NICE publishes draft update to Fertility Guideline

The National Institute for Health and Care Excellence (NICE) recommends three NHS-funded IVF cycles for those eligible under 40, with potential for three more if unsuccessful, in a proposed guideline update.

Since 2004, NICE has recommended that the NHS should provide three full cycles of IVF to any woman (under 40 years of age) who meets certain eligibility criteria. In a long-awaited draft revision of its Fertility Guideline, NICE has retained this recommendation, adding that professionals should 'consider' offering 'up to three further full cycles of IVF treatment', if the first three cycles have not been successful and if the patient has not yet reached 40.

'The evidence considered by our committee demonstrates that providing three IVF cycles to women under 40 with fertility problems offers them a good chance of a successful pregnancy,' said Professor Jonathan Benger, chief medical officer and interim director of the centre for guidelines at NICE.

However, the Fertility Policy Tracker maintained by PET (the Progress Educational Trust) shows that 40 out of 42 Integrated Care Boards (ICBs) in England currently fail to offer the number of NHS-funded cycles recommended by NICE. Furthermore, two ICBs in the North West of England recently opened consultations on proposals to reduce the number of NHS-funded IVF cycles to one (see BioNews 1294).

'Disgracefully, this three-cycle recommendation has never been fully implemented across the UK, despite having been in place for more than two decades,' said Sarah Norcross, director of PET. 'Thankfully, NICE has retained this recommendation in its new draft guideline, and has also retained its robust definition of a "full cycle" of IVF.'

Norcross added that the new recommendation that professionals should 'consider' offering a further three cycles if the first three are unsuccessful is 'welcome but it does not go far enough'. She said ICBs 'are unlikely to be moved by something that is framed as a matter for consideration. What we need are firm recommendations, and a way to ensure that these recommendations are actually implemented.'

The revised guideline also draws particular attention to problems with 'add-ons' to IVF treatment, which have become more widely used in recent years (see BioNews 1283). The guidance recommends against the use of ICSI where sperm meets normal parameters, and recommends against endometrial scratch, hysteroscopy and endometrial receptivity tests completely.

'These add-ons can give false hope and put people through unnecessary procedures at an already very difficult time,' said Professor Benger.

Norcross said that while it is 'significant' that NICE has criticised IVF add-ons, 'this is something of a distraction, when it is the private fertility sector rather than NHS clinics that predominantly use such add-ons.'

The updated recommendations also significantly broaden who may access NHS fertility preservation services, to include people with conditions affecting their reproductive organs such as severe and recurrent endometriosis.

However, access and funding for same-sex couples and single fertility patients has not been included in the draft guideline, despite the latest HFEA data highlighting a sharp rise in treatment among these groups.

The draft guideline is open for consultation until 21 October 2025.