IVF age limit should be raised to 42, says NICE

The draft proposals from the National Institute for Health and Clinical Excellence (NICE) updates previous guidance from 2004, and also suggests new groups of patients should be eligible for IVF treatment.

NICE says gay and lesbian couples should be eligible for treatment, as well as those carrying an infectious disease such as hepatitis B or HIV, and cancer patients, whose treatment may cause infertility.

Under the current guidelines, women aged 23 to 39 in England and Wales are entitled to three cycles of IVF if they have been infertile for three years, or have an identifiable cause of infertility.

NICE on Tuesday proposed that women aged 39 to 42 should have access to one cycle of IVF, but only if they have never undergone treatment before and patient groups said this would only affect a small minority of women.

Postcode lottery

While the revised guidelines were welcomed by patient groups medical experts alike, there are still concerns that NHS provision of IVF treatment still varies hugely across the country.

Unless PCTs follow the NICE guidance it won’t make much difference for patients. Susan Seenan, Infertility Network UK

Regardless of NICE’s proposed changes, which are not statutory, a patient’s postcode is more likely to impact on access to treatment. Last year the all party parliamentary group (APPG) on infertility found that 70 per cent of NHS trusts are ignoring guidance to offer infertile couples three chances of IVF.

“Generally around the country it’s still a very patchy picture – there’s still too much of a postcode lottery,” Gareth Thompson MP, who leads the cross-party group, told Channel 4 News. “Some PCT areas are offering three cycles of IVF treatment in accordance to NICE guidelines, however they are in the minority.”

Even if a GP refers a couple for IVF, the primary care trust (PCT) decides on whether to fund the treatment. In its damning report published in June 2011, the APPG said that five PCTs – Warrington, West Sussex, Stockport, North Yorkshire and York, and North Staffordshire – offered no IVF at all.

PCT provision

“Unless PCTs follow the NICE guidance it won’t make much difference for patients,” Susan Seenan, deputy chief executive of Infertility Network UK told Channel 4 News.

“The prime minister has said couples should have access to IVF, as does Nice – everyone’s on side with this, but not all the PCTs are accepting that.”

Generally around the country it’s still a very patchy picture – there’s still too much of a postcode lottery. Gareth Thompson MP

The patients’ charity said that PCT provision varies hugely: some PCTs put their own further restrictions on womens’ age and the number of cycles permitted on the NHS, while others impose criteria based on whether women’s partners have children who live with them.

Mr Thompson said that IVF is still considered an “expensive luxury” by some PCTs, rather than the cheapest way of offering fertility treatment.

“Women who go to their GPs are instead referred for fairly complex operational procedures instead, which cost a lot more than IVF treatment,” he told Channel 4 News.

Infertility can cause “distress”

In announcing the draft proposals, which will be open to consultation before the final guidelines are released, NICE Deputy Chief Executive Dr Gill Leng said there have been many advances in both treatments and in the understanding of different techniques since its previous guidelines in 2004.

“Infertility is a medical condition that can cause significant distress for those trying to have a baby,” she said. “This distress can have a real impact on people’s lives, potentially leading to depression and the breakdown of relationships.

“However, in many cases infertility can be treated effectively – there are thousands of babies and happy parents thanks to NHS fertility treatment – which is why the NHS provides services and why Nice produces guidance on the topic.”