What Does the NICE Fertility Guideline Update Mean for You?

The latest event from PET (the Progress Educational Trust) was the first public discussion of the newly updated Fertility Guideline published by the UK's National Institute for Health and Care Excellence (NICE).

Sarah Norcross, director of PET, acted as chair and opened the session. She outlined some of the changes made to the Guideline, and highlighted how – despite being in place for more than 20 years – the NICE recommendation of three full cycles of NHS-funded IVF has never been implemented across England.

The first speaker was Dr Raj Mathur, a member of the committee that developed the updated Guideline, as well as a consultant in reproductive medicine at St Mary's Hospital and at Manchester Fertility. He provided an overview of what has been the first comprehensive update to NICE fertility guidance since 2013.

Dr Mathur explained that referral criteria have been clarified, in the hope that being referred will no longer depend on the goodwill, expertise or opinion of the patient's GP (see BioNews 1190). The relevant IVF recommendation has been updated, saying that women under 40 should be offered three cycles of IVF, and if conception is not successful then a further three cycles should be considered (see BioNews 1334). The consideration of a further three cycles is an improvement, with the previous Guideline only recommending three full cycles.

One shortcoming of earlier NICE guidance was that intrauterine insemination (IUI) was not recommended, whereas the updated Guideline establishes a clear role for IUI in clinical practice. The new Guideline states that patients' options should be discussed, and before embarking on IVF, up to four cycles of IUI with gonadotrophins and ovarian stimulation should be considered. There is also a greater focus on male fertility, which has previously been understudied and under-discussed.

A new endometriosis pathway is a significant part of the update. Endometriosis was previously grouped under 'unexplained infertility', but Dr Mathur argued that the earlier approach was 'not coherent logically or scientifically.' Key changes were also made in relation to fertility preservation, with explicit mention of the needs of transgender and nonbinary people, and the addition of ovarian tissue cryopreservation.

The second speaker was Richard Anderson – professor of clinical reproductive science at the University of Edinburgh's Centre for Reproductive Health, chair of the British Fertility Society's Policy and Practice Committee, and a trustee at PET. Professor Anderson outlined his reservations about the new Guideline, arguing that despite endometriosis now being recognised as a specific cause of infertility, the new pathway will not necessarily lead to accelerated treatment.

Professor Anderson welcomed the recommendation to consider three further cycles of IVF (if an initial three had not been successful), but took issue with the wording. The use of the word 'consider' falls short of mandating three further cycles, allowing clinicians to opt out. This is not good enough in the context of current practice – according to the PET NHS Fertility Funding Tracker, 40 out of 42 integrated care boards (ICBs) in England do not offer three full cycles (see BioNews 1326). It is difficult to see how recommending mere consideration of three further cycles will make any difference in practice.

The third person scheduled to speak – Sharon Martin, interim chief executive of the charity Fertility Network UK – was unfortunately unable to participate, and so her presentation was read out by Norcross. Martin's central point was that access to fertility treatment still relies on location. England relies on individual ICBs to decide their policy on the number of IVF cycles offered, whereas in Scotland provision is centralised and three full cycles is the norm. In Wales, access is nationally coordinated but is limited to two cycles. Northern Ireland has historically had the most limited access, with only one fully funded cycle of IVF offered.

Martin's presentation also drew attention to other factors that can affect the availability and the success of IVF treatment. She noted the varying IVF success rates across ethnic groups, with black patients having the lowest birth rates (27 percent, compared with 33 percent in white patients). The Guideline does not address these deeper-rooted issues, and future policies should take such matters into account.

The fourth speaker was Anya Sizer – a trustee at the charity Fertility Alliance, and member of the Human Fertilisation and Embryology Authority – whose presentation focused on the new endometriosis pathway. She began by observing that endometriosis has previously been downplayed, when it can have a drastic impact on people's daily lives and health, and also has an economic impact due to patients needing to take time off work.

Sizer welcomed a renewed focus on listening to women's voices and experiences, and the introduction of a multidisciplinary care approach. At the same time, she highlighted problems arising from long NHS waiting times for gynaecological care. She concluded by saying the new Guideline is just that – guidance – and that we need to find financial, social, and emotional 'levers' to ensure that it translates into practice.

The final speaker was Katie Rollings, founder and chief executive of the charity Fertility Action. Rollings began by presenting findings from Dr Carole Gilling-Smith, who has analysed the new Guideline through the lens of LGBTQIA+ inclusivity. Rollings noted that there is an explicit commitment to inclusion throughout the Guideline, but expressed concern that ICBs and frontline services may struggle to translate this into a consistent policy in the absence of more detailed guidance, as it does not include all of the nuances that healthcare providers may need.

Rollings also pointed out that while the increased commitment to male fertility is important, there are no mandated parallel pathways, meaning that assessments may not happen at the same pace as they do for women. There is a lack of routine data and accountability for male outcomes – no clear requirements to monitor diagnosis rates, timelines or treatment outcomes for men. Rollings concluded by pointing out that while the updated Guideline provides a strong foundation for male fertility, real-world outcomes will depend very much on implementation, commissioning and accountability across the system.

The event concluded with audience questions, with one member of the audience asking how to get ICBs to take infertility seriously. Dr Mathur raised an interesting argument regarding the long-term impact that having more children will have on society, including the economic impact of having more future taxpayers, and said that this point should be made more prominently in politics. Sizer agreed, observing that the present Government's number one objective is growth, and that to achieve this objective we need fertility. Perhaps this is how we might finally get ICBs to take fertility treatment seriously.

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PET is grateful to Merck for supporting this event.

Register for these upcoming PET events:

• What Is the Impact of Fertility Treatment on Patient Health?, taking place online this coming Wednesday (22 April 2026) – register here.
• What Is the Impact of Fertility Treatment on the Health of Resulting Children?, taking place online on Wednesday 29 April 2026 – register here.