Fertility problems: assessment and treatment

Introduction

Recommendations that represent a change to current practice cover:

Recommendation 1.39.6 - If the woman, or trans man or non-binary person with female reproductive organs is under 40 years and meets the criteria in recommendation 1.39.3, offer an initial 3 full cycles of IVF treatment. If they reach their 40th birthday without conceiving, complete any current full cycle of IVF but do not offer any more cycles.

Recommendation 1.32.1 - Offer cabergoline to treat ovulatory disorders due to hyperprolactinaemia.

For further analysis on these recommendations, see the resource impact template which has been developed and published alongside this report.

Resource impact (cash and capacity items)

IVF Cycles (Under 40)

HFEA Fertility treatment 2023: trends and figures estimates there are approximately 11,000 NHS funded patients (out of a total of around 45,700) who receive in vitro fertilisation (IVF) treatment in England each year. The average number of IVF cycles funded is 1.4; the table below from the Department of health data on NHS-funded IVF in England shows a breakdown of the policy in relation to cycles funded for all 42 ICBs, (currently the policy for 4 ICBs is under review).

Table 1 – ICB policy on NHS-funded in vitro fertilisation (IVF) in England (March 2026)

Based on the NCL CCG Fertility Policies Review: Recommendations Report, for every ICB which funds 3 cycles, it is expected the average number of completed cycles will be 1.3. Reasons for non-completion include conception at 1st cycle, responding poorly, psychological and emotional burden of treatment.

If the funding were to increase to 3 cycles this would equate to an additional cost of £9.7 million per year for England. This is based on 1.3 cycles completed per 3 cycles available to be funded. This also assumes there are no changes to the proportion of patients who are NHS funded. Users can amend the proportions of people receiving 1 to 3 cycles in current and future practice to reflect local assumptions.

The price of an IVF cycle (one fresh and one frozen cycle) is £3,764 (NHS England 2025/26 NHS Payment Scheme), the price include drugs, scans and all components of the service including freezing of gametes and embryos for 2 years from the point the woman is seen by the consultant to when she ends her NHS care, or when she is no longer entitled to NHS care, has a baby or exceeds CCG eligibility criteria.

Ovulatory disorders due to hyperprolactinaemia

There are approximately 27,000 people in England with ovulatory disorders due to hyperprolactinaemia.

For patients with ovulatory disorders due to hyperprolactinaemia, the difference in costs between cabergoline and bromocriptine is estimated to be a saving of £22 per person per week of treatment when moving to cabergoline. For every 1,000 patients that receive cabergoline instead of bromocriptine there are potential savings of £22,000 per week of treatment. The annual savings will depend on the treatment duration, which is until conception takes place. Currently the average treatment duration is unknown. Users can amend the number of cycles in the resource impact template to calculate the financial impact of switching from bromocriptine to cabergoline. Clinical advice stated that cabergoline is already given in many centres due to its less frequent dosing compared to bromocriptine.

The recommendation will increase the use of cabergoline for ovulatory disorders due to hyperprolactinaemia and reduce the use of bromocriptine. This will reduce costs for the NHS.

Other recommendations

The new guidance specifically recommends against several treatments, including not using:

• intracytoplasmic sperm injection for non-male factor fertility problems if the semen parameters are normal.

There may be variation across the country on treatment with intracytoplasmic sperm injection (ICSI) for non-male factor fertility problems. Based on the updated recommendations there may be a decrease in the use of ICSI which could therefore result in cost savings. The cost of one IVF with ICSI cycle is estimated to be £4,250 which include drugs, scans and all components of the service including freezing of gametes and embryos, (the cost of a full IVF cycle without ICSI is £3,764; NHS England 2025/26 NHS Payment Scheme).

• endometrial scratch as a pre-treatment means of improving the outcome of IVF.
• hysteroscopy as a pre-treatment means of improving the outcome of IVF. If uterine or endometrial abnormalities are suspected.

There may be a reduction in unnecessary procedures such as endometrial scratch, and hysteroscopy which are sometimes done in current clinical practice. The cost of an endometrial scratch is estimated to be between £230 and £425 depending on if sedation is needed (Centre for Reproductive Medicine Fee Schedule for In Vitro Fertilisation and Intracytoplasmic Sperm University Hospitals Coventry and Warwickshire (UHCW)).

The cost of a hysteroscopy is estimated to be £425 (NHS England 2025/26 NHS Payment Scheme).

• endometrial receptivity testing as a treatment add-on for embryo transfer.

There may be a reduction in endometrial receptivity testing performed which are sometimes done in current clinical practice. The cost of an endometrial receptivity test is estimated to be £795 (NICE’s guideline on fertility problems: Evidence review D on endometrial receptivity testing).

Population covered

Table 2 shows the number of people having IVF treatment. The HFEA Fertility treatment 2023: trends and figures report states there are approximately 45,700 people receiving IVF in England, the same report states 24% are funded via the NHS.

Table 2 Eligible population for 3 or more cycles of IVF treatment

Table 3 shows the eligible population with ovulatory disorders due to hyperprolactinaemia. Datta et al. (2016) states that 12.5% of women will experience infertility problems. NICE's clinical knowledge summary on infertility states ovulatory disorder equates to 25% of females with infertility. PubMed Central - Hyperprolactinemia along with clinical expert opinion states 10% of people with ovulatory disease have hyperprolactinaemia.

Table 3 Eligible population with ovulatory disorders due to hyperprolactinaemia

Key information

Table 4 Key information

About this resource impact summary report

This resource impact summary report accompanies the NICE guidance on fertility problems: assessment and treatment and should be read with it.