More to receive IVF under draft fertility guidelines

8042167-article-pregnantSome women in their early 40s should be allowed to have fertility treatment on the NHS, according to draft updated guidelines from NICE.

Infertility is thought to affect one in six heterosexual couples in the UK. Women receiving fertility treatment are 35-years-old on average and have been trying to conceive for more than 4 years.

Since NICE launched its guidelines on fertility in 2004, a greater proportion of people have been seeking help for infertility. A quarter have unexplained infertility, a further quarter have ovulatory disorders, and factors causing male infertility occur in 30 per cent of cases.

To address this, NICE has published a draft version of update guidelines on infertility today. The guidelines are open for public consultation, and include a number of new and updated recommendations.

The 2004 guideline recommends that couples in which the woman is aged 23-39 years at the time of treatment and who have an identified cause for their fertility problems or who have infertility of at least three years' duration should be offered up to three stimulated cycles of IVF treatment.

The new guidance recommends that in women aged 40 to 42 years who have not had IVF treatment, consider one full cycle of IVF, with or without intracytoplasmic sperm injection, where there is no chance of pregnancy with expectant management ('absolute infertility') and where IVF is the only effective treatment.

NICE also recommends that unstimulated intrauterine insemination should be considered as a treatment option for people who are unable to, or would find it very difficult to have vaginal intercourse because of a physical disability or psychosexual diagnosis who are using partner or donor sperm, people with conditions that require specific consideration in relation to methods of conception, and people who are in same-sex relationships.

HIV treatments have improved significantly since the original guideline was published, and the updated draft guideline recommends that the transmission of HIV to the female partner is negligible through unprotected sexual intercourse when certain criteria are met.

Gillian Leng, Deputy Chief Executive of NICE, said: "NICE reviews all guidance at regular intervals to ensure recommendations are based on the most up-to-date evidence available.

"Since the original recommendations on fertility were published in 2004 there have been many advances in both treatments and in the understanding of different techniques.

"For this update we are using the latest statistical and clinical evidence to make sure that treatment for infertility is offered at a time and in a way which is most likely to result in pregnancy."

She continued: "The updated draft guideline issued today for public consultation includes a number of new and updated recommendations.

"The aim of these new and updated recommendations is to ensure that everyone who has problems with fertility has access to the best levels of help.

"We are now consulting on this draft guideline and we welcome comments from interested parties."

Prof Chris Barratt, School of Medicine, University of Dundee, said: "It is really good to see that the upper age for women has been raised as the evidence shows that we can have success with older women, though that should not take away from the clear message that for age is still a major factor in fertility and that the longer one waits the greater the likelihood of problems.

"This is also true for men and it's good that NICE have raised that in these draft guidelines.

"The evidence has also been mounting with regards the spread of HIV and the research shows that there is a minimal risk of transmission IF the man has a plasma viral load that is fewer than 50 copies per ml."

Catherine Murphy, Head of Public Affairs at the Terence Higgins Trust, said: "We're pleased with the announcement of the draft guidelines, which are very much reflective of where HIV medicine has been heading in the last few years.

"Parenthood is what many people diagnosed with HIV want in their lives, and our research has shown that many have mixed experience due to the level of care in certain PCTs and the areas where they live.

"Hopefully with NICE producing clear, definitive guidelines, this will level out the care presented across the UK."

A draft version of the guidelines, and a form for providing comments on the updated recommendations, are available from our website.

22 May 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.