NICE Guidelines Summary

New NICE guidelines have been published in Feb 2013

They replace previous guidelines

The full guidelines can be found here: http://publications.nice.org.uk/fertility-cg156

Some important changes and new guidance for 2013 includes:

• Do not offer oral ovarian stimulation agents (such as clomifene citrate, anastrozole or letrozole) to women with unexplained infertility.
• Inform women with unexplained infertility that clomifene citrate as a standalone treatment does not increase the chances of a pregnancy or a live birth.
• Offer IVF treatment (see recommendations 1.11.1.3–4) to women with unexplained infertility who have not conceived after 2 years (this can include up to 1 year before their fertility investigations) of regular unprotected sexual intercourse.
• Do not routinely offer intrauterine insemination, either with or without ovarian stimulation
• Offer an earlier referral for specialist consultation to discuss the options for attempting conception, further assessment and appropriate treatment where:
  1. the woman is aged 36 years or over
  2. there is a known clinical cause of infertility or a history of predisposing factors for infertility
• Do not use any of the following tests individually to predict any outcome of fertility treatment:
  • ovarian volume
  • ovarian blood flow
  • inhibin B
  • oestradiol E2
• For women who are taking clomifene citrate, do not continue treatment for longer than 6 months.

There is also guidance on the number of embryos to transfer for IVF and the number of IVF/ICSI cycles by age.

These points relate to good practice and do not imply that any treatments will be state funded

Advice regarding treatment of endometriosis where fertility is the main issue has been updated (2017,2024)

1.11.1

Offer excision or ablation of endometriosis plus adhesiolysis for endometriosis not involving the bowel, bladder or ureter, because this improves the chance of spontaneous pregnancy.

1.11.2

Offer laparoscopic ovarian cystectomy with excision of the cyst wall, or laparoscopic drainage and ablation, to women or people with endometriomas, because this improves the chance of spontaneous pregnancy.

Take into account:

• the possible impact on ovarian reserve
• that ablation and drainage may preserve ovarian reserve more than cystectomy (also see the section on ovarian reserve testing in the NICE guideline on fertility problems). [2017, amended 2024]

1.11.3

Discuss the benefits and risks of laparoscopic surgery as a treatment option with women or people who have deep endometriosis (including endometriosis that involves the bowel, bladder or ureter) and who are trying to conceive so they can make an informed decision on its use. Topics to discuss may include:

• the possible impact of deep endometriosis on pregnancy outcomes
• whether laparoscopic surgery may alter the chance of future pregnancy
• the possible impact on fertility if complications arise
• alternatives to surgery
• other fertility factors. [2017, amended 2024]

1.11.4

Do not offer hormonal treatment alone or in combination with surgery to women or people with endometriosis who are trying to conceive, because it does not improve spontaneous pregnancy rates. [2017, amended 2024]

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