As National Fertility Awareness Week (4th-8th November) spotlights infertility, this year’s focus includes the unique psychological challenges within minority ethnic communities. Professor Geeta Nargund, a prominent fertility doctor and Medical Director of CREATE Fertility and abc ivf, highlights the need for change. With deep insight into cultural stigmas and the barriers Asian communities face in accessing IVF, she advocates for better fertility education, improved NHS funding, and the eradication of taboos around infertility. Professor Nargund emphasises the importance of equal access to fertility care, underlining the pressing disparities affecting minority communities' health and well-being.
What are some of the unique cultural challenges and stigmas Asian couples face when it comes to discussing or seeking help for infertility, and how can these taboos be addressed within the community?
I have spoken to many Asian patients who unfortunately still face significant cultural taboos surrounding infertility in their communities. Unable to have open conversations with loved ones about their experiences, these stigmas can increase the mental challenges for those facing what is already a difficult personal journey. Given that stress can have a significant impact on pregnancy and fertility treatment success rates, addressing these taboos through community education is crucial.
One prevalent misconception within Asian communities is the belief that infertility is solely a woman's issue. While this assumption is false – in reality, male factors contribute to nearly half of all infertility cases – it can nonetheless have a significant impact on a couple’s journey towards parenthood. By raising awareness and understanding of fertility issues through community networks and patient support groups, we can help improve education, access, and outcomes of fertility treatments. I have previously been involved in running educational sessions amongst community groups and know firsthand the positive impact it can have.
Another unique challenge faced by Asian couples is that there is currently a shortage of Asian egg donors. A 2021 HFEA report highlighted that 52% of Asian couples seeking IVF had to rely on White donor eggs, as only 4% of egg donors are of Asian descent. With many patients feeling it is important for the donor's ethnicity to match their own, this challenge can result in treatment delays and consequently poorer outcomes. Further, awareness-raising within all Asian communities could significantly help address this challenge.”
With disparities in NHS funding and a “postcode lottery” for fertility treatment across England, how do these issues particularly impact the access and outcomes for minority ethnic communities, including Asian patients?
“While an unacceptable postcode lottery for NHS-funded fertility treatments across England persists for all, ethnic minority communities, which depend more heavily on NHS-funded services, are particularly impacted. The current disparities in care severely limit ethnic minority patients’ access to fertility treatments and their consequent outcomes. Single women and same-sex couples face a unique set of challenges when trying to access fertility treatment due to cultural taboos as well as inequalities in egg and sperm donor provision.
Despite NICE recommendations for three full NHS-funded IVF cycles, only 7% of Integrated Care Boards adhere to this guideline. I have long campaigned to end the IVF postcode lottery to ensure that all individuals, regardless of their background, have equitable access to funded IVF treatment, thereby improving health equity and outcomes. The NICE guidelines should also specifically address access to treatment and timely diagnosis of gynaecological conditions impacting fertility that are more prevalent for individuals from ethnic minority backgrounds.
We must continue to advocate for cross-departmental collaboration between the Department of Health and Social Care, the Department for Work and Pensions, the Women and Equalities Committee and the Treasury to address this issue and its disproportionate impact on minority ethnic communities.”
The latest HFEA data indicates that Asian patients experience lower IVF success rates compared to other groups. What are the primary factors driving these outcome disparities, and what steps can be taken to bridge this gap?
The disparities that lead to lower birth rates in IVF treatment amongst Asian patients are extensive and multifaceted. Alongside the above economic and cultural factors, pre-existing health conditions provide another primary factor that contributes to inequalities in IVF access and outcomes.
For example, Asian women tend to be more prone to polycystic ovarian syndrome (PCOS), a condition that can lead to extended delays in treatment due to NHS waiting lists and prolonged IVF referrals. Given the impact of age on both men's and women's fertility, timely diagnosis and accessible treatment of underlying health conditions can have a huge impact on fertility treatment outcomes for Asian patients.
To improve fertility treatment outcomes for Asian couples, we must eliminate the NHS postcode lottery, educate communities about fertility misconceptions, and raise awareness regarding pre-existing conditions that can hinder timely treatment.
