The National Institute for Health and Clinical Excellence (NICE) has begun a review of its 2004 NHS guidance on the assessment and treatment of people with fertility problems, expected to take until 2012, and has published the scope for the review.
The review will take into consideration the many advances in infertility, and new evidence, since the original guidance was published. The scope confirms that the review will include:
- effectiveness of different embryo/blastocyst transfer strategies (timing of transfer and number of embryos)
- effectiveness of intrauterine insemination, with or without ovulation induction agents
- effectiveness of mild versus conventional IVF
- sperm washing
- tests for ovarian reserve.
NICE’s Dr Fergus Macbeth said: “There is inevitably going to be speculation about the nature of this review and any new recommendations that might be made. However, recommendations can only be made in the light of available research evidence. Where there is new evidence, some recommendations may change while others may not.
“It is not NICE’s purpose to describe how funding for infertility treatment is organised but it is our role to provide the NHS with recommendations about what constitutes clinical and cost-effective treatment.”
Current guidance is that couples will normally be referred for further investigation of infertility if they are: heterosexual couples having unprotected regular intercourse, and who do not conceive after 12 months; or non-heterosexuals trying to conceive using methods of donor insemination, and who do not conceive after six cycles.
Dr Macbeth continued: “The experts who will be developing this update will also look at the effectiveness of fertility treatments for certain groups of patients who may need special consideration in their treatment or care. This includes people who are preparing for cancer treatment who may wish to preserve their fertility, or those who carry an infectious disease, such as HIV or hepatitis B who are unable to have unprotected intercourse as they need to prevent virus transmission both to their partner and potential offspring. In both cases, it may mean that such people need extra help to conceive.
“The group will also consider all couples where there is explained or unexplained infertility.”
Mr Tony Rutherford, chairman of the British Fertility Society, said: “There have been significant developments in infertility practice since 2003 when the original document was finalised.
“Advances in reproductive medicine include new tests to assess the likely response of patients to treatment, and the evolution of controlled ovarian stimulation strategies, some using new medications, which provide patients with gentler, less invasive and safer treatments. The place of intra-uterine insemination in the management of infertility, one of the more controversial aspects of the original guideline, will be questioned in light of recent evidence.
“We welcome the decision to review the effectiveness of different embryo transfer strategies to reduce the burden of multiple pregnancies. It is also important that the revised guidelines will cover certain more specialised areas, such as those patients wishing to reserve fertility in the face of cancer, as new developments in embryology have made treatments more effective.”