20 February 2013

Fertility Treatments Should be 'Appropriate, Effective and Timely' says NICE

GPs should offer appropriate and effective fertility treatments in a timely manner for women having problems with conception, according to latest guidelines from NICE.

Around 1 in 7 heterosexual couples are affected by fertility problems, with both the number of people affected and those seeking help increasing over the past decade.

GPs should refer women of reproductive age for further clinical assessment and investigation along with their partners if they have not conceived after 1 year of unprotected vaginal sexual intercourse, and in the absence of any known cause of fertility, says NICE.

The guidelines recommend 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 specific criteria for this is if they have never previously had IVF treatment, there is no evidence of low ovarian reserve, there has been a discussion of the additional implications of IVF and pregnancy at this age.

Previously, NICE said that IVF treatment should not be recommended for women older than 39.

The definition of a full cycle of IVF treatment has been updated to avoid any ambiguity in interpretation or variation of treatment. A full cycle is now defined as comprising one episode of ovarian stimulation and the transfer of any resultant fresh and frozen embryos.

The guideline also recommends that intrauterine insemination should not be routinely offered for people who are having regular unprotected intercourse with unexplained fertility, mild endometriosis or ‘mild male factor infertility'.

The updated guideline adds that GPs should not offer oral stimulation agents such as clomifene citrate, anastrozole or letrozole, to women with unexplained fertility.

New recommendations on lifestyle advice also feature in the updated guideline.

GPs should advise patients presenting with fertility problems that the consumption of more than 1 unit of alcohol per day reduces the effectiveness of assisted reproduction procedures, including IVF.

Patients should be informed that maternal and paternal smoking can adversely affect the success rates of assisted reproduction procedures, including IVF treatment.

In addition, patients should be informed that maternal caffeine consumption has adverse effects on the success rates of assisted reproduction procedures, including IVF treatment.

Dr Clare Searle, a GP based in Hertfordshire and member of the Guideline Development Group, said: "This guideline should help GPs to actively manage the possibility of infertility in people, from offering lifestyle advice to referring people for further investigations.

"The guideline sets out a clear pathway of care for GPs and other healthcare professionals to follow. This will help identify fertility problems in a timely manner and give people access to the most effective, appropriate treatments."

Tim Child, Consultant Gynaecologist, Director of the Oxford Fertility Unit and part 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-30's her fertility begins to decline, even more so from her late 30's.

"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."

Listen to a discussion with Tim Child on the updated guideline for more information on the new recommendations.