A survey of GPs has revealed that their knowledge of referral and eligibility criteria for IVF treatment, and their understanding of completion points for IVF treatment, are at odds with the NICE Fertility Guideline. This is liable to result in poorer outcomes for fertility patients.
Almost 20 years ago, NICE introduced its recommendation that the NHS should provide up to three full cycles of IVF to a woman (under 40 years of age) undergoing fertility treatment.1
The PET report 'The Power of Three IVF Cycles' shows that the NICE Fertility Guideline is not being followed, and is not understood by GPs in England.2
Headline findings
- Around half (48%) of GPs report that their area meets or exceeds the NICE Guideline. This is almost certainly an overestimate, as previous research has indicated that only around 10-12% of areas are offering the recommended three IVF cycles.3
- Only half (50%) of all GPs correctly identified that the NICE Guideline recommends three full cycles of IVF for women aged under 40.4
- The profile of your GP could make a difference to your referral success, with female GPs more likely to refer patients for NHS-funded IVF treatment, compared with male GPs. For example, when there was a known cause of infertility or reduced fertility, 52% of male GPs said that they would refer for treatment compared to 73% of female GPs. Younger and less experienced GPs are more likely to refer patients for IVF treatment.
- Multiple embryos are often created as part of an IVF cycle, but only 16% of GPs correctly identified 'When all viable embryos are transferred' as the IVF cycle completion point in the NICE Guideline. Commissioning decisions which do not provide this are reducing patients' chances of a successful outcome.
- The majority of GPs (54%) stated that they had seen a change in referral criteria, with almost all access requirements becoming more restrictive. Where there was change, almost three-quarters (74%) reported at least one criterion becoming more restrictive.
- GPs identified four key patient challenges relating to NHS-funded IVF treatments: funding, access, waiting times, and emotional stress.
- Nearly three-quarters of GPs (71%) have received a complaint about access to fertility treatment in their area, with 10% of GPs having received more than 10 patient complaints in the last 12 months.
PET commissioned this survey – which involved 200 interviews with GPs and ICS/ICB Commissioners across England – as part of its 'Power of Three' campaign, which demands that NICE recommendations are followed. Where NICE recommendations are not followed, the campaign demands that reasons are given, in line with the Women's Health Strategy for England published by the UK Government in July 2022.
Sarah Norcross, Director of PET, said:
These survey results show that there is utter confusion over the current NICE Fertility Guideline. Our results should send a strong message to the Government, NHS England, the Women's Health Ambassador and commissioning bodies. The lack of understanding of the Guideline by GPs is making the postcode lottery worse.
As NICE updates its Fertility Guideline, we urge it to make its new recommendations crystal clear, so that there is less room to misunderstand or cynically misinterpret the Guideline.
We also urge the Government to honour its commitment, in the Women's Health Strategy for England, 'to greater transparency of the provision of IVF services across the country' and 'to publish data nationally on provision and availability of IVF'.5
PET research in 2022 showed that 67% of the UK public supported NHS funding of fertility treatment.6 The public wants this, patients need this, and doctors should offer this.
Adam Balen, Professor of Reproductive Medicine and Surgery at the University of Leeds and past Chair of the British Fertility Society, said:
Sadly, over the last three years, we have seen a huge drop in support for people requiring fertility treatment. Not only are couples finding it very difficult to get an appointment with their GP, but when they do, there is a huge lack of knowledge about testing – and a reluctance to initiate investigations, and refer for treatments – despite clear national guidelines.
Furthermore, around 90% of CCGs (as they were known when a survey was performed two years ago) do not offer the recommended three full IVF cycles to clinically eligible women under 40. Fertility declines significantly with age, and so time is of the essence when helping women to have their desired family.
Notes
- This recommendation was included in the original version of Fertility: Assessment and Treatment for People with Fertility Problems, a Guideline published in 2004 by NICE (when it was known as the National Institute for Health and Clinical Excellence).
The recommendation was retained in an updated version of Guideline, with the simplified title Fertility Problems: Assessment and Treatment, published in 2013 by NICE (which by then had rebranded as the National Institute for Health and Care Excellence).
The current version of the Guideline can be found on the NICE website here.
- Independent market research specialists 2CV interviewed a sample of 200 participants across England – 194 GPs and 6 commissioners, across 40 out of 42 English ICS/ICB regions. Those qualified for less than 3 years or with no fertility caseload in the last 6 months were excluded from the survey. Fieldwork was undertaken online between 6 April and 26 April 2023. All research was conducted by 2CV Ltd, in accordance with the UK Market Research Society (MRS) Code of Conduct.
Download the full report here.
- Audit of England's Clinical Commissioning Groups, produced by Fertility Network UK as part of National Fertility Awareness Week, 1-5 November 2021.
Further details can be found on the Fertility Network UK website here.
- NICE recommends 3 full IVF cycles for women under 40 years old. A full cycle of IVF is one in which 1 or 2 embryos produced from eggs collected after ovarian stimulation are replaced into the womb as fresh embryos (where possible), with any remaining good quality embryos frozen for use later. When these frozen embryos are used later, this is still considered to be part of the same cycle.
Further details can be found on the NICE website here.
- Women's Health Strategy for England, Department of Health and Social Care, July 2022.
This document can be found on the UK Government website here.
- Fertility, Genomics and Embryo Research: Public Attitudes and Understanding, Progress Educational Trust, June 2022, p9. Ipsos interviewed a sample of 2,233 adults aged 16-75 in UK using its online i:omnibus between 24 and 27 March 2022.
Download this report here.