British Fertility Society response to the review of the NICE fertility guidelines

The British Fertility Society (BFS), representing professionals working in reproductive medicine, welcomes the review of the NICE fertility guidelines, which are being released today for public consultation. Once again the guidelines make recommendations about the management of the whole spectrum of fertility treatment, from simple therapies such as ovulation induction, the management of male factors and of course IVF.  The fact that the majority of Primary Care Trusts still do not provide funding to cover the recommendations in the original 2004 guidance exposes the unacceptable situation that has denied fertility treatment to eligible couples by the arbitrary nature of their postcode.  The BFS calls on all Primary Care Trusts to fulfil their obligations and comply with the NICE guidance and provide couples with infertility access to the treatment which is their right.

Approximately one sixth of couples are involuntarily childless and at least a quarter of all couples experience unexpected delays in achieving their desired family size. There is also a steadily rising proportion of women in the UK who have never had a child. In recent years there has been an increase in publicity about infertility and reproductive medicine technologies, which has gone some way to reduce both the stigma of infertility and the reluctance of couples to seek advice. Whilst the infertility itself is a psychological blow to the couple, the suffering is magnified if they find that NHS eligibility criteria excludes them from receiving treatment, particularly when it is known that others are included.  This questions the name of any service with “National” in its title.  The National Health Service currently rations infertility treatment and does so on non-clinical grounds.

The review of the NICE fertility guidelines is a firm statement that the diagnosis and treatment of infertility remains a crucial part of NHS-funded treatment in England, Wales and Northern Ireland. The first edition of the guidelines, published in 2004, was a major step forward for the one in six couples who experience infertility. Updating these guidelines will ensure that NHS fertility services have access to guidance on a cost-effective programme of infertility diagnosis and treatment, based on the best available evidence.

The British Fertility Society welcomes the review and the important role that NICE plays in defining cost-effective healthcare. The BFS will be carefully reviewing these guidelines and will respond to NICE with the views of its members as part of the consultation process. We look forward to working with patients, professionals, Commissioners and the wider NHS to assist in the implementation of the final guidelines across England, Wales and Northern Ireland.

It is unfortunate that to date, the 2004 guidelines (which recommended three cycles of IVF for couples diagnosed with infertility) have not been implemented in full across the majority of the Trusts that they are designed to cover. This is in spite of many strong statements and assurances from government ministers and the Prime Minister^{1, 2} that the guidelines should be implemented. Many patients have therefore been embroiled in an unfair and arbitrary postcode lottery, adding to the distress that infertility brings. We hope that the updated guidelines will bring infertility further up the agenda of many NHS commissioners and encourage them to provide the funds necessary to implement them.

Professor Adam Balen, Chair of the BFS Practice and Policy Committee and Professor of Reproductive Medicine and Surgery, Leeds Teaching Hospitals NHS Trust says:

“This review shows that infertility is still on the radar for the NHS. It is welcomed, however, we know from the publication of the 2004 guidelines that the real challenge is persuading Commissioners to provide appropriate funding.

“Excuses for not complying with NICE guidelines generally state that infertility is not a life-threatening condition, but this is unjustified: infertility causes psychological harm for many of the one-in-six couples it affects, and is recognised as a medical condition by the World Health Organisation. Furthermore 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.

“IVF was pioneered in the UK and we continue to lead the field in research into the causes of and treatments for infertility. No-one who stands a reasonable chance at conception should be denied the opportunity, and these NICE guidelines outline how that can be achieved.”