Most couples seek medical advice after 1-2 years of trying to conceive, meaning that fertility issues are the second most common reason for women to visit their GP, after pregnancy. If left untreated, infertility can result in stress, depression, and emotional distress.
Chances of success
Age has been shown to be the only robust factor in predicting success of IVF treatment. The likelihood of becoming pregnant declines as couples age, but the average age of women seeking fertility treatment has steadily increased over the last 20 years, reflecting the trend for couples to start families later on.
The chances of IVF success falls sharply after the age of 42. Data collected by the Human Fertilisation and Embryology Authority (HFEA) showed that the percentage of IVF cycles that resulted in births decreases from 20% when the mother is aged 38-39, to 14% at age 40-42, to just 5% when she is over 42.
What patients can expect
Given that around 3.5 million people in the UK - 1 in 7 heterosexual couples - have problems conceiving, our recommendations will have far-reaching implications for fertility treatment services.
The NICE fertility guideline, which we updated last year, recommends that women under 40, who have been trying to get pregnant for 2 years, should be offered 3 full cycles of IVF. For women aged between 40 and 42, who have been trying for 2 or more years, and have not previously received IVF or shown evidence of low ovarian reserve, NICE recommends 1 full cycle of treatment.
We published our quality standard on fertility last week, which is a concise set of statements that summarise what the best possible care looks like. The quality standard states that previous children, sexual orientation, and relationship status should not be a factor in determining eligibility for treatment; and that counselling should be available throughout treatment.
Factors such as body weight, smoking, drinking, and drug use can all influence the chances of getting pregnant, so our new quality standard includes provision of lifestyle advice, and specialist services and consultation, along with advice on the number of embryos transferred. This depends on age and other predictors of success, and aims to strike a balance between maximising the chances of success and minimising the risk of multiple pregnancy.
The importance of 3 full cycles of IVF
A full cycle of IVF treatment covers ovarian stimulation and egg recovery, insemination, and embryo replacement.
Many patients think that an 80% chance of getting pregnant through IVF is excellent, while anything less than 50% is poor. However, young healthy couples usually only have around a 20% chance of conceiving naturally in a month.
Most women typically see success rates of 20-35% per cycle, but the likelihood of getting pregnant decreases with each successive round, while the cost increases. The cumulative effect of three full cycles of IVF increases the chances of a successful pregnancy to 45-53%. This is why NICE has recommended 3 IVF cycles as it is both the most cost effective and clinically effective number for women under the age of 40.
Why the quality standard is important
The investigation by Fertility Fairness showed that more than 80% of clinical commissioning groups (CCGs) in England are failing to provide the recommended number of IVF cycles, with more than half only offering 1 cycle to eligible couples, and some not offering any treatment at all. Fertility First also found that the eligibility criteria varied from location to location, with previous children, relationship status, and sexuality all used as deciding factors.
This “postcode lottery” of IVF treatment availability has been criticised by several charities and campaigning organisations; and the NICE guidance and quality standard underlines the importance of consistent treatment availability across England.