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Older women to get IVF sooner, say NICE guidelines

21 February 2013

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Couples with fertility problems and older women should be able to get IVF sooner according to new NHS guidelines published today (20 February 2013). 
The National Institute for Health and Clinical Excellence (NICE) guidelines suggest IVF should be given after two years of trying to conceive, not the current three. 

New evidence
Sir Andrew Dillon, NICE Chief Executive, said medical advances have ensured the right support, care and treatment can be available to “those who will benefit the most”.
Women aged up to 42 will be offered one full cycle of IVF if they have not conceived after two years of unprotected sex or 12 cycles of insemination, according to the changes. 
Previously, NICE did not recommend IVF for women older than 39. 
“Recommending IVF treatment for a very select group of women over 40 was not a decision that was taken lightly,” said Tim Child, consultant gynaecologist and director of the Oxford Fertility Unit. 
Child, who was part of the Guideline Development Group (GDG) said: “Many women do conceive naturally in that age group, but for those who can’t, improvement in IVF success rates over the last decade mean that we are now able to offer cost effective treatment with a single IVF cycle.”
Dr Tony Falconer, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said: “The recommendation that IVF treatment be made available up to the age of 42 provides more choice for women but they should still be aware of the increased risks associated with pregnancy at advanced maternal age.”
NICE’s proposals
Around one in seven heterosexual couples have trouble conceiving per year. 
People with unexplained infertility, mild endometriosis or mild male factor infertility should try to conceive through regular vaginal intercourse for two years rather than receive intrauterine insemination, NICE have said. 
New evidence has shown that insemination is no better at achieving a live birth than people attempting to conceive through regular intercourse. 
Same-sex couples, those with HIV for Hepatits B, and those with physical disabilities have been included in the guidelines for the first time. 
‘Clear’ new pathway 
NICE have said the updated guidelines, which apply to England and Wales, are relevant to a range of NHS professionals including GPs. 
In 2011, the NHS Deputy Chief Executive reminded NHS commissioners to utilise NICE fertility guidelines and to “continue to make treatments and services available to those experiencing fertility problems”. 
The British Fertility Society (BFS) have called on clinical commissioning groups (CCGs) to “fully implement the NICE fertility guidelines” as primary care trusts (PCTs) had not done so. 
BFS spokesman Dr Sue Avery said: “We are still an in untenable position that patients in many areas of the country are unable to access treatment.”
Dr Clare Searle, a Hertfordshire GP and guideline development group member, said: “This guideline should help GPs to actively manage the possibility of infertility in people, from offering lifestyle advice to referring people for further investigations. 
“The guideline sets out a clear pathway of care for GPs and other healthcare professionals to follow.