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The National Institute for Health and Clinical Excellence (NICE) is currently updating its 2004 NHS guidance on the assessment and treatment of couples with fertility problems. Yesterday (22 May), NICE has issued a draft version of the updated guideline for public consultation.
Dr Gill Leng, Deputy Chief Executive, NICE, said: "Infertility is a medical condition that can cause significant distress for those trying to have a baby. This distress can have a real impact on people's lives, potentially leading to depression and the break-down of relationships. However, in many cases infertility can be treated effectively - there are thousands of babies and happy parents thanks to NHS fertility treatment - which is why the NHS provides services and why NICE produces guidance on the topic.
"NICE reviews all guidance at regular intervals to ensure recommendations are based on the most up-to-date evidence available. Since the original recommendations on fertility were published in 2004 there have been many advances in both treatments and in the understanding of different techniques. For this update we are using the latest statistical and clinical evidence to make sure that treatment for infertility is offered at a time and in a way which is most likely to result in pregnancy.
"The updated draft guideline issued today for public consultation includes a number of new and updated recommendations. These include new specific recommendations on the number of embryos to be implanted and a broadening of the criteria for the provision of in vitro fertilization (IVF) to include some women aged 40 to 42.
"New groups of the population have also been included in this update. These groups include people who are preparing for cancer treatment who may wish to preserve their fertility, those who carry an infectious disease, such as Hepatitis B or HIV, same-sex couples and those who are unable to have intercourse, for example, if they have a physical disability.
"The aim of these new and updated recommendations is to ensure that everyone who has problems with fertility has access to the best levels of help. We are now consulting on this draft guideline and we welcome comments from interested parties."
When published, the update will replace some but not all parts of the original fertility guideline. Until then, NHS bodies should continue to follow the recommendations from the current guideline.
Key changes and updates include:
The new draft recommendations published for consultation recommend that in women aged 39 years and younger and who have not conceived after two years of regular unprotected intercourse or after 12 cycles of artificial insemination (where 6 or more are intrauterine insemination) are offered three full treatment cycles of IVF with or without intracytoplasmic sperm injection1.
The new guidance also recommends that in women aged 40 to 42 years who have not had IVF treatment, consider one full cycle of IVF, with or without intracytoplasmic sperm injection, where there is no chance of pregnancy with expectant management ('absolute infertility') and where IVF is the only effective treatment.
New draft recommendations do not support the use of IUI in this group as it has been shown that couples are more likely to become pregnant if they continue to try to conceive for two years without medical intervention (80% chance they will become pregnant).
For people who have not conceived after six cycles of donor or partner insemination, despite evidence of normal ovulation, tubal patency and semenalysis, offer a further six cycles of unstimulated intrauterine insemination before IVF is considered.
1. The draft recommendations will be available on the website from 22 May 2012 - http://guidance.nice.org.uk/CG/WaveR/90. Please contact the press office for an embargoed copy of the draft guideline.
2. The 2004 guideline can be found here: http://publications.nice.org.uk/fertility-cg11
3. Infertility affects around one in six heterosexual couples in the UK.
4. In 2010, 47,249 women received fertility treatment. Of these:
5. A total of 1,254 cycles of IVF were performed in 2009 using donated eggs. This resulted in 417 births, and 550 babies being born.
6. A minority (40.6%) of IVF treatment cycles was funded by the NHS in 2010. The majority (59.4%) were funded privately. These figures are broadly similar to the year before.
Please note: The majority of these statistics are taken from the Human Fertilisation and Embryology Authority (HFEA) publication, Fertility treatment in 2010 - trends and figures published in 2011.
7. A cycle of IVF can cost the NHS around £1,300 ((if the embryos implanted inside the woman's uterus were originally frozen) or just over £3,000 (if the woman's eggs had been removed, inseminated and the embryos implanted back into the body without having to be frozen). A cycle of intracytoplasmic sperm injection (ICSI) costs the NHS about an extra £500 in addition to the £3,000 figure above.
1. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health
2. NICE produces guidance in three areas of health:
3. NICE produces standards for patient care:
4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.
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).
2 A blastocyst is an embryo that has developed for five to six days after fertilisation. With blastocyst transfer, embryos are cultured in the laboratory incubator to the blastocyst stage before they are transferred to the womb.
3 This is based on the Association of Clinical Embryologists (ACE/UK) National External Quality Assessment Service (NEQAS) for Reproductive Science embryo and Blastocyst Grading schematic.
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