Practice Guidelines

Fertility (update): summary of NICE guidance

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f650 (Published 20 February 2013) Cite this as: BMJ 2013;346:f650
  1. Ella Fields, research fellow1,
  2. Jiri Chard, senior research fellow1,
  3. David James, clinical co-director1,
  4. Tom Treasure, professor of cardiothoracic surgery2
  5. on behalf of the Guideline Development Group
  1. 1National Collaborating Centre for Women’s and Children’s Health, London W1T 2QA, UK
  2. 2University College London, London WC1H 0BT, UK
  1. Correspondence to: J Chard jchard{at}ncc-wch.org.uk

Infertility affects about one in seven couples in the United Kingdom1 and can have a severe psychological impact.2 Since publication in 2004 of the original fertility guideline by the then National Institute for Clinical Excellence (NICE),3 more people are now having fertility treatment, which is increasingly successful.4 5 It is mandatory that this care is appropriate. This article summarises the recommendations relevant to general clinicians from the recent update of NICE’s fertility guideline.6

Recommendations

NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Information on conception

  • Inform people who are concerned about their fertility that:

    • -Over 80% of couples in the general population will conceive within one year if the woman is aged under 40 years and they have regular sexual intercourse without contraception

    • -Of those who do not conceive in the first year, about half will do so in the second year (cumulative pregnancy rate over 90%)

    • -Vaginal sexual intercourse every two to three days optimises the chance of pregnancy.

    • [Based on low quality evidence from observational studies and on the experience and opinion of the Guideline Development Group (GDG)]

  • For people who are unable to, or would find it very difficult to, have vaginal intercourse, offer an initial consultation to discuss other options for attempting conception (such as in vitro fertilisation (see definitions box)). (New recommendation.) [Based on the experience and opinion of the GDG]

  • Female fertility declines with age. Use a woman’s age as an initial predictor of her overall chance of success through natural conception or with in vitro …

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