.
Gamete retrieval and cryopreservation will not be funded where the patient has previously undergone elective sterilisation (vasectomy or the fallopian tubes are blocked or sealed to prevent the eggs from reaching the sperm and becoming fertilised).
ALL funding renewals for gamete storage will be considered in line with the ages specified in the Assisted Conception Policy in place at the time of application.
Advice and guidance
Patients may choose to self-fund storage once NHS funding ceases within the terms of the Human Fertility and Embryology Act 1990.
- For more information, search for ‘infertility’ at www.nhs.uk
- Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
Treatment policy for patients covered by NHS Birmingham and Solihull CCG