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NICE guidance, shame about the implementation

25 February 2004
By BioNews
Appeared in BioNews 247

The UK's National Institute of Clinical Excellence (NICE) has recommended that, in line with earlier draft guidance published in August 2003, the NHS should fund up to three attempts at IVF for infertile couples meeting specific criteria. NICE is a cost-effectiveness watchdog established by the government in 1999 to provide guidance on 'best practice' in healthcare, and was asked to look at IVF provision on the NHS, which until now has varied across different regions of the country, leading commentators to suggest that IVF is governed by a 'postcode lottery'.

The NICE recommendations say that some infertile couples should be offered up to three attempts at IVF using fresh embryos, with the possibility of a further three cycles using frozen embryos. Couples should be eligible for state-funded infertility treatment if the woman is between 23 and 39 years old, and if there is either a diagnosed cause of infertility, or at least three years of unexplained infertility. IVF should also be offered by the NHS if a couple had 'an unequivocal need' for treatment, such as prior treatment for cancer, very poor semen quality, or Fallopian tube blockage. It also recommends that up to six cycles of intra-uterine insemination (IUI), a cheaper treatment where the 'best' sperm is injected through the cervix directly into the womb, should be offered on the NHS. NICE estimates that demand for IVF, which costs about £2,700 a cycle, will increase by 80 per cent in England, and that 70 per cent of people now relying on the private sector for treatment moving to the NHS. This is expected to increase the number of IVF babies born in the UK each year by 5,000.

However, in response to the recommendations, the UK Health Secretary, John Reid, has announced that, by April next year, couples meeting the NICE criteria will be offered just one free cycle of IVF. This does have the effect of making provision of NHS-funded IVF treatment uniform across the country, but falls short of the level of provision recommended by NICE. In addition, NHS-funded IVF will only be available at first to couples who don't already have children living with them. The Health Secretary said that 'in the longer term I would expect the NHS to make progress towards full implementation of the NICE guidance', but has not committed to a timetable for full implementation of the new clinical guidance, despite the fact NICE estimated it would cost £85 million, far less than the £400 million originally estimated by the government.

Alan Templeton, chairman of the Royal College of Obstetricians and Gynaecologists, said that the Government's implementation of the guidelines is 'sentencing [couples] to having a much reduced chance of having a baby'. The likelihood of a successful birth in a single cycle of IVF are put at around 25 per cent for women under 35, but this rises to about 50 per cent with three cycles. Professor Alison Murdoch, chair of the British Fertility Society, said that 'anything less than NICE recommend will mean that services continue to be inadequate'. But, in response to the Health Secretary's comments, Andrew Dillon, chief executive of NICE, said that 'full implementation of the guideline will take time, and the Government's advice to NHS organisations on a stepped approach to improving access to IVF treatment makes sense'.

Free fertility treatment on NHS
The Daily Mail |  25 February 2004
IVF for all will increase births by 5,000 a year
The Times |  25 February 2004
NHS to offer IVF to women under 40
The Guardian |  25 February 2004
NHS to offer one free IVF cycle
BBC News Online |  25 February 2004
6 May 2008 - by MacKenna Roberts 
Last week, nurses in the UK decided to take action and lobby the British government to demand uniform eligibility criteria for infertility treatment and for the provision of up to three cycles of NHS-funded IVF be implemented by all UK fertility clinics, replacing the arbitrary 'postcode lottery...
20 June 2006 - by Dr Kirsty Horsey 
BioNews reporting from ESHRE conference, Prague (sponsored by Planer cryoTechnology). By Dr Kirsty Horsey: Research presented today at the annual conference of the European Society of Human Reproduction and Embryology (ESHRE) in Prague, Czech Republic, suggests that the benefits that would come from the UK's government providing free fertility treatment...
10 April 2006 - by BioNews 
The UK's Independent on Sunday (IoS) says that 'a generation of women is being denied the chance to give birth', following an investigation that shows that provision of IVF services in the UK remains a 'postcode lottery'. The newspaper revealed that only 40 per cent of the nation's primary care...
21 November 2005 - by BioNews 
A study of Primary Care Trusts (PCTs) in the UK has found that at least 23 were not providing any National Health Service (NHS)-funded fertility treatment by an April deadline earlier this year. Eighteen other PCTS were only offering IVF under 'exceptional circumstances' and many others were denying treatment...
26 September 2005 - by BioNews 
Some UK couples seeking help to have children will have to wait until their thirties before they qualify for state-funded IVF treatment on the National Health Service (NHS), according to a report in the Independent on Sunday (IOS) newspaper. While many health authorities set an upper age limit for treatment...
25 February 2004 - by Dr John Mills 
Today is not the greatest day for those hoping that they might receive NHS treatment to overcome their inability to have children, nor is it for those who try to provide them with help. Doctors have struggled for years to provide good treatment for deserving patients with realistic results and...
23 February 2004 - by BioNews 
The UK Government is expected to announce that the provision of in vitro fertilisation (IVF) treatment on the National Health Service (NHS) is to be made uniform across the country, but that only one attempt will be allowed per couple. NHS-funded IVF will also only be available to couples who...
26 August 2003 - by BioNews 
The UK's National Institute for Clinical Excellence (NICE) has published the second draft of its proposed guidelines for infertility treatment provided by the National Health Service (NHS). It recommends that infertile couples meeting certain criteria should be offered up to three IVF attempts using fresh embryos, with the possibility of...
11 August 2003 - by Dr Jess Buxton 
Draft guidelines aimed at standardising the government-funded provision of fertility treatment in the UK triggered media speculation last week. The first version of the recommendations being developed by the National Institute for Clinical Excellence (NICE) suggest offering up to six IVF attempts to women under forty, according to a report...
11 August 2003 - by Juliet Tizzard 
This weekend, the Daily Mail newspaper broke a story that a British government agency is considering a proposal to offer six IVF cycles to women under 40 years of age on the National Health Service (NHS). If NICE, the National Institute for Clinical Excellence, ends up publishing what are at...
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