Introduction

This quality standard covers the assessment and treatment of fertility problems in:

  • people with explained or unexplained infertility

  • people preparing for cancer treatment who may wish to preserve their fertility.

For more information see the Fertility problems overview.

Why this quality standard is needed

Fertility problems exist when a woman cannot conceive (get pregnant) despite having regular unprotected vaginal intercourse, or artificial insemination, at and around the time of ovulation. Fertility (NICE guideline CG156) recommends that in practice, healthcare professionals should define infertility in terms of the period of time people have been trying to conceive without success after which formal investigation is justified and possible treatment implemented.

It is estimated that infertility affects 1 in 7 heterosexual couples in the UK. The main causes of infertility in the UK (with approximate prevalence given as a percentage) are:

  • unexplained infertility (no identified male or female cause) (25%)

  • ovulatory disorders (25%)

  • tubal damage (20%)

  • factors in the male causing infertility (30%)

  • uterine or peritoneal disorders (10%).

In about 40% of cases, fertility disorders are found in both the man and the woman.

The quality standard is expected to contribute to improvements in the following outcomes:

  • singleton births

  • multiple births

  • live births

  • incidence of anxiety and/or depression.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following outcomes framework published by the Department of Health:

Table 1 shows the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2014/15

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Improvement areas

Reducing deaths in babies and young children

1.6 ii Neonatal mortality and stillbirths

Patient experience and safety issues

Ensuring that care is safe and that people have a positive experience of care is vital in a high‑quality service. It is important to consider these factors when planning and delivering services relevant to fertility.

NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (see the NICE pathway on patient experience in adult NHS services), which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and be supported to understand their options and make fully informed decisions. They also cover the provision of information to patients. Quality statements on these aspects of patient experience will not usually be included in topic‑specific quality standards. However, recommendations in the development source(s) for quality standards that impact on patient experience and are specific to the topic will be considered during quality statement development.

Coordinated services

The quality standard for fertility specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole fertility care pathway. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to people experiencing fertility problems.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality fertility service are listed in Related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating people with fertility problems should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source(s) on specific types of training for the topic that exceed standard professional training will be considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting people with fertility problems. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision‑making process about investigations, treatment and care.