Survey of fertility counselling provision in UK licensed treatment centres during the first phase of the COVID-19 pandemic.

A survey of UK fertility counsellors' experiences of the impact on their service, including its availability, during the first phase of the COVID-19 pandemic in the spring of 2020 received 64 responses. Fifty three respondents had continued to provide a service. Forty now worked from a wholly/substantially different location to normal but many clinics provided no practical support for this (n = 17), or remote access to relevant clinic (n = 17) or client information (n = 12) and twenty five respondents reported reduced multi-disciplinary involvement. Few received regular information updates. Some whose service was stopped (n = 11) abruptly lost income and/or were unsure whether they could or would resume working. Increased remote counselling proved crucial for accessibility and could be effective. Concerns included fatigue, technical and practical challenges, confidentiality, lowered therapeutic effectiveness. Respondents supported patients having choice over how to receive counselling in the future but a third (n = 21) had not been included in such planning. These findings suggest the need for increased involvement and support of fertility counsellors in the event of a future waves, other pandemic or healthcare crisis. More needs to be understood about why clinic responses varied; how to improve the safety and efficacy of remote counselling; and how to accommodate future needs for face-to-face contact.

Counselling challenges associated with donor conception and surrogacy treatments - time for debate.

Fertility counselling services have had to respond to significant developments in fertility treatments in recent years, prompting increasingly complex personal and professional ethical challenges. This Commentary focuses on those rising from donor conception and/or surrogacy. The profile of those seeking such treatments has changed to include growing numbers of same sex couples, single people, people who are transitioning or have done, people seeking posthumous use of gametes, and people using cross-border services. Alongside, awareness has grown of life-span implications, the impact of commercial DNA testing, and the need for 'later-life' support. Responses vary internationally and the time for debate is overdue. Who should provide fertility counselling and how? Should specialist qualifications, training, continuing professional development, and regulation be required? Should counsellors play a role in assessing suitability to parents? What aspects of different contractual arrangements and conflicts of interest need attention? Has the time come for counselling to be mandatory as part of pre-treatment pathways? What should be the relationship between fertility counsellors and multi-disciplinary clinic teams? How might fertility counsellors be represented nationally and internationally? What should be their relationship to 'later life' professional support? What place should professional knowledge hold in the evidence base?