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New infertility guidelines

By
WebMD UK Health News
Medically Reviewed by Dr Keith David Barnard
microscopic view of ivf

20th February 2012 - New guidelines on fertility treatment have been published for the NHS in England and Wales.

The National Institute for Health and Clinical Excellence (NICE) sets out when and how fertility problems should be investigated and treated.

The new recommendations include same sex couples, people who are about to have cancer treatment and want to preserve their fertility, people with an infectious disease, such as Hepatitis B or HIV and those who are unable to have sex, such as people with a physical disability.

Infertility is a medical condition that affects around one in seven heterosexual couples. It can cause significant distress for those trying to have a baby, which can potentially lead to depression and the break-down of relationships.

Updated guidelines

The updated guidance makes a number of changes, including:

Most people with unexplained infertility, mild endometriosis or mild male factor infertility should attempt to conceive through regular vaginal intercourse for two years rather than receiving intrauterine insemination. NICE says this has been shown to be the best way to achieve a live birth. However, the two years can include up to one year before their fertility
Investigations if the couple have been having regular unprotected intercourse.

IVF treatment is recommended for eligible women who have been unable to conceive after two years of regular vaginal intercourse (or 12 cycles of artificial insemination). That's one year earlier than under the old guidance.

Previously, NICE did not recommend IVF for women older than 39. Women aged 40-42 years who have not conceived after two years of regular unprotected sex or 12 cycles of artificial insemination will now be offered one full cycle, as long as they meet certain criteria. These include never having had IVF treatment before and with no evidence of low ovarian reserve.

Oral ovarian stimulation medicines, such as clomifene citrate, anastrozole or letrozole, will not be offered to women with unexplained infertility.

There are changes to the recommended number of fresh or frozen embryos to transfer in IVF treatment, depending on the woman's age. This ranges from one embryo for the first full IVF cycle for a woman under 37 to two double embryo transfers for women aged 40-42.

Intrauterine insemination may be offered as a treatment for people who are unable to, or would find it very difficult to, have vaginal intercourse because of a diagnosed physical disability, psychosexual problem, HIV status and those in same-sex relationships.

Lifestyle changes

As part of fertility treatment, couples will be told of lifestyle issues which could be affecting their ability to have children.

  • Men and women who smoke will be told this is likely to harm fertility.
  • Women with a body mass index (BMI) of 30 will be told that they are likely to take longer to conceive.
  • When it comes to tight underwear for men, men will be told there is an association between elevated scrotal temperature and reduced semen quality
  • Women who are trying to become pregnant should know that taking no more than one or two units of alcohol once or twice a week and avoiding getting drunk, reduces the risk of harming a developing foetus. For men, alcohol consumption within the recommended three to four units per day is unlikely to affect semen quality, but excessive alcohol intake is detrimental to semen quality.
  • People will be informed that drinking more than one unit of alcohol a day reduces the effectiveness of assisted reproduction procedures, including IVF.

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