The National Institute for Health and Care Excellence (NICE) is a body which reviews latest evidence based on clinical trials, in order to provide robust guidelines and recommendations which will help achieve better health care. It serves as an executive, non-departmental public body under the Department of Health in the United Kingdom, and supplies its services to the NHS in England and Wales.
It sets forth guidelines in four areas, namely, health technologies, clinical practice, public health care, and social care. One of its most important roles is the evaluation of various health, public, and social services on the basis of their effectiveness and cost-benefit ratio based on studies undertaken in a wide range of situations.
NICE quality standards focus on improving specific areas of health care or service within a field of health. They consist of statements which describe the recommendations of the responsible committee, prioritized in order of importance, in a brief and assessment-friendly manner. Clinical guidelines may include recommended best practice in diagnosis, prevention, treatment, and patient information. Public health management may also be addressed by the implementation of these guidelines.
The NICE fertility guidelines deal with the diagnosis and treatment of infertility and subfertility, with the aim of incorporating advances in knowledge in this area, as well as the increased awareness of risks that are faced with this treatment. This will help to minimize practice-specific differences in investigation and management of this problem, and so improve overall excellence in fertility care.
The following are some of the areas included in the latest NICE fertility guidelines:
- Definition of infertility
- Recommended advice on delayed conception
- Principles to be followed in providing health care for infertile couples or patients: evidence-based, accessible, and informed care
- Diagnosis and treatment of infertility, including initial evaluation and guidelines for referral
- Information to be effectively transmitted to patients with treatable lifestyle factors contributing to infertility
- Medical and surgical management of common causes of infertility, such as male factor infertility, anovulation, or unexplained infertility, as well as cryopreservation of oocytes and sperm from patients who are about to undergo cancer therapy which may impair fertility
- Criteria and recommended procedures for frequently used techniques of assisted reproduction, such as intrauterine insemination and in vitro fertilization, including the use of donor sperm or oocytes, and intracytoplasmic sperm injection
- The safety of ART in the long term on the basis of available data
These statements seek to answer some frequently asked questions such as:
- The reliability of various tests used in infertility, such as tests of ovarian reserve which may dictate the decision to use donor oocytes
- What determines the number of embryos transferred or the timing of transfer in various patients?
- How effective and safe are various ovarian hyperstimulation regimens when used in women with apparently normal ovarian function or with different grades of ovulation disorders?
- The side effects of various medications used in infertility treatment, both on the women and the fetuses, over the short and long term?
- The expected outcomes of various ART techniques
One notable outcome of the NICE guidelines is the reduction of multiple embryo transfers to single transfers, which now make up almost 17 percent (2011) up from 5 percent (2008). This is largely the result of disseminating data about the advantages of transferring single embryos in all patients who would not experience the benefits of multiple embryo transfer. This includes a fall in the number of multiple pregnancies, without a corresponding decline in the pregnancy rate. Multiple gestation is the largest single source of risk for both mothers and fetuses following in vitro fertilization.
Groups which may derive benefit from the NICE guidelines include:
- Health care providers
- Patients with infertility and their families or other stakeholders
Reviewed by Susha Cheriyedath, MSc