My day explaining what the new NICE guideline really says…

I had a busy day yesterday doing interviews about the new NICE fertility guideline as I’d been a lay members on the group that helped to develop it. One of the most fascinating things about doing so many interviews (I think it was 21 by the end of the day!) was seeing how differently journalists covered the story.  There were some who had made the effort to read the press release and relevant parts of the guideline, some who had even done a little additional research – but others who were clearly relying more on other journalist’s headlines than anything else…

One of the main misunderstandings was around the raising of the age limit to include some women aged 40-42.  There was a general assumption that this meant that women aged 40-42 would qualify for exactly the same treatment as younger women, and that it applied to all women in this age group.  What the guideline actually says is that women of this age should be offered one full cycle of IVF (rather than the three full cycles offered to younger women) if they have been trying to conceive for two years or more, if they have not had any previous treatment and if they have a good ovarian reserve – so in reality, this is a fairly small group of women.

The other main topic of fascination to many journalists was the idea that same sex couples should be offered IVF.  This was heralded not only as some totally new idea, but was often covered as if treatment was going to be offered to same sex couples who couldn’t get pregnant purely because they had a partner of the same sex.  Again this is not the case.  Women who have been unsuccessful after twelve cycles of artificial insemination (of which at least six must be IUI) will now qualify. So, this is infertile women who happen to be in same sex relationships – not women who can’t get pregnant because they are lesbians.  The idea that this is totally new is not true either as infertile women who are in same sex relationships are already getting NHS treatment in some areas.

The most bizarre thing I came across yesterday was a local radio presenter who started talking about “gay men with HIV” being offered IVF under the new guideline – clearly one of those who hadn’t found time for any reading…  IVF is not going to do much to help two men to have a child – they need a surrogate, and surrogacy was not within the scope of this guideline.

When it comes to HIV, the guideline does not suggest that IVF would be the most appropriate treatment for a couple where the man is HIV positive.  What it says is that couples where the male partner is HIV positive should be informed that the risk of HIV transmission to the female partner through unprotected intercourse is negligible where certain stringent criteria around antiretroviral therapy and plasma viral load are met (see the guideline for full details on this). In such cases, it is suggested that unprotected intercourse limited to the time of ovulation would be most effective – so, where the male partner is HIV positive, it’s more a matter of suggesting that fertility treatment may not be necessary at all…

Much was made of the additional costs to the NHS of following the guideline, and little of the fact that there are a number of areas where less money will be spent – particularly on IUI for for people with unexplained infertility, mild endometriosis or mild male factor infertility.  New research has shown that IUI not a clinically effective treatment for these people, so now they will move forward more quickly to IVF instead – allowing them access to a more effective treatment.

Of course, there were the inevitable questions about whether the stretched NHS can afford to treat infertile couples at all – but one of the most important things to me about this guideline is that it recognises throughout that infertility is a hugely distressing and difficult medical condition – and sets out the most appropriate treatment for that condition.  Infertility is so often described as a “lifestyle choice” – I’ve never understood why it suddenly becomes a matter of “lifestyle” when it’s your ovaries or sperm which aren’t working rather than any other part of your body…

I believe the guideline helps all of us who know how horrible it is to live with infertility, how distressing it can be and how much access to treatment can help – and now it is a matter of persuading commissioners to follow it to ensure that people with fertility problems receive the most effective treatment at the right time.

For more detail about the new NICE fertility guideline, go to www.nice.org.uk 

 

 

 

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