May 22, 2012

expert reaction to NICE’s draft guidelines on treating infertility

NICE released a review of their fertility guidelines for public consultation. The guidelines make recommendations about the management of the whole spectrum of fertility treatment, from simple therapies such as ovulation induction, the management of male factors and of course IVF.

On the draft guidelines generally:

Prof Chris Barratt, School of Medicine, University of Dundee, said:

“It has been nearly ten years since these guidelines were updated and a lot has changed. We are now much better at identifying good quality embryos, and success rates have been increasing, particularly with women in the older age band.

“The key point that NICE have highlighted is that with our greater knowledge we can move towards single embryo transfers and reduce the number of multiple pregnancies – and all the risks that they entail.

“It is really good to see that the upper age for women has been raised as the evidence shows that we can have success with older women, though that should not take away from the clear message that for age is still a major factor in fertility and that the longer one waits the greater the likelihood of problems. This is also true for men and it’s good that NICE have raised that in these draft guidelines.

“The evidence has also been mounting with regards the spread of HIV and the research shows that there is a minimal risk of transmission IF the man has a plasma viral load that is fewer than 50 copies per ml.”

Prof Adam Balen, Chair of the British Fertility Society (BFS) Practice and Policy Committee and Prof of Reproductive Medicine and Surgery, Leeds Teaching Hospitals NHS Trust, said:

“This review shows that infertility is still on the radar for the NHS. It is welcomed, however, we know from the publication of the 2004 guidelines that the real challenge is persuading Commissioners to provide appropriate funding.

“Excuses for not complying with NICE guidelines generally state that infertility is not a life-threatening condition, but this is unjustified: infertility causes psychological harm for many of the one-in-six couples it affects, and is recognised as a medical condition by the World Health Organisation. Furthermore many treatments are simple, cheap and effective and even the most high tech IVF therapies can be provided in a cost-effective manner through NHS clinics.

“IVF was pioneered in the UK and we continue to lead the field in research into the causes of and treatments for infertility. No-one who stands a reasonable chance at conception should be denied the opportunity, and these NICE guidelines outline how that can be achieved.”

On the issue of HIV:

Prof Jane Anderson, Chairman of the British HIV Association (BHIVA) and Director of the Centre for the Study of Sexual Health and HIV at Homerton University Hospital in London, said:

“For the many people with HIV who wish to have children this advice will be particularly welcome, especially for couples where the man is HIV positive and the women HIV negative. HIV treatment and care has advanced significantly and the advice reflects the current state of knowledge.

“The recommendation of HIV testing for all couples who attend fertility services is very timely as we work towards making an HIV test a routine part of medical care.”

Prof Robin Weiss, Division of Infection and Immunity, University College London, said:

“As a virologist, rather than a clinician, the advice sounds sensible. We know that HIV transmission per sexual act is low when the HIV load is low and there are no other incident ST infections or inflammation; we know that anti-retroviral therapy severely reduces viral load in the semen as well as in the blood; thus this recommendation would make sense.

“As there is actually a finite risk, it’s better to use protection for sex at all other times.”