NICE guidance, shame about the implementation

Dr. Kirsty Horsey

Progress Educational Trust

27 February 2004

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[BioNews, London] The UK's National Institute of Clinical Excellence (NICE) has recommended that, in line with earlier draft guidance published in August 2003, the National Health Service (NHS) should fund up to three attempts at in vitro fertilisation (IVF) for infertile couples meeting specific criteria. NICE is a cost-effectiveness watchdog established by the government in 1999 to provide guidance on 'best practice' in healthcare, and was asked to look at IVF provision on the NHS, which until now has varied across different regions of the country, leading commentators to suggest that IVF is governed by a 'postcode lottery'.

The NICE recommendations say that some infertile couples should be offered up to three attempts at IVF using fresh embryos, with the possibility of a further three cycles using frozen embryos. Couples should be eligible for state-funded infertility treatment if the woman is between 23 and 39 years old, and if there is either a diagnosed cause of infertility, or at least three years of unexplained infertility. IVF should also be offered by the NHS if a couple had 'an unequivocal need' for treatment, such as prior treatment for cancer, very poor semen quality, or Fallopian tube blockage. It also recommends that up to six cycles of intra-uterine insemination (IUI), a cheaper treatment where the 'best' sperm is injected through the cervix directly into the womb, should be offered on the NHS. NICE estimates that demand for IVF, which costs about ?2,700 a cycle, will increase by 80 per cent in England, and that 70 per cent of people now relying on the private sector for treatment moving to the NHS. This is expected to increase the number of IVF babies born in the UK each year by 5,000.

However, in response to the recommendations, the UK Health Secretary, John Reid, has announced that, by April next year, couples meeting the NICE criteria will be offered just one free cycle of IVF. This does have the effect of making provision of NHS-funded IVF treatment uniform across the country, but falls short of the level of provision recommended by NICE. In addition, NHS-funded IVF will only be available at first to couples who don't already have children living with them. The Health Secretary said that 'in the longer term I would expect the NHS to make progress towards full implementation of the NICE guidance', but has not committed to a timetable for full implementation of the new clinical guidance, despite the fact NICE estimated it would cost ?85 million, far less than the ?400 million originally estimated by the government.

Alan Templeton, chairman of the Royal College of Obstetricians and Gynaecologists, said that the Government's implementation of the guidelines is 'sentencing [couples] to having a much reduced chance of having a baby'. The likelihood of a successful birth in a single cycle of IVF are put at around 25 per cent for women under 35, but this rises to about 50 per cent with three cycles. Professor Alison Murdoch, chair of the British Fertility Society, said that 'anything less than NICE recommend will mean that services continue to be inadequate'. But, in response to the Health Secretary's comments, Andrew Dillon, chief executive of NICE, said that 'full implementation of the guideline will take time, and the Government's advice to NHS organisations on a stepped approach to improving access to IVF treatment makes sense'.

Reproduced with permission from BioNews, an email and online sources of news, information and comment on assisted reproduction and genetics.