Fertility care and fertility nursing
The World Health Organization (WHO) refers to infertility as being 'a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse'.
WHO goes on to explain fertility care:
‘Fertility care encompasses the prevention, diagnosis, and treatment of infertility. Equal and equitable access to fertility care remains a challenge in most countries, particularly in low and middle-income countries. Fertility care is rarely prioritised in national universal health coverage benefit packages’ (WHO, 2020).
In the UK, one in six to seven couples will be affected by fertility issues or will struggle when trying to conceive. Infertility and trying to conceive will impact both the physical, emotional, and psychological wellbeing of those on a fertility journey and effects all people. NHS funded fertility care is subject to a specific criteria (which varies across the UK) and is not routinely available to all who need it, meaning that the majority of fertility care carried out in the UK, takes place in the private sector. Fertility nursing staff work across acute and primary care and in the independent sector. They are involved in the delivery of all levels of fertility care including diagnosis, treatment and management of fertility and practise at an advanced level to deliver fertility care for complex needs and conditions.
This video provides an overview of Fertility Care in 2022, presented at RCN Congress 2022 by Francesca Steyn, Chair of the RCN Fertility Nursing Forum.
The RCN Fertility Nursing Forum aims to lead and influence policy, service provision and high-quality care with regards to fertility nursing. They engage with other professional bodies and stakeholder groups to ensure the voice of nursing is heard in this sector.
Career pathways in fertility nursing
Since the birth of the first baby born using in vitro fertilisation (IVF) in 1978, fertility care and treatment have been transformed. Fertility nursing has developed into a complex specialist area of practice requiring specific education to enable registered nurses and midwives to deliver safe, effective evidence-based care, as well as adapt to frequent innovations in practice. Fertility nurses work in the NHS and the independent sector, and some may also provide elements of fertility care in oncology, gynaecology and other settings.
The RCN Education and Career Progressions Framework for Fertility Nursing updated in 2021, has comprehensive information for all nurses and midwives providing fertility care in any setting to plan their career pathway and enhance their knowledge and skills.
In 2021, the RCN Fertility Nursing Forum reviewed and updated the standards, using an impact assessment model. For the results of that activity, see: Impact Assessment of the Education and Career Progression Framework for Fertility Nursing
Following on from this assessment the Fertility Nursing Forum, working collaboratively with the British Fertility Society (BFS) and the Senior Infertility Nurse Group (SING), has now expanded on the recommendations, and in 2023 plan to publish a consensus statement on the RCN Education and Career Progression Framework for Fertility Nursing, focusing specifically on:
- staffing for safe and effective staffing
- implementation of the framework
- ultrasound training
- continuing professional development
- being politically aware.
Physical care
Infertility affects an estimated 10 to 15 per cent of couples of reproductive age and one in six to seven heterosexual couples in the UK. In recent years, the number of couples seeking treatment for infertility has dramatically increased due to factors such as postponement of childbearing in women, development of newer and more successful techniques for infertility treatment, and increasing awareness of available services.
Fertility treatment will begin with a range of investigations to establish a possible cause. The care that follows will be dependent on the findings, and interventions will be considered that will range from increasing fertility awareness methods to medication. It may then progress to surgical procedures and more advanced innovative methods associated with IVF. Further information on these interventions can be found in Transition from Fertility to Maternity Care (RCN 2022).
Emotional wellbeing
Emotional wellbeing is as important as physical wellbeing when caring for those accessing and using fertility care. Those working in the fertility sector are aware of the emotional and mental impact infertility can take on individuals. Health professionals, who are a constant point of contact, need to be aware of the signs of the emotional and mental struggles that individuals may go through during treatment and should also know how to support and signpost individuals to the available help.
The RCN guidance Fertility care and emotional wellbeing (2023) is a resource for all health care professionals in all areas of fertility care and acknowledges the differences between emotional support and wellbeing, implications counselling and therapeutic counselling.
Fertility preservation
Fertility preservation is the process of freezing eggs, sperm, embryos, or reproductive tissue so that it can be used at a later date for the chance of creating a family. Reasons why an individual may need or consider fertility preservation include medical, clinical, or social freezing.
If an individual is freezing their gametes due to surgery or medical treatment such as oncology treatment, they will usually freeze them prior to surgery or chemotherapy. The patient may be able to obtain funding from their local commissioning authority for their gametes to be frozen. It is important to note that each authority will have their own criteria. The patient’s surgical consultant or oncologist may refer them to a fertility clinic to freeze their eggs, sperm, or embryos.
For those choosing to freeze their sperm a consultation, blood screening and completion of consent forms is required prior to the sperm being frozen.
When freezing eggs or embryos, a consultation, blood screening, and consent forms are required prior to the patient completing a cycle of ovarian stimulation and egg collection, the eggs or embryos are then frozen.
It is important for clinics to provide follow up and support for patients once their gametes have been frozen and provide information about annual storage fees and payment.
From July 2022, recent changes in the UK mean that patients now have the option to freeze their gametes for up to 55 years, regardless of the rationale for doing so. A medical review every 10 years is required for individuals who have chosen to freeze their gametes for social reasons.
Some key facts about social egg freezing:
- Currently only a small number of clinics carry out the majority of egg freezing in the UK.
- Women consider freezing their eggs for a variety of social reasons including having no partner, not being ready to start a family, establishing a career or better financial security.
- The age at when a woman chooses to freeze her eggs combined with the total number of eggs frozen are the key factors that will determine the best outcome.
- Most women who elect to freeze their eggs for social reasons are in their late 30s with the average age at being 37.8 years.
- Social egg freezing does not receive any NHS funding.
- In relation to the cost of social egg freezing it is important to advise women to ensure they are fully informed about all the costs involved. See: HFEA - Egg freezing.
The RCN publication Fertility Preservation provides information for nurses who are supporting and caring for those beginning treatment for potentially life-limiting diseases and where the treatment may adversely affect their ability to have children in the future. It also encompasses those who may wish, for non-medical reasons, to defer having children until later in life, for example members of the armed forces, transgender people, or those considering gender reassignment surgery.
Page last updated - 09/10/2023
