National Institute for Health and Clinical Excellence (NICE)
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Stop restricting IVF treatment, NICE urges NHS

The NICE quality standard on fertility reminds the NHS that IVF treatment is a core part of NHS services and should not depend on where you live.

  • The National Institute for Health and Care Excellence (NICE) recommends 3 full cycles of IVF for women aged under 40 and 1 full cycle for some women aged 40-42.
  • Some parts of England are providing good fertility services, but other areas are still failing to fund the full number of IVF cycles.

Local NHS funding bodies who aren’t following official recommendations for IVF treatment should rethink their approach to treating infertility.

A new quality standard published by the National Institute for Health and Care Excellence (NICE) re-emphasises the importance of fertility treatment as a core NHS service.

Under the Health and Social Care Act 2012, NHS England must have regard for NICE quality standards.

The NICE quality standard says that the NHS should provide 3 full cycles of IVF treatment[1] for women aged under 40 who have failed to get pregnant after 2 years of trying (or 12 cycles of artificial insemination). Women aged 40-42 should receive 1 full cycle if certain criteria are met. This is in line with current NICE guidance, published in 2013.

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said: “Infertility is a recognised medical condition. People affected, which includes 1 in 7 heterosexual couples, should be able to receive treatment as a core NHS service.

“Some parts of England are doing very well in offering the full NICE-recommended number of IVF cycles for all eligible women up to the age of 42. This is particularly true in the North, in areas like Northumberland, Oldham and Cumbria.

“Others are still to introduce a cycle of IVF for women between the ages of 40 and 42, but have at least committed to providing 3 full cycles of IVF to women under 40-years-old, such as Camden and Gloucestershire.

“But, many areas are not even doing this.”

Professor Leng continued: “Infertility can have a potentially devastating effect on people’s lives: it can cause significant distress, depression and possibly lead to the breakdown of relationships. It is unacceptable that parts of England are choosing to ignore NICE recommendations for treating infertility. This perpetuates a postcode lottery and creates inequalities in healthcare across the country.”

Research by the organisation Fertility Fairness shows that fewer than 1 in 5 Clinical Commissioning Groups (CCGs), which commission health services at a local level, offer the full number of NICE-recommended cycles. More than half (52%) only offer 1 cycle to eligible couples while people with fertility problems in the Vale of York are refused IVF treatment altogether.

And last month, Mid Essex CCG, once one of the best providers of IVF in the country, confirmed it would no longer provide any specialist fertility services except in “exceptional clinical cases”.

Professor Leng said: “We understand that the NHS is under financial constraints, but fertility is a core NHS service. The NICE guidance from 2013 is based on what is considered to be the best use of NHS resources for treating fertility problems, including IVF treatment.”

Susan Seenan, chief executive of Infertility Network UK and co-chair of Fertility Fairness, said “It is totally unacceptable that ten years on from the initial NICE recommendations, access to fertility treatment still depends entirely on where you live. Patients are still suffering as a result of CCGs ignoring national guidance and cutting services. We are therefore delighted that NICE has published this quality standard which reinforces the cost and clinical effectiveness of this treatment.”

The quality standard also identifies other key areas where improvements in care and services are most needed. These include:

  • nurses and GPs giving people written and verbal advice about lifestyle factors that may affect fertility, if they are worried that it is taking longer than expected to fall pregnant.
  • GPs referring women for specialist consultation if they have not conceived after 1 year of trying, or earlier in certain circumstances. This is to ensure people get the treatment they need in a more timely manner.
  • offering counselling to people who are having problems conceiving before, during and after investigation and treatment for their fertility problems.
  • for people who are preparing to have treatment for cancer that is likely to result in fertility problems, giving them the option of freezing their embryos or sperm ahead of treatment (cryopreservation).

Fertility services should also follow NICE guidance on the optimum number of embryos that should be implanted into a woman at any one time. The standard says that women having IVF should have 1 or 2 embryos transferred according to the woman’s or donor’s age, the cycle number and the quality of the embryos.

Anna Bradley, Chair of Healthwatch England, said: "Fertility issues are a particularly emotive subject and it should be a basic right of couples from Bradford to Bedfordshire, or wherever they live, to be able to access the same level of care and support on the NHS.

"Sadly, the so called 'postcode lotteries' created by the inconsistent decisions at local level is causing widespread inequality, resulting in unnecessary confusion and frustration for patients and their loved ones. Ultimately, this raises some very serious questions about whether NICE treatments should indeed be made mandatory.  

"We therefore fully support this move by NICE, and would urge anyone who is being denied access to a NICE recommended treatment to get in touch with their local Healthwatch for help in challenging the decision.”

The new quality standard is designed to complement existing NICE guidance on the treatment and support of people with fertility problems, creating a comprehensive guide to help the NHS provide and maintain consistent and high-quality care for all.

For more information call the NICE press office on 0845 003 7782 or out of hours on 07775 583 813.

Notes to Editors

Explanation of terms

  1. A full cycle of IVF, with or without intracytoplasmic sperm injection (ICSI), comprises one episode of ovarian stimulation and the transfer of any resultant fresh and frozen embryo(s).
    For each IVF cycle, one or more of a woman’s eggs are removed from her ovaries, fertilised and then either implanted back into her body or stored for later use (depending on how many eggs were harvested). Although a maximum of two embryos are implanted during each IVF procedure, a cycle of IVF is considered to be complete once all fertilised eggs are transferred back into the woman’s body. This could comprise several procedures.

About the NICE quality standard

  1. The quality standard for fertility problems is available at /guidance/QS73
  2. The quality standard is different from the Institute’s fertility guidance which was updated last year and gives recommendations across broad areas of care from advice giving and referral to specialist care to fertility tests and treatment.
  3. The updated NICE guideline on fertility, which makes recommendations on the whole pathway of care for people who are experiencing fertility problems, is available to view at /CG156.   

Fertility facts and figures

  • Infertility affects about 1 in 7 heterosexual couples in the UK.
  • Of couples who are actively trying for a baby, around 70% will have conceived by 6 months, 85% by 12 months and 95% will be pregnant after 2 years of trying.
  • With regular unprotected sexual intercourse, 94% of fertile women aged 35 years, and 77% of those aged 38 years, will conceive after 3 years of trying.
  • Infertility most commonly occurs because of:
    • unexplained infertility (no identified male or female cause) - 25%
    • ovulatory disorders - 20%
    • tubal damage - 15%
    • factors in the male causing infertility - 30%
    • uterine or peritoneal - 10%.
    • In about one third of cases disorders are found in both the man and the woman.
  • It is estimated that no more than 5% of all referrals for NHS fertility services are from same-sex couples.
  • One full cycle of fresh IVF can cost the NHS around £3,000. This includes ovarian stimulation, removing the woman’s eggs, insemination of the eggs in the laboratory, embryo culture, transfer of 1 or 2 embryos back into the body, and freezing of any spare suitable embryos.
  • A cycle of intracytoplasmic sperm injection (ICSI) costs the NHS about an extra £500 in addition to the £3,000 figure above.
  • The thawing and transfer of frozen IVF embryos costs the NHS significantly less than fresh IVF.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.

To find out more about what we do, visit our website:www.nice.org.uk and follow us on Twitter: @NICEComms.

 

Channel website: https://www.nice.org.uk/

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