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Abstract Study question How does fertility treatment access, usage, and outcomes differ between family types in the UK? Summary answer IVF is increasingly used by single patients and female same-sex couples, with higher birth rates than opposite-sex couples. However, inequalities remain in state funding rates. What is known already The “Family formations in fertility treatment 2018” report was published by the Human Fertilisation and Embryology Authority (HFEA) in September 2020. This found differences in IVF use, birth rates, and rates of state-funded treatment between different family types. It was found that opposite-sex couples obtained treatment funding at higher rates than other family types. Additionally, recent documentation published by the UK government shows a variation in funding criteria for female same-sex couples across England. This report builds on the work of the previous HFEA publication, continuing to explore possible new data trends and disparities with regards to family type. Study design, size, duration This report used data from the UK national register held by the HFEA, where all licensed clinics in the UK are required to submit treatment data. All cycles recorded on the UK national register were analysed retrospectively from 2012-2022 (N = 901,866) with regards to family types, categorised into: opposite-sex couple, same-sex couple, and single patient. Participants/materials, setting, methods Power BI was used to perform descriptive statistical analysis, and to visualise the data. Statistics on IVF and Donor Insemination (DI) use, age at first treatment, births per embryo transferred, egg freezing and thawing, proportion of state-funded treatment, and surrogacy intended parents were produced. SQL Server Management Studio was used to perform data linkage on the UK national register to produce outputs pertaining to reciprocal IVF estimates and surrogacy. Main results and the role of chance The proportion of treatments among female same-sex couples and single patients doubled from 2012-2022, from 4% to 7% (n = 2,433 to n = 5,557), and 4% to 9% (n = 2,491 to n = 7,523), respectively. Female same-sex couples are now having IVF more than DI, with IVF accounting for 39% of their treatment cycles in 2012, rising to 58% in 2022. This in part relates to a rise in reciprocal IVF. We estimate that around 1 in 6 female same-sex couple IVF cycles (n = 497) were reciprocal IVF in 2022. Female same-sex couples and single patients had the highest birth rates per embryo transferred at 43% and 40% respectively, compared to 35% among opposite-sex couples for patients aged 18-34 in 2018-2022. Furthermore, single patients started IVF later than other family types at 36.3 in 2022, compared to 33.9 for female same-sex couples and 35.0 for opposite-sex couples. IVF funding was least common for single patients and female same-sex couples, aged 18-39, at 18% and 16% state-funded respectively, compared to 52% among opposite-sex couples in 2022. In 2022, opposite-sex couples made up at least 39% of surrogacy cycles. Other family types made up the other 61%, with the majority likely to be male same-sex couples. Limitations, reasons for caution Family type comparisons are limited by the data held on the UK national register. Classification of family types are based on sex assigned at birth and linked partner details; information on sexual orientation and gender identity are not available on the HFEA register. Wider implications of the findings Main findings from this study highlight inequality in state funding use by family types. This should be considered by funding commissioners reviewing funding eligibility criteria to consider where there may be adverse impacts on access to treatment among particular patients or families. Trial registration number No