National Institute for Health and Clinical Excellence (NICE)
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Greater treatment options for women with fertility problems
More women can receive appropriate and timely fertility treatment such as IVF, following updated guidelines from NICE.
Infertility is a common medical condition which can have devastating, painful, and life-long effects extending to personal relationships and wider family.
It is caused by various reasons, with a quarter of cases unexplained, a further quarter caused by ovulatory disorders, and 30 per cent of cases due to factors affecting male fertility.
The condition affects around 1 in 7 heterosexual couples, with both the number of people affected by fertility problems, and those seeking help for them, increasing over the past decade.
The rising number of people seeking help coincides with an increasing trend for couples to start families later in life, despite fertility declining rapidly with age especially after 35. In 2011, women who received fertility treatment were 35-years-old on average, and had been trying to conceive for around 4 years.
NICE has updated its guidelines on fertility to ensure people experiencing fertility problems get the most appropriate and effective treatment earlier.
In the previous 2004 fertility guideline, NICE said that IVF treatment should not be recommended for women older than 39.
Under the updated recommendations, NICE says that under certain criteria, women aged between 40 and 42 years should be offered one full cycle of IVF with or without intracytoplasmic sperm, if they have not conceived after two years of regular unprotected intercourse, or 12 cycles of artificial insemination where six or more are by intrauterine insemination.
The definition of a full cycle of IVF has been updated to prevent any ambiguity in interpretation or variation in treatment. A full cycle is now defined as including one episode of ovarian stimulation and the transfer of any resultant fresh and frozen embryos.
The updated guideline also recommends that IVF treatment should be made available for eligible women earlier than was previously recommended.
Women who are eligible for IVF can now receive treatment after two years of regular vaginal intercourse, or 12 cycles of artificial insemination, if they have been unable to conceive. This is one year earlier than in the previous recommendations.
The updated guideline additionally contains recommendations to ensure that only the most effective treatments are offered in a timely manner to people experiencing problems in conceiving.
NICE says people with unexplained infertility, mild endometriosis or mild male factor infertility should attempt to conceive through regular vaginal intercourse for two years rather than receive intrauterine insemination.
This is because evidence available since the previous guideline was published shows that intrauterine insemination treatment provides no further benefit to producing a live birth than regular vaginal intercourse.
Furthermore, oral ovarian stimulation agents, such as clomefine citrate, anastrozole or letrozole, should now not be offered to women with unexplained fertility.
The guideline for the first time also covers same-sex couples, those who carry infectious diseases such as Hepatitis B or HIV, and those who are unable to have intercourse, for example if they have a physical disability.
Tim Child, a Consultant Gynaecologist and Director of the Oxford Fertility Unit and member of the Guideline Development Group, said: "Recommending IVF treatment for a very select group of women over 40 was not a decision that was taken lightly. When a woman reaches her mid-30s her fertility begins to decline, even more so from her late 30s.
"However, many women do conceive naturally in the 40-42 year age group, but for those who can't, and who have been diagnosed with the medical condition of infertility, then improvement in IVF success rates over the last decade mean that we are now able to offer cost-effective treatment with a single IVF cycle.
He added: "This decision was taken after considerable discussion and close analysis of the available evidence."
Sir Andrew Dillon, Chief Executive of NICE, said: "Whatever the cause, we know fertility problems can have a potentially devastating effect on people's lives; causing significant distress, depression and possibly leading to the breakdown of relationships.
"The good news is that, thanks to a number of medical advances over the years, many fertility problems can be treated effectively.
"It is because of these new advances that we have been able to update our guideline on fertility, ensuring that the right support, care and treatment is available to those who will benefit the most."
Listen to a discussion with Tim Child on the updated guideline for more information on the new recommendations.