The National Institute for Health and Clinical Excellence (NICE) has published a draft updated guideline on fertility that would see same-sex couples and women aged up to 42 eligible for fertility treatment on the NHS in England, Wales and Northern Ireland.
The current NICE guidance on the assessment and treatment of couples with fertility problems was issued in 2004, but advances in fertility treatment and fresh clinical data have prompted an update. One key new recommendation is an increase in the upper age limit from 39 to 42 for women where IVF is the only possible route to pregnancy. These women should be offered one full cycle of IVF. Also, the lower age limit of 23 has been removed.
Under the draft guideline, eligibility is to be extended to same-sex couples, as well as people who have a disability that prevents them from having sex. People facing cancer treatment who wish to preserve their fertility, as well as those carrying an infectious disease, such as HIV (human immunodeficiency virus) or hepatitis B, would also be eligible.
Dr Gill Leng, deputy chief executive at NICE, said: 'Infertility is a medical condition that can cause significant distress for those trying to have a baby. The aim of these new and updated recommendations is to ensure that everyone who has problems with fertility has access to the best levels of help'.
The draft guideline includes updated recommendations on the number of embryos implanted during treatment, preserving the limit of two embryos for any one cycle of IVF recommended in 2004. It also recommends that clinics should use single embryo transfer in the first full cycle of IVF for women under 37 but says clinics should consider double embryo transfer for women aged between 40 and 42.
The health risk presented by a number of previously sanctioned oral ovarian stimulation drugs means that they, too, are no longer recommended.
The new guideline follows implementation of the Human Fertilisation and Embryology Act 2008, which removed the need for fertility clinics to consider the need for a father or male role model (reported in BioNews 459).
The Daily Telegraph reports that following the 2008 Act, demand from gay couples for fertility treatment in the private sector boomed; lesbian couples undergoing IVF rose from 178 in 2007 to 417 in 2010. Ruth Hunt, director of public affairs at Stonewall, the gay rights charity, welcomed the proposals, saying they gave 'explicit acknowledgements of the issues same-sex couples face'.
The National Infertility Awareness Campaign and Infertility Network UK also welcomed the updated guideline, but remained cautious as the recommendations are not mandatory. NICE provides guidance to the NHS on appropriate treatment in clinical practice and health departments may choose to issue advice on their implementation.
Susan Seenan, deputy chief executive of Infertility Network UK commented: 'New guidelines are pointless if they are not put into practice and people are suffering every day because some Primary Care Trusts continue to flout the NICE guidance'.
Each IVF cycle costs about £3,000 and the cost of implementing the new recommendations has also increased. Speaking to the Daily Telegraph, Dr Gedis Grudzinskas, an independent consultant in infertility, said that a fundamental question was: 'How do we reconcile the changes in society and equality of access to healthcare, with the economic predicament?'
But Professor Adam Balen, chair of the British Fertility Society Policy and Practice Subcommittee, told the BBC: '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'.
The new guidelines are provisional and are now up for public consultation until 3 July 2012; significant changes may yet be made.