NICE updates fertility and IVF guidance in major overhaul

NICE has updated its guidance on the assessment and treatment of fertility problems, introducing changes covering IVF access, fertility investigations and treatments offered to people struggling to conceive.

The updated guideline, NG257, replaces previous guidance dating from 2013 and is intended to reduce variation in practice and improve how fertility problems are investigated and managed.

The changes include updated recommendations on when people should be referred for fertility investigations and treatment, the assessment of male and female fertility problems and access to assisted conception.

For people experiencing unexplained fertility problems who have been trying to conceive through regular unprotected sex for two years, NICE recommends discussing treatment options based on their individual circumstances, benefits, risks and preferences.

This can include considering up to four cycles of intrauterine insemination (IUI) with ovarian stimulation before IVF, or offering IVF treatment where appropriate.

The guidance also sets out recommendations governing access to NHS-funded IVF.

For women under 40 who meet the eligibility criteria, NICE recommends offering three full cycles of IVF. If those cycles do not result in a live birth, up to three additional full cycles can be considered.

For women aged 40 to 42, one full cycle of IVF should be offered where they have never previously undergone IVF treatment, there is no evidence of low ovarian reserve and the implications of IVF and pregnancy at this age have been discussed.

The updated guidance also addresses fertility investigations, including semen analysis and assessment of ovarian reserve, as well as treatment for specific causes of fertility problems.

NICE has reviewed the evidence for a number of procedures and treatments used alongside fertility treatment.

The guidance states that endometrial scratching should not be offered before IVF because evidence does not support its use to improve the chance of a live birth.

Hysteroscopy should also not be offered before IVF solely as a treatment intended to improve the likelihood of a live birth, although it may still be appropriate where there are clinical indications for the procedure.

The recommendations cover fertility preservation for people whose future fertility may be affected by medical treatment, alongside the management of conditions and circumstances that can affect the ability to conceive.

The updated guideline comes more than a decade after NICE’s previous major fertility guidance was published and reflects new evidence on fertility assessment and treatment.

NICE said the guideline aims to reduce variation in fertility care and improve how fertility problems are investigated and managed.

The recommendations provide national clinical guidance, although access to NHS-funded fertility treatment can continue to vary locally according to commissioning arrangements and eligibility criteria.

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