25 February 2013
ByAppeared in BioNews 694
Women over the age of 40, same-sex couples, and people with disabilities have been addressed for the first time in the updated NICE (National Institute for Health and Clinical Excellence) guideline on fertility treatment.
'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', said Sir Andrew Dillon, Chief Executive of NICE.
In the clinical guideline, NICE recommends women aged between 40 and 42 should be offered one cycle of IVF if they have not conceived after two years of regular, unprotected intercourse and meet other criteria. This marks a change from the 2004 guideline that suggested women over the age of 39 should not be offered IVF (as reported in BioNews 247).
Dr Tim Child, Director of Oxford's Institute of Reproductive Sciences and a member of the guideline development group, said: 'This decision was taken after considerable discussion and close analysis of the available evidence'.
The updated guideline also suggests that IVF treatment should be made available to eligible women earlier than previously recommended - after two years, rather than three years, of regular, unprotected intercourse without conceiving. Same-sex female couples and people with certain disabilities that prevent them having intercourse were also highlighted as eligible for IVF, if they have undergone six unsuccessful cycles of artificial insemination.
Issues around artificial insemination and the use of drugs to stimulate egg release were also addressed, as well as the question of how many embryos should be implanted during IVF treatment. Implanting several embryos increases the chance of multiple births, which can result in medical complications for both mother and child.
The updated guideline recommends women under the age of 37 undergoing their first cycle of IVF should have only one embryo transferred. The transfer of two embryos was suggested for further cycles of treatment and in women aged between 40 and 42.
Some fertility experts fear that the guideline may not lead to changes being applied in practice. Dr Sue Avery of the British Fertility Society told the Telegraph: 'It is now almost ten years since NICE first published guidelines on fertility treatment and we are still in the untenable position that the majority of PCTs have not fully implemented these and patients in many areas of the country are unable to access treatment'.