That this House takes note of the adequacy of the law on the regulation of fertility treatment.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

My Lords, I am grateful to the noble Baroness, Lady Deech, for bringing these important questions to the House. Women’s health, fertility, and experience of motherhood are matters that are rarely given the attention they deserve, and I am hugely grateful for the opportunity to learn from the expertise of so many of your Lordships on these issues today.

I want to speak about surrogacy, and begin by acknowledging the wonderful, loving families that have been created through surrogacy and the generosity of spirit that can motivate altruistic surrogates. As we have heard from the noble Baroness, the Law Commission has proposed reforms to the laws governing domestic surrogacy. It has made many important recommendations. However, it was not tasked with considering the policy challenges or the ethics of surrogacy, as it says, nor does its work cover international surrogacy.

The practice of surrogacy in this country is growing and changing, so I agree with the noble Baroness, Lady Deech, that we need to stand back and consider the implications further before we legislate. There are four fundamental questions to answer. First—and here I am starting with first principles—do we stand by our current position that surrogacy should be legal? Surrogacy has been legal in this country for many years and is increasingly used as a means of assisting conception. However, many European countries oppose it. France, Germany, Italy, Spain and Switzerland all prohibit surrogacy on the grounds that it is incompatible with human dignity and amounts to the commodification of women’s bodies. India, Thailand and Nepal have all moved to ban or severely restrict surrogacy after seeing the reality of the industry at scale: low-income women taking on high-risk pregnancies for wealthy foreigners.

Reem Alsalem, the United Nations special rapporteur on violence against women and girls, argues:

“Surrogacy reduces women and children including girls to mere commodities, stripping them of their equality and dignity and encouraging their exploitation and abuse”.

Of course, many completely disagree with this analysis, and a full debate in this country may reveal that our sensibilities are closer to those of the Americans than to those of the Europeans on this issue. Some may conclude that surrogacy poses no challenges whatever to female equality or human dignity; others may conclude that there are challenges, but these can be dealt with through the right legal and regulatory framework. Either way, we need a wider and deeper discussion before we change the law.

Secondly, if we conclude that surrogacy is an acceptable practice, what safeguards do we need to protect the women who become surrogate mothers? Take consent as one example. There is no legal requirement for a woman to have given birth before becoming a surrogate mother, and the Law Commission does not propose it. Is that right? Do you need to know what pregnancy and birth will entail to give informed consent? Canadian research suggests that gestational surrogate mothers carry three times the risk of severe complications compared to unassisted pregnancies. Are women properly informed about these risks?

Even more difficult, how do we feel about money changing hands? It has long been a criminal offence to buy or sell organs for transplantation in this country, and since 2022 it has been an offence for UK residents to do so anywhere in the world. The risk of exploitation is deemed too great. However, we treat surrogacy differently. UK residents are free to enter commercial surrogacy arrangements abroad. While third-party organisations cannot profit from surrogacy services here, surrogate mothers receive payments from commissioning parents. These are meant to cover expenses, but they are uncapped and unregulated. That is unlike the payments allowed for egg and sperm donors, which are capped by the HFEA precisely to prevent a market in human gametes. We do not have reliable data on average payments to surrogate mothers. We know they can run to tens of thousands of pounds; they can be paid in regular monthly instalments, and they are not tied to specific expenses. We also know that, as Maternity Action described,

“there is generally a power imbalance between surrogate mothers and intended parents. Intended parents tend to be older, wealthier, better educated and employed in higher status jobs than surrogate mothers”.

Given that structural context, what safeguards do we need to prevent the exploitation of women? The Law Commission—rightly, in my view—proposes regulating expenses, but it does not propose capping them. Is that sufficient? If so, who has the expertise and resources to regulate those payments, since the HFEA has said it does not? Further thought on safeguards is clearly needed.

Thirdly, do we believe that there should be any restrictions whatever on who may commission babies? Take age: in 2025, our courts considered cases involving commissioning parents in their 70s. There is no upper age limit for commissioning parents, and the Law Commission does not propose one. In one case, the judge noted plainly that the child would experience the loss and grief of elderly or incapacitated parents during their childhood.

Do we believe that all adults should be able to have the option of commissioning surrogate mothers, or do we believe that there should be some checks or restrictions? Commissioning parents may rightly note that biological fatherhood has no age limit, and that other couples face no suitability checks before conceiving. That is of course true. On the other hand, we have extremely strict frameworks governing adoption, which also involves the separation of a child from its birth family. Which is the more appropriate model for surrogacy?

My fourth and final question is: what do children need? Even if a surrogate mother is consenting freely and the commissioning parents will provide a loving home, how do we centre the child in the practice? In all other circumstances we would consider it traumatic for a newborn to be removed from its birth mother. Does that trauma exist for babies born to surrogate mothers? The adoption framework has evolved over decades as we have come to understand, often painfully, that questions of identity and origin matter deeply to children as they grow.

Many children born to surrogates will never see their birth mothers again. Does that matter, and if it does, how can we best support them? What those children need from us is expertise in child development—expertise that has generally been missing in this debate so far.

These are sensitive and emotive questions, but they are hugely important for the women and children involved. So, if this Government, or a future one, conclude that reform of surrogacy is the right path, I very much hope that they will commit to significantly more work and a full, open and, as the right reverend Prelate the Bishop of Chelmsford described, compassionate debate on these issues before the legislation comes to this House.

My Lords, I thank the noble Baroness, Lady Deech, for bringing forward this important short debate and for her work in this area. I am also grateful for the richness of the debate from noble Lords across the House, and with such expertise, and for the personal contribution from right reverend Prelate the Bishop of Chelmsford.

One in seven couples may have difficulty conceiving, and as the noble Baroness, Lady Nargund, stated, there is now roughly one IVF child in every classroom, with IVF births making up around one in 32 of UK births. The number of patients having fertility treatment has increased over the last 30 years—over 52,000 in 2023.

The noble Lord, Lord Winston, stated that there are more than 100 reasons for infertility, which are not always investigated, but the noble Baroness, Lady Boycott, highlighted for us the issue of plastics and chemicals and their impact on fertility.

As we have heard today, there is a postcode lottery of access to IVF and fertility services across the country, which is undermining the hopes and family life of many couples. Patients in England are struggling to access publicly funded IVF, despite the NICE recommendation that has been in place since 2004 that the NHS should offer an initial three full cycles of IVF treatment to any woman under the age of 40. A briefing from the Progress Educational Trust highlighted that only two out of the 42 integrated care boards in England comply with the NICE fertility guidelines, and 19 offer only a partial IVF cycle, not even a full cycle. This means stopping treatment before all the viable embryos already created have been transferred.

It is therefore crucial that people be able to expect high-quality fertility treatment wherever they live, rather than being priced out of having children just because of their postcode and their local ICB’s policy at that time. Can the Minister advise whether the Government have considered following Wales and Scotland in centralising commissioning for IVF, rather than the current postcode lottery approach?

A specific inequality that has not been mentioned today still exists for the LGBTQ+ community. In England, NHS-funded access to IVF is available only to women who have not conceived after two years of regular unprotected intercourse or 12 cycles of artificial insemination. But in practice, that requires all lesbian couples to pay for artificial insemination cycles before becoming eligible for NHS-funded IVF. That is a considerable financial barrier for many of those couples, given that cycles can cost thousands of pounds.

Despite the previous Government’s women’s health strategy pledging to remove that requirement for lesbian couples, the rollout has been at a snail’s pace. As of April 2024—the last data I could find—only four of the 42 integrated care boards in England have implemented this. There should be equitable access to IVF for all lesbian couples who are looking to start a family. Can the Minister update the House on what work the department is undertaking to ensure that the requirement is rolled out across all ICBs?

As we have discussed, the Human Fertilisation and Embryology Authority was established back in 1991 and was the first regulatory body of its kind in the world. But as we have also been discussing, a lot has changed since 1991—both scientific developments and societal attitudes. Although the Human Fertilisation and Embryology Act was last amended in 2008, there has been no significant change to how the HFEA regulates, despite the significant changes to the UK fertility sector.

As we have heard so clearly today, while much of the original 1990 Act remains fit for purpose, the regulatory framework is not flexible enough and change is required to deal with the shift to fertility services that are being provided online. A greater range of powers to improve compliance and protect patients is needed. Particularly given that there is limited access to IVF on the NHS, with 73% of treatment privately funded, this regulation needs an urgent update.

With groups of private clinics and changes to the types of fertility services and related services being offered—as was outlined by the noble Baronesses, Lady Deech, Lady Owen and Lady Nargund; and the noble Baroness, Lady Gerada, described in detail some of those so-called add-ons—it is very important that patients can have full confidence that the services they are paying for are carefully and thoroughly regulated, safe and adding value, whether it is in a physical clinic or online.

I was surprised to read in preparing for this debate that patient-specific fertility treatment information has an almost exceptional status, with staff at the relevant fertility clinic and at the HFEA being pretty much the only professionals able to access patient-specific fertility treatment information records. However, as we have heard, that may compromise patient safety, and I am not sure how this will fit with the newly proposed single patient record, as the noble Baroness, Lady Nargund, also raised. Perhaps the Minister could comment on that.

As my noble friend Lord Palmer of Childs Hill said, the legislation is now unfit for today. The HFEA proposals for reform relate to a number of areas: patient protection and safety; effectively regulating a changing sector; and effective and proportionate sanctions, including financial.

The HFEA wishes to match its regulatory oversight to the risks involved in a changing sector. That seems like a proportionate approach. As we heard, the HFEA published its proposed changes in autumn 2023—some time ago. Perhaps the Minister can advise when the Government will be responding in full to these proposals. I am sure we would be happy with a season rather than a specific date.

The other side of this is the need for research. There is a clear desire for the HFEA to be able to permit patients to give generic consent for the use of their embryos in research. I think many patients would want their embryos to be used to help science in this area, but currently this is not permitted. It is of course important that we have an ethical framework for embryo research, but will the Government consider any movement in this area regarding general consent?

We have heard today about other important issues such as surrogacy and the current law, which is some 40 years old. This is a complex area and, as the noble Baroness, Lady Shawcross-Wolfson, set out so clearly, it needs careful consideration, along with a discussion on what is going on in the so-called industry. For those who wish to start a family and are having trouble conceiving, are in a same-sex relationship, or are by themselves, the role of IVF becomes an absolute lifeline. We were ahead of the game, with the first IVF baby born in the UK in 1978. We need to update some areas to ensure that they are fit for purpose in the 21st century and the digital world, and to help people to have the child—and children—they desire.

I look forward to hearing the Minister’s response to this important debate.

My Lords, I thank the noble Baroness, Lady Deech, for her focus on this subject, drawing on her extensive experience in the sector, including chairing the Human Fertilisation and Embryology Authority for eight years. I also highlight the deep knowledge of the noble Baroness, Lady Nargund, who combines her role as the lead consultant for reproductive medicine services at St George’s Hospital with being an honorary professor of women’s health at the University of London and an international advisory board member of the Lancet Obstetrics, Gynaecology, & Women’s Health journal. She is also the founder CEO and now medical director of a fertility clinic.

The UK has long been regarded as a world leader in the regulation of fertility treatment and embryo research. The Human Fertilisation and Embryology Act 1990 was landmark legislation. It established a framework that balanced scientific innovation, ethical oversight and public confidence in a way that was pioneering at the time. Much of that framework remains strong. The principle that the embryo merits special legal and ethical status continues to command cross-party support. Having treatment in licensed clinics remains safe, with incident rates low, even as IVF has become increasingly common.

In line with other noble Lords, I suggest that the question before your Lordships’ House is whether a framework designed in the early 1990s is appropriate for the fertility sector as it exists in 2026. There is an increasing consensus that it is not. As the noble Baroness, Lady Deech, highlighted, the sector has changed fundamentally. Around one in 32 births in the United Kingdom now results from IVF. As the noble Lord, Lord Winston, flagged, fertility treatment is no longer marginal or exceptional medicine; it is close to mainstream healthcare and, for many, a central route to family formation.

However, while demand and complexity have increased, the structure of provision has shifted dramatically. Treatment is now predominantly privately funded. While this plays a positive role in increasing capacity and reducing pressure on the NHS, it raises concerns for some. Increasingly, elements of fertility care are delivered through online or hybrid “virtual clinic” models that sit outside the traditional boundaries of regulation. This is creating a system that is more nuanced and potentially harder for patients to navigate. The HFEA has argued that the current legislative framework is increasingly out of step with the modern fertility sector. My noble friend Lady Owen highlighted the growth of online fertility services operating beyond the traditional licensed clinic model. The HFEA has argued that its enforcement powers are no longer sufficiently flexible and has proposed that the Act should contain an explicit, overarching focus on patient protection.

The right reverend Prelate the Bishop of Chelmsford talked about social media disinformation. My noble kinswoman Lady Boycott referenced the “Wild West”. The noble Baroness, Lady Gerada, pointed to hope that has been sold. The regulatory gaps become particularly visible in relation to online fertility services, where patients are increasingly looking for advice from charity websites, social media, online forums and clinic websites. Patients are increasingly encountering providers marketing themselves as offering “fertility services”. However, key clinical interventions take place elsewhere, sometimes under separate regulatory arrangements and sometimes outside clear regulatory oversight altogether. Patients may reasonably assume that a service presenting itself as a clinic-equivalent is fully regulated. However, as the noble Baroness, Lady Nargund, agreed, it can be a mistake to make assumptions. The fertility sector has evolved rapidly, with new online models and commercial networks that do not fit neatly within the assumptions of the 1990 Act. This is precisely the kind of gap that undermines transparency and public confidence, notwithstanding the related issue concerning surrogacy reform.

My noble friend Lady Shawcross-Wolfson gave us a deep and informed insight into the topic of surrogacy. The Law Commission has proposed reforms which would, for some arrangements, transfer legal parenthood to the intended parents from birth, place greater reliance on consent given before conception and reduce the role currently played by the courts and the Children and Family Court Advisory and Support Service after birth. Supporters argue that these changes would provide greater certainty for intended parents and children. However, others have questioned whether they would weaken important safeguards by reducing the significance of post-birth consent and judicial oversight.

Some are concerned that the proposals would make it more difficult for a surrogate mother to change her mind and move away from the long-established principle that the woman who gives birth is initially recognised as the child’s legal mother. These concerns arise against the backdrop of a growing international surrogacy market. Increasing numbers of British residents enter into commercial surrogacy arrangements overseas, raising wider questions around child protection, exploitation and the legal recognition of arrangements that would simply not be permitted here.

There are also legitimate questions about whether reforms designed to expand domestic surrogacy arrangements, including proposals allowing regulated organisations to recruit surrogate mothers, command public support. As reproductive technologies continue to evolve, parliamentary oversight of embryo research and emerging technologies must remain central. Given the Government’s decision not to proceed with the Law Commission’s proposals, can the Minister clarify whether the Government have reached a new, settled view on surrogacy reform and what safeguards they consider essential in any future review of the law?

While regulation is one challenge facing the sector, consistency of access remains an issue. Despite updated National Institute for Health and Care Excellence guidance recommending up to three NHS-funded IVF cycles for eligible women under 40, access remains highly variable across England, because ICBs are not required to implement that guidance. As a result, we continue to see variations in fertility treatment. The noble Baroness, Lady Deech, suggested a postcode lottery.

His Majesty’s loyal Opposition recognise that the Government have stated that ICBs should “consider and reflect” national institute guidance. We welcome efforts to improve consistency through NHS England. However, there remains a clear gap between guidance and enforceable entitlement. That inconsistency sits uneasily alongside the Government’s Renewed Women’s Health Strategy for England, which commits to ensuring that every woman “can easily access” fertility services and places strong emphasis on consistency of care and patient experience.

That commitment is most welcome, but it raises important questions. While some ICBs do offer up to three NHS-funded IVF cycles, in line with NICE guidance, what plans are there to help or encourage those ICBs which offer only one NHS-funded IVF cycles or impose additional eligibility restrictions? This was so well put by the noble Baronesses, Lady Gerada and Lady Pidgeon. If the patient experience is to be placed at the centre of women’s health policy, do the Government plan to embed patient protection explicitly within fertility legislation, as the HFEA has proposed?

In closing, I suggest that the strength of the 1990 Act was not only its technical design but its willingness to confront emerging science and changing societal realities head-on. The fertility sector has changed profoundly since then. It is more commercial, more technologically complex and more integrated with digital service delivery. Scientific techniques are evolving rapidly and the boundaries of what constitutes fertility treatment are no longer as clearly defined as they once were. The HFEA’s reform proposals are therefore measured and pragmatic. They seek not to dismantle the existing system but to modernise it through strengthening patient protection, clarifying regulatory scope and introducing more proportionate enforcement tools. At their core, these proposals are about ensuring that regulation keeps pace with reality. The United Kingdom became a global leader in this field because it combined scientific advancement with ethics and public trust. Long may that continue.

My Lords, I am very pleased to respond to this debate, particularly regarding the adequacy of law on the regulation of fertility treatment. I thank the noble Baroness, Lady Deech, for raising this topical and important matter and for her thoughtful and wide-reaching comments which framed the debate that followed.

As always, I have to start with the caveat that I probably will not be able to answer everything that has been raised today in the time that I have, but I am always happy to write to noble Lords to expand on their very thoughtful points around this complex issue. Just to reframe it, I remind everyone that the UK’s Human Fertilisation and Embryology Act came in 1990, and we all need to reflect on just how long ago that is. The Act set out to regulate assisted reproduction and human embryo research. It established the Human Fertilisation and Embryology Authority, as we have heard from the noble Baroness, Lady Deech, and I shall refer to that as the HFEA. This was the first dedicated regulator of fertility treatment and embryo research anywhere in the world. It is quite extraordinary that it still has so many robust features that are applied to this day.

The HFEA ensures that fertility clinics operate to high standards and that sensitive and complex treatments are carried out safely and ethically. It remains an important and effective regulator, helping to ensure that treatment and research are conducted responsibly, with positive outcomes for patients. This is particularly important as fertility treatments continue to help people in the UK to have children—we must not forget this—with almost 21,000 babies born from IVF in 2023, accounting for one in 32 UK births. Having treatment in a UK-licensed fertility clinic continues to be very safe. In 2024-25, out of more than 100,000 cycles of fertility treatment, storage or donations, incidents occurred in less than 1% of cycles.

The issue of postcode lottery was raised by many noble Lords today, including the noble Baronesses, Lady Deech, Lady Pidgeon and Lady Gerada, and the noble Earl, Lord Effingham. The National Institute for Health and Care Excellence guidelines for fertility problems, assessment and treatment were published on 31 March 2026, and this guidance informs how ICBs should commission fertility services within their local populations. However, the Government recognise that access to NHS-funded fertility services is variable in England and are looking into achievable ambitions to improve access to fertility services. With regard to ICBs, the nature of commissioning that we have in England is a really important element of this.

However, the Government recognise that the success of the legislative framework does not mean that it is fully adequate for the modern day, which has framed so many comments today. The fertility sector has evolved significantly since 1990, when the first Act was introduced—the noble Baroness, Lady Deech, was quite right to highlight the challenging issues—and, although it was updated in 2008, that is still a significant amount of time away. Scientific advancements, changes in societal attitudes and the growth of a largely privately funded treatment sector have transformed both demand and delivery for such a service. The HFEA itself has concluded that while much of the original framework remains fit for purpose, targeted reform is now required.

In 2023, the HFEA published the detailed set of recommendations to update the original Act, identifying four key areas in which reform is required, including patient protection and safety, as we have heard so clearly today, consent, donor anonymity and scientific developments. Within this, the HFEA set out its views to strengthen regulatory powers to protect patients, simplify consent, and ensure that the system can accommodate scientific innovation, as so clearly raised by the noble Baroness, Lady Owen, and the noble Earl, Lord Effingham. These issues do not undermine the foundations of the existing system; rather, they highlight an opportunity to update and future-proof the framework.

The HFEA has highlighted the need for the regulatory framework to reflect changes in how patients access information and treatment decisions. Since 1990, the growth of online platforms and social media has fundamentally reshaped the fertility landscape, influencing how patients engage with clinics, access information, and make decisions about treatment.

In terms of the very thoughtful contributions around surrogacy, I should add that the Government recognise the significance and importance of this issue and welcome the Law Commission’s comprehensive report, published in 2023. However, given the limited parliamentary time available and competing legislative priorities, we are not currently able to bring forward the reform immediately, but we will publish a formal response as soon as capacity allows and keep this issue under review.

To the point made by the noble Lord, Lord Palmer, on setting financial penalties, I say this would also need to be considered as a part of the broader update in regulatory powers. The other absolutely critical area covered by so many noble Lords, including the noble Baronesses, Lady Gerada and Lady Deech, the right reverend Prelate the Bishop of Chelmsford, and the noble Lord, Lord Winston, is the whole issue of consent. The Government recognise concerns raised by noble Lords on the complexity of consent arrangements, including withdrawal of consent and ensuring patients fully understand the legal implications, and we will consider all these issues as part of any wider reform.

I am very grateful to my noble friend Lady Nargund for her informed contribution to this debate. She is right to highlight the success and the continuing importance of the regulatory framework. That framework, together with the work of the HFEA, has delivered tangible improvements in patient outcomes, including significant reductions in multiple birth rates and greater transparency through the publication of clinic performance data.

The Government are clear that patients must be at the centre of the system. Fertility treatment can be physically and emotionally demanding, and we expect providers to meet the highest standards of care, safety, and ethical practice. We recognise the argument that the legislation should more explicitly reflect the safety and protection of those undergoing treatment. This has been carefully considered as part of the wider discussions on potential reform.

We acknowledge concerns about the limits of the current enforcement regime to drive improvement and that better use of data has the potential to strengthen oversight and support joined-up care. I assure the House that all these issues are receiving careful and ongoing consideration. Any reforms must strike the right balance in maintaining public trust and patient safety while enabling responsible scientific progress.

I again emphasise the fact, which I know will be disappointing to noble Lords, that the legislative programme for this parliamentary Session is very full. Due to the limited time available to undertake legislative reform and the priorities the Government set out in the King’ Speech, we are not able to pursue immediate legislative reform of the Act in the current Session. However, the Government are considering potential legislative options and, if parliamentary time allows, will ensure that any future reforms support patient safety, reflect societal change and maintain the UK’s position as a global leader in fertility regulation. I can tell that the noble Baroness, Lady Owen, is perhaps not as impressed as she might be, but I am sure she was expecting my comments none the less.

On the possibility of setting up a Select Committee, which was raised by the noble Baroness, Lady Deech, we will of course consider all the different options. As she outlined, one of those options could indeed be setting up a relevant committee.

I recognise the need to update the Act. On the significant changes in fertility and scientific innovation we have witnessed and the comments by the right reverend Prelate the Bishop of Chelmsford, I am sure she will appreciate that any reform must be approached in a considered and balanced way, given the ethical sensitivity and complexity of this area.

On the issues raised about the lack of clarity on the fate of embryos for those families who very sadly could not continue treatments, any future reform would include a review of issues relating to digital clinics and how we might move forward to improve the regulatory regime in the digital area.

On the inequity and commercial exploitation in the fertility sector, raised by my noble friend Lord Winston, it is right to highlight the pace of change in the sector. While we acknowledge that the legal framework has provided strong safeguards and recognise the growing pressures from the expanding and increasingly complex private market, the Government are clear that patient safety and fairness must remain paramount and support the HFEA in maintaining the robust regulation of clinics. However, we also recognise concerns about affordability, access and the risk of inequity. While the UK continues to have a strong, established regulatory regime, we are not complacent and will continue to determine next steps to ensure that it reflects developments in both technology and the market.

Going back to the framework, the task before us is to build on the framework to retain the strengths of the existing legislation while reinforcing the capability of the HFEA and ensuring that the law keeps pace with science, society and patient expectations. We look to ensure that the UK continues to lead in the responsible regulation of fertility treatment.

My noble friend Lord Winston raised important issues about egg freezing. As we are aware, elective egg freezing is not a service provided by the National Health Service. The HFEA publishes advice about egg freezing on its website, including information about the process, risks, success and data on this. Those who freeze their eggs do so within a tightly regulated system with strict rules set out in law and in the HFEA code of practice. The HFEA expects clinics to follow consumer law and advertising guidance for UK fertility clinics produced by the CMA and the ASA. Although egg freezing is becoming a popular choice, it is not, as we have heard very clearly today, an insurance policy that can guarantee a baby in the future. Fertility clinics have a responsibility to ensure that anyone using fertility services understands the risks and the long-term impact of any treatment decisions that they make.

I am pleased to say that my noble friend Lady Merron listened very carefully to the issues raised by my noble friend Lord Winston during the King’s Speech. Although she was not winding up on that particular debate, she undertook to write to him, sparing the noble Lord, Lord Hendy, from attempting to answer his questions in the summing up. I am pleased to say that she has since written to him to address his concerns and will, Iusb have no doubt, engage with him on the further concerns that he has raised.

The noble Baroness, Lady Owen, raised particular concerns about Apricity. I think all of us will have heard about those cases with extreme concern and felt sensitivity for those people who went through such a distressing experience. Of course, we know that Apricity’s closure did not fall under the HFEA’s regulatory remit, as it was a digital service only. Of course, affected patients were advised to complain through trading standards about the service that was offered. Cases such as this will be very much at the forefront in considering the work we need to do going forward.

I have on several occasions listened with enormous interest to the noble Baroness, Lady Boycott, about the impact of chemicals in our system. I do not have the ability to respond to her fully on that point, but it is an issue—also raised by my noble friend Lord Winston—that is generating a huge amount of concern. I reassure her that I will write to Defra colleagues and ask them to pass on their comments. We will send a copy of the words she said today to move that on.

I do not think I have debated with the noble Baroness, Lady Shawcross-Wolfson, before. I was very interested to hear her comments, obviously based on a lot of experience at the policy end of the spectrum. I look forward to her further contributions on this point.

I again thank everyone for taking part in this important debate. The challenges are very well recognised, and we look forward to addressing them in a way that many couples, families and individuals can benefit from in the future.

Before the Minister sits down, I wonder whether she would be kind enough to answer one question for me. The figures that I presented on embryo freezing show that there were 909 births, some of which miscarried. However, it is clear that at least 42,000 treatments with embryos were given to different women in that period of time. That is a massive disappointment for women who are hoping to preserve their fertility. Even that figure is clearly an underestimate. I repeat my question to my noble friend Lady Merron and request that she be kind enough to write to me explaining why the HFEA no longer keeps these figures in the way it used to. It is really important to find out what is happening.

I am delighted to say that I will pass on my noble friend’s comments to the noble Baroness, Lady Merron. As I said, she will follow up on further comments that he has made today. I was struck by the statistics that I looked at and that my noble friend has raised in the debate today. In this day and age, we should make sure that we have up-to-date data to analyse. We have the tools to do it, and we should make sure that everyone involved makes full use of that opportunity.

My Lords, this debate has consisted of highs and lows. One high, of course, is that it is wonderful that the House of Lords has so many world experts on infertility ready to speak today and contribute their knowledge. That is what we are all about. The lows I am coming to.

I can pick out only a few comments in the limited time left. The noble Lord, Lord Winston, quite rightly pointed out that there are underlying causes of infertility, but time is of the essence. When women are in their 30s or late 30s, there is not time to queue for medical investigations that could take years. The practice of IVF, including freezing eggs, has brought happiness to so many and should not be overlooked. This is an area where there are great disappointments but also great happinesses, and we should not overlook that.

I have been invited all over the world to speak about the virtues of regulation, in particular in the United States, which is regarded as the Wild West of this area. There, things go terribly wrong, because, as you would expect, autonomy and no interference is the theme there, leading many women to fall into severe traps and malpractice. From my limited global experience, I know that the HFEA and its model of regulation was widely admired and indeed copied. When they cut me open when I am gone, they will find “Dolly the sheep” carved on my heart, because, under my watch, the Scots made that terrific breakthrough that led to the use of stem cells. Because the HFEA was supervising that and being cautious, we have been able to advance with that treatment and research, and that is something we should be very proud of indeed.

How wonderful it is that a Bishop in our House should have had that experience. I was privileged to work with two outstanding bishops at the HFEA: Bishop Richard Holloway, who I am glad to say is still with us, a man of great heart and compassion, and, of course, the sorely missed Richard Harries was able to contribute. There was nobody better than him. How much we miss his voice in all areas of life.

On the issue of plastics, all I can say is that it is certainly worth looking at. I have had my own argument with Optrex—I am sure noble Lords all know Optrex—about glass bottles now being replaced by plastic. I wrote to ask why I should introduce plastic into my eyes. Of course, I got no reply, even though many other people objected as well.

The noble Baronesses, Lady Shawcross-Wolfson and Lady Pidgeon, and others mentioned surrogacy. There are great reservations about the practice of surrogacy. We must take this very cautiously, although it has of course brought joy to some people.

The Minister’s response is disappointing. I can see that she and no doubt her staff have taken all this into account, but time is of the essence, as I have said before. I call once more on the Government to get going and to set up a Select Committee and produce a draft Bill, which is what happened the last time the Human Fertilisation and Embryology Act was revised. It takes time but, if they do not start now, we will never get around to it. The Government need to draw on the expertise that was so evident in this House today. In future years, we may not have such a wealth of expertise. Now is the time to get going. It might well take some years, but the Government really need to set up that Select Committee and do the legislative scrutiny right now.

Let me end on a note of joy, because there has not been much of that. To serve on the HFEA was a joy and the privilege of my life. People of my generation thought we were clever in not conceiving. That was the big issue—it never crossed my mind that there were fertility issues. I learned that there were and how painful they were. To see the joy of people who have managed to have families, such as the right reverend Prelate and others I could mention, thanks to the expertise of the noble Lord, Lord Winston, and others was very special.

We are told that we live in a country where there are not enough babies. The HFEA is helping people to produce those much-wanted babies and I wish it well. It was a great privilege to serve. At the time, there were ethical considerations. As members, we had a bishop, a rabbi and an actress—you could not have a broader spread of input than that—and it all worked very well, with great results. I end by pleading with the Minister to get on with legislative reform for the sake of our health, growth in families and the joy of would-be parents.