Quality statement 6: IVF for women aged 40–42 years

Quality statement

Women aged 40–42 years who meet the criteria for in vitro fertilisation (IVF) are offered 1 full cycle of IVF.

Rationale

The overall chance of having a live birth after IVF treatment falls with rising female age and also decreases as the number of unsuccessful cycles increases. Access to the appropriate number of full cycles of IVF for women who meet the criteria for IVF will increase the likelihood of those women becoming pregnant. IVF should be considered as an option only if expectant management and first‑line treatments for women have not led to a pregnancy. This staged approach to treatment supports the efficient and equitable use of healthcare resources.

Quality measures

Structure

Evidence of a locally agreed policy on provision of 1 full cycle of IVF for women aged 40–42 years who meet the criteria for IVF.

Data source: Local data collection. National data on provision of IVF and intracytoplasmic sperm injection (ICSI) are available from the Human Fertilisation and Embryology Authority.

Process

Proportion of women aged 40–42 years who meet the criteria for IVF who are offered 1 full cycle of IVF.

Numerator – the number in the denominator who receive 1 full cycle of IVF.

Denominator – the number of women aged 40–42 years who meet the criteria for IVF.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (specialist fertility services) ensure that policies are in place on provision of 1 full cycle of IVF for women aged 40–42 years who meet the criteria for IVF.

Healthcare professionals (in specialist fertility services) adhere to policies on provision of 1 full cycle of IVF for women aged 40–42 years who meet the criteria for IVF.

Commissioners (clinical commissioning groups) should commission sufficient capacity within specialist fertility services to provide 1 full cycle of IVF for women aged 40–42 years who meet the criteria for IVF.

What the quality statement means for patients

Women aged 40 to 42 finding it difficult to get pregnant who have been trying for 2 years or longer or they have had 12 cycles of artificial insemination (which is the direct insertion of sperm into a woman's womb or the neck of the womb) are offered 1 full cycle of IVF if all of the following apply:

  • they have never had IVF before

  • tests show that their ovaries would respond normally to fertility drugs

  • they have discussed the risks of IVF and becoming pregnant at this age with their doctor.

A full cycle of IVF involves collecting eggs and sperm, fertilising the eggs outside the woman's body, and placing 1 or 2 fertilised eggs (embryos) into the womb to start a pregnancy.

Source guidance

  • Fertility (2013) NICE guideline CG156, recommendation 1.11.1.4 (key priority for implementation).

Definitions of terms used in this quality statement

Criteria for IVF for women aged 40–42 years

Women aged 40–42 years should be offered 1 full cycle of IVF if they have not conceived after 2 years of regular unprotected vaginal intercourse or 12 cycles of artificial insemination (including 6 or more by intrauterine insemination) and have never had IVF treatment before, have no evidence of low ovarian reserve (when a women doesn't have many eggs left) and have had a discussion of the additional implications of IVF and pregnancy at this age. The use of ICSI should not preclude the provision of the appropriate number of IVF cycles. [Fertility (NICE guideline CG156), recommendation 1.11.1.4].

Full cycle of IVF

A full cycle should include 1 episode of ovarian stimulation and the transfer of any resultant fresh and frozen embryo(s). [Fertility (NICE guideline CG156)]

Equality and diversity considerations

The existence of living children should not be a factor that precludes the provision of fertility treatment.

The statements include reference to specific age groups. This is to promote effective care because age was found to be the only robust factor in determining IVF success.

The statement focuses on people who have a possible pathological problem to explain their infertility. It includes women in same‑sex relationships and single women having artificial insemination.