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Draft NICE guideline recommends IVF for same-sex couples and women over 40

28 May 2012
Appeared in BioNews 658

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.

Fertility (update): guideline consultation
NICE |  22 May 2012
Gay couples and women over 40 to get free IVF treatment on NHS
Daily Telegraph |  22 May 2012
IVF overhaul proposed
NHS Choices: behind the headlines |  22 May 2012
NICE consults on updated recommendations for treating infertility
NICE |  22 May 2012
Women in their 40s and same-sex couples may be offered IVF on NHS for first time
Mail Online |  22 May 2012
18 November 2013 - by Cait McDonagh 
Two women claim to have been refused IVF treatment on the NHS at St Mary's Hospital in Manchester on the basis of their sexuality...
25 February 2013 - by Michelle Downes 
Women over the age of 40, same-sex couples, and people with disabilities have been addressed for the first time in the updated NICE guideline on fertility treatment...
10 December 2012 - by Ari Haque 
A couple who was refused fertility treatment on the NHS for being 'too old' has said it intends to challenge the decision in the courts, arguing that the decision amounts to age discrimination....
3 December 2012 - by Cait McDonagh 
The Progress Educational Trust's annual conference 'Fertility Treatment: A Life-Changing Event?' was an opportunity for experts in the fertility sector to debunk myths surrounding the impact of life-style factors on fertility and fertility practice...
17 September 2012 - by Jennie Bristow 
In the 80 hours of Parliamentary debate given to the Human Fertilisation and Embryology Bill in 2008, a full ten percent were devoted to a heated discussion of the clause on the 'welfare of the child' that might be born as a result of treatment...
12 March 2012 - by Dr Rosie Morley 
Nine NHS primary care trusts (PCTs) have introduced restrictions to IVF treatment for patients who smoke or are overweight...
16 January 2012 - by Jessica Ware 
The number of publicly funded IVF cycles dropped by nearly 14 percent this financial year in the UK, an investigation by the GP magazine Pulse has revealed...
11 October 2010 - by Ben Jones 
The National Institute for Health and Clinical Excellence (NICE) is considering tightening its guidelines on embryo implantation with the possibility that, in future, only single embryo transfers (SET) may be recommended....
16 January 2006 - by Professor William L Ledger 
Many years ago the then Minister of Health, Frank Dobson, drew attention to the unfairness of the 'postcode lottery' of provision of infertility treatments in the UK. Following his initiative, a subsequent Minister, Alan Milburn, later commissioned the National Institute for Health and Clinical Excellence (NICE) to look into this...
14 February 2005 - by Professor Brian Lieberman 
The failure of the UK government to provide, or to identify additional funds for NHS funded IVF treatment is of increasing concern to many thousands of infertile couples, led to believe that they would receive such treatment following the report by the National Institute of Clinical Excellence (NICE) in February...
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