In February 2004, NICE published its clinical guideline on fertility, recommending as best practice that the NHS offer three cycles of in vitro fertilisation to couples where the woman is between the ages of 23 and 39. Over four years later, however, three PCTs still offer no IVF treatment at all.

Given the high media profile of the IVF “postcode lottery”, the Department of Health established an Expert Group on Commissioning NHS Infertility Provision at the beginning of the year, seeking to identify the barriers to the implementation of the NICE guideline and to offer assistance to PCTs in overcoming these barriers. Although the group is not due to report until June 2009, it has produced an interim report suggesting several measures designed to improve access to treatment.

Failure to fully implement the guideline is attributed to a “huge variation in understanding and knowledge of infertility and the treatments available” coupled with a misperception of infertility as not constituting a “real health need”. The group has said that its final report will seek to consider the “collateral damage” incurred by infertile couples, in terms of the impact of infertility on mental health and general wellbeing. The report also makes clear that one “full cycle” of IVF includes the transfer of any viable embryos which have been frozen and stored after the fresh cycle.

While many PCTs had been awaiting the review of the NICE guidance, anticipated to be available before the end of 2008, before overhauling their IVF provision, NICE has now confirmed that this will not take place before 2010.

In the meantime, the group has recommended that consideration be given to the establishment of a clear clinical pathway and national tariff for regulated fertility services. Whether enhanced transparency on costs would be sufficient to bolster implementation of the guidance, in the absence of dedicated funds from the Department of Health, however, remains to be seen.