British Fertility Society responds to the review of the NICE fertility guidelines.

The National Institute for Clinical Excellence (NICE) has recently released draft fertility guidelines. The British Fertility Society (BFS), representing all professionals (doctors, scientists and nurses) working in the field of fertility and reproductive medicine, welcomed the review of the NICE fertility guidelines, which were recently released for public consultation. The guidelines, as before, make recommendations about the management of the whole spectrum of fertility treatment, from simple therapies such as ovulation induction, artificial insemination, the management of male factors and of course IVF. The funding issue however remains a very important factor regarding the implementation of the guidelines. The fact that the majority of Primary Care Trusts (PCTs) still do not provide funding to cover all recommendations in the original 2004 guidance exposes the unacceptable situation that has, over years, denied fertility treatment to eligible couples by the arbitrary nature of their postcode-so called post code lottery. The BFS calls on all Primary Care Trusts to fulfil their obligations and comply with the NICE guidance and provide couples with infertility access to the treatment which is their right.

Statistics show that approximately one sixth of couples are involuntarily childless and at least a quarter of all couples experience unexpected delays in achieving their desired family size. There is also a steadily increasing proportion of women in the UK who have never had a child. In recent years there has been an increase in publicity about infertility and reproductive medicine technologies, which has gone some way to reduce both the stigma of infertility and the reluctance of couples to seek advice. Whilst the infertility itself is a psychological and emotional blow to the couple, the suffering is magnified if they find that NHS eligibility criteria excludes them from receiving treatment or their PCT may not be funding their treatment in the first place. It is particularly difficult when the couples know that others are included in the treatment criteria elsewhere while they are not. This questions the name of any service with "National" in its title. The National Health Service currently rations infertility treatment and does so on non-clinical grounds.

It is therefore encouraging to see that the review of the NICE fertility guidelines is a firm statement that the diagnosis and treatment of infertility remains a crucial part of NHS-funded treatment in England, Wales and Northern Ireland. The first edition of the guidelines, published in 2004, was a major step forward for the one in six couples who experience infertility. Updating these guidelines will make sure that fertility services within the NHS have access to guidance on a cost-effective programme of infertility diagnosis and treatment, based on the best available evidence.

The British Fertility Society welcomes the review and the important role that NICE plays in defining cost-effective healthcare. The BFS announced that it will be carefully reviewing these guidelines and will respond to NICE with the views of its members as part of the consultation process at the shortest time possible. The British Fertility Society will be looking forward to working with patients, professionals, Commissioners and the wider NHS to assist in the implementation of the final guidelines across England, Wales and Northern Ireland. It is unfortunate that to date, the 2004 guidelines (which recommended three cycles of IVF for couples diagnosed with infertility) have not been implemented in full across the majority of the Trusts that they are designed to cover. This is in spite of many strong statements and assurances from government ministers and the Prime Minister¹, ² that the guidelines should be implemented. Many patients have therefore been embroiled in an unfair and arbitrary postcode lottery, adding to the emotional stress and the distress that subfertility and infertility brings. It is hoped that the updated guidelines will bring infertility further up the agenda of many NHS commissioners and encourage them to provide the funds necessary to implement them.

Professor Adam Balen, Chair of the BFS Practice and Policy Committee and Professor of Reproductive Medicine and Surgery, Leeds Teaching Hospitals NHS Trust said:

"This review shows that infertility is still on the radar for the NHS. It is welcomed, however, we know from the publication of the 2004 guidelines that the real challenge is persuading Commissioners to provide appropriate funding.

Excuses for not complying with NICE guidelines generally state that infertility is not a life-threatening condition, but this is unjustified: infertility causes psychological harm for many of the one-in-six couples it affects, and is recognised as a medical condition by the World Health Organisation. Furthermore many treatments are simple, cheap and effective and even the most high tech IVF therapies can be provided in a cost-effective manner through NHS clinics.

IVF was pioneered in the UK and we continue to lead the field in research into the causes of and treatments for infertility. No-one who stands a reasonable chance at conception should be denied the opportunity, and these NICE guidelines outline how that can be achieved."

Dr. R. Gazvani, Fertility Specialist (London and Liverpool) warns and points out that it is very important for all our patients and couples to appreciate that what has been oublished by NICE at this time are merely draft guidelines. The final version may be different from what we are seeing now especially with respect to the upper limit of female age for NHS funded IVF treatment. Furthermore, even if the upper age is raised as it is suggested to 42, then it will be up to the relevant PCTs to decide whether to fund the treatments or not. So, in the end it will still be the PCTs that will be the decision makers. my patients are already asking me if the rules have now been changed and if they can have treatment. Unfortunately sometimes the media can give out false hope. We must be careful to not to do that".

Notes for readers

National Institute for Health and Clinical Excellence (NICE) guidance provides healthcare professionals and others with evidence-based guidelines on the cost-effective diagnosis and treatment of many different medical conditions, including infertility. The updated guidelines are currently undergoing consultation and can be viewed at http://www.nice.org.uk/.

¹ Prime Minister's Questions, 8 June 2011. Question 11. http://www.publications.parliament.uk/pa/cm201011/cmhansrd/cm110608/debtext/110608-0001.htm#11060855000012. Accessed 17/05/12

² Prime Minister and Health Minister Show Support for NHS Funding - 15th July 2008. Infertility Network UK. http://www.infertilitynetworkuk.com/press/index.aspx?id=664 Accessed 17/05/12

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The British Fertility Society is a national multidisciplinary organisation representing professionals practising in the field of reproductive medicine. The British Fertility Society is committed to promoting good clinical practice and working with patients to provide safe and effective fertility treatment. For general information, please visit our website: http://www.fertility.org.uk/