NICE outlines review of fertility guideline
The National Institute for Health and Care Excellence (NICE) is currently in the process of updating its 2004 NHS guidance on the assessment and treatment of people with fertility problems. Today (7 October), NICE has published the scope of the review, which outlines the topics that will be reviewed in the update. The final updated guideline is not expected to be published before 2012.
Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE, said: "NICE reviews all guidance at regular intervals to ensure recommendations are based on the most up-to-date evidence available. The scope is an important part of this process because it focuses the guideline on relevant issues. This is especially important for this review because there have been a number of advances in the field of infertility over recent years."
The scope confirms that the review will look at issues relating to the management of infertility where there is new evidence. It will include:
- effectiveness of different embryo/blastocyst transfer strategies (timing of transfer and number of embryos)
- effectiveness of intrauterine insemination, with or without ovulation induction agents
- effectiveness of mild versus conventional IVF
- sperm washing
- tests for ovarian reserve.
Dr Macbeth continued: "There is inevitably going to be speculation about the nature of this review and any new recommendations that might be made. However, recommendations can only be made in the light of available research evidence. Where there is new evidence, some recommendations may change while others may not. It is not NICE's purpose to describe how funding for infertility treatment is organised but it is our role to provide the NHS with recommendations about what constitutes clinical and cost-effective treatment."
To develop the update's recommendations, NICE has brought together a group of clinical experts and patient representatives to form a 'Guideline Development Group' (GDG). They will now begin a series of meetings to discuss the evidence in the areas outlined by the scope and develop recommendations accordingly.
Dr Macbeth added: "The experts who will be developing this update will also look at the effectiveness of fertility treatments for certain groups of patients who may need special consideration in their treatment or care. This includes people who are preparing for cancer treatment who may wish to preserve their fertility, or those who carry an infectious disease, such as HIV or Hepatitis B who are unable to have unprotected intercourse as they need to prevent virus transmission both to their partner and potential offspring. In both cases, it may mean that such people need extra help to conceive.
"The group will also consider all couples where there is explained or unexplained infertility because anyone can face infertility issues. It is important to remember though that recommendations can only be made according to the evidence that exists and will only relate to the management of infertility."
The national charity, Infertility Network UK, will be helping to develop the update. Spokesperson, Susan Seenan said: "We welcome the review of the guideline and hope that any new recommendations which may be made as a result of the review will lead to improvements in treatment for patients."
Mr Tony Rutherford, Chairman of the British Fertility Society, said: "The 2004 NICE guideline on the assessment and treatment of fertility was a landmark development in the management of infertility, appreciated, not only in the UK, but around the world. There have been significant developments in infertility practice since 2003 when the original document was finalised.
"Advances in reproductive medicine include new tests to assess the likely response of patients to treatment, and the evolution of controlled ovarian stimulation strategies, some using new medications, which provide patients with gentler, less invasive and safer treatments. The place of intra uterine insemination in the management of infertility, one of the more controversial aspects of the original guideline, will be questioned in light of recent evidence. We welcome the decision to review the effectiveness of different embryo transfer strategies to reduce the burden of multiple pregnancies. It is also important that the revised guidelines will cover certain more specialised areas, such as those patients wishing to reserve fertility in the face of cancer, as new developments in embryology have made treatments more effective.
"Of course, there are areas of infertility practice that have changed, which are not included in this review. It is true to say that infertility is one area of medicine where today's science is tomorrow's practice. The profession should endorse this timely review, which will address most of today's relevant issues, but continue to strive to provide the evidence on which future practice will be based."
When published, the update will replace some but not all parts of the original fertility guideline. However, this will not be before 2012 and until then, NHS bodies should continue to follow the recommendations from the current guideline. This is available to download from the NICE website.
Notes to Editors
- The final scope for the update of the NICE fertility guideline is available from the NICE website from Thursday 7 October.
- The NICE guideline on fertility, which was published in 2004, is available from the NICE website.
- It is estimated that infertility affects one in six heterosexual couples in the UK. Causes can include ovulatory disorders, damage to the fallopian tubes, embryo defects and pelvic conditions such as endometriosis. In approximately a quarter of cases, the cause is never identified.
Couples will normally be referred for further investigation of infertility if they are:
- heterosexual couples having unprotected regular intercourse do not conceive after 12 months
- non-heterosexuals who are trying to conceive using methods of donor insemination do not conceive after six cycles.
1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.
2. NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
This page was last updated: 06 October 2010