Fertility clinics should not offer unproven treatments, said the National Institute for Health and Care Excellence (NICE) in its new draft guidance.

In the first update of its fertility treatment guidance in more than 10 years, the regulator also specified who should be offered in vitro fertilization (IVF) treatment and recommended suggesting fertility preservation to a wider range of people undergoing a medical treatment that might affect their future chances of having a baby.

NICE specifically advised against several popular fertility “add-ons” that are currently offered to people receiving private and NHS fertility treatments in the UK, “despite no clear evidence that they work,” it said.

The regulator especially recommended against using intracytoplasmic sperm injection for men with healthy semen, endometrial scratch, hysteroscopy as a pretreatment means of improving the outcome of IVF, and endometrial receptivity testing as a treatment add-on for embryo transfer.

Vulnerable and Willing to Try Anything

NICE emphasised that patients should be given full information about any treatments, including how likely they were to work and what risks they carried.

Last year, a patient survey by the Human Fertilisation and Embryology Authority found that almost three quarters (73%) of patients had used additional tests, treatments, or emerging technologies. More than half (52%) had used them even after their clinic explained their effectiveness, with 59% choosing to use one based on their clinic’s recommendation. Of concern was that clinics explained the risks to only one in three (37%) patients.

“People going through fertility treatment are often willing to try anything that might help them conceive,” said Fergus Macbeth, DM, MBA, chair of the fertility problems guideline committee, in a press release. This makes them vulnerable to being offered treatments that sound promising but have not been properly tested, he warned.

“Too many people hoping to start a family are being offered expensive treatments that simply don’t work,” added Professor Jonathan Benger, MD, chief medical officer and interim director of the Centre for Guidelines at NICE. “These add-ons can give false hope and put people through unnecessary procedures at what is already a very difficult time.”

“Clinics should focus on providing proven treatments rather than offering unproven add-ons that may do more harm than good,” stressed Macbeth.

Clearer IVF Treatment Criteria

The updated draft guideline specified who should be offered IVF treatment, making the criteria clearer for both patients and healthcare providers.

NICE identified stronger evidence than had previously been available that three full cycles of IVF give couples a good chance of a baby and also represent good value for the NHS. 

Therefore, the updated guidelines recommended three full cycles of IVF for women under 40 and one full cycle of IVF for women aged 40 and 41 if they have fertility problems and meet certain criteria.

However, the NHS faces significant financial challenges, Benger pointed out. He said integrated care boards will have to weigh up local priorities when determining how many IVF cycles to fund.

Fertility Preservation Services Extended

NICE also extended who can access NHS fertility preservation services to anyone facing medical treatments or conditions that could harm their ability to have children in the future. Previously, these services were mainly available to people with cancer.

Now included are people undergoing chemotherapy, radiotherapy, bone marrow transplantation, or any cancer treatment likely to cause infertility, those with severe and recurrent endometriosis, Turner Syndrome, and other chromosomal conditions. Also included are people with metabolic and genetic disorders, autoimmune diseases requiring gonadotoxic treatment, and those undergoing any surgery that might harm fertility or procedures that affect the reproductive organs.

The extension makes these services “more accessible and equitable,” said Macbeth.

Rob Hicks is a retired National Health Service doctor. A well-known TV and radio broadcaster, he has written several books and has regularly contributed to national newspapers, magazines, and online publications. He is based in the United Kingdom.