NICE has published the long awaited partial update of its fertility assessment and treatment guideline CG11. The updated publication will be known as CG156.
CG156 provides a new definition of infertility whereby a woman of reproductive age, who has not conceived after one year of unprotected sexual intercourse, in the absence of any known cause of infertility, should be offered further assessment and investigation along with her partner. The referral for specialist consultation should be made earlier where the woman is over 36 or there is a known cause or history of predisposing factors.
Under CG11, NICE did not recommend IVF treatment for women over the age of 39. Under the updated guideline, NICE recommends that women under the age of 40, who have not conceived after two years of regular unprotected intercourse or 12 cycles of artificial insemination, are offered three full cycles of IVF, while women in the same situation who are aged 40 to 42 are offered one full cycle (with possible double embryo transfer) provided they have never had IVF before, do not have low ovarian reserve and have been counselled on the additional implications of IVF and pregnancy at what is considered to be an "advanced maternal age". The differential arises from the fact that egg quality diminishes with age and therefore, success rates are considerably lower, making the procedure markedly less cost-effective.
The update also provides for new rules on the number of embryos transferred in IVF, depending on the age of the woman and quality of the embryos. Multiple births are one of the biggest risks associated with IVF for both mother and child, and the Human Fertilisation and Embryology Authority has long endorsed a policy of single embryo transfer.
The purpose of the update was to revise recommendations in the light of new scientific evidence but additional consideration was also given to:
- People in same-sex relationships who remain infertile after donor insemination
- People who are unable to, or would find it very difficult, to have vaginal intercourse (such as people with a clinically diagnosed disability or psychosexual problem)
- People with conditions that require specific consideration in relation to methods of conception (such as couples where the male is HIV positive)
- People who are preparing for cancer treatment who may wish to preserve their fertility
Specific recommendations relating to these groups can be found in the new guideline.
The NHS Commissioning Board has produced a factsheet on the commissioning of fertility services that aims to support clinical commissioning groups (CCGs) in taking on the commissioning of fertility services from April 2013 and takes into account the publication of G156.