Fertility Care in Focus - Our Response to the New Draft NICE Guidance

Written by Sophie Sulehria

This September, the NICE - National Institute for Health and Care Excellence released draft guidance that could mark a major shift in how fertility treatment is delivered across the UK. The proposals focus on two key areas: stopping the use of unproven treatments that don’t improve outcomes, and ensuring that eligible women under 40 are offered three full IVF cycles.

The Fertility Show exists to provide a platform for open, honest conversation between patients, experts, and policymakers. We welcome this latest draft from NICE because it addresses issues that our community has repeatedly raised - variation in care and inequity of access. In this article, we’ll unpack the proposed changes, highlight the response from the Human Fertilisation and Embryology Authority (HFEA) and share our perspective on what this means for people going through fertility treatment.

Stopping Unproven Treatments

One of the clearest messages in the draft guidance is that fertility clinics should no longer offer treatments that lack evidence of effectiveness. Patients have often told us how overwhelming it feels to be presented with a menu of “add-ons” at clinics. While the HFEA’s traffic-light system has helped provide some guidance, many still report feeling confused and vulnerable when faced with these choices.

NICE’s proposal sends an important signal - if the evidence is not there, clinics should not be offering these options as standard. This change is designed to protect patients, reduce unnecessary financial strain, and shift the focus back to treatments that genuinely improve outcomes.

At The Fertility Show, we believe this is a welcome step forward. Fertility patients deserve clarity and transparency at every stage of their journey.

We also recognise the importance of innovation. Clinics must continue to embrace modern practices and new technologies, of course, and we support that - but always with careful oversight and clear, evidence-based guidelines. Add-ons should only be offered when there is robust proof of their safety and effectiveness, ensuring patients can move forward with confidence.

Offering Three Full IVF Cycles to Eligible Women Under 40

The second headline proposal is perhaps the most transformative - that we should be offering three full IVF cycles to eligible women under 40 on the NHS.

The current NICE guidance, last updated in 2013, already recommends three cycles in certain circumstances. However, in practice, this has not translated into equal access across the UK. Many local NHS trusts have restricted IVF provision due to budget pressures, meaning that in some areas, couples may only be offered one cycle - or none at all.

This “postcode lottery” has been one of the most consistent concerns raised by our visitors and speakers. The heartbreak of infertility is hard enough without the added injustice of being denied treatment simply because of where you live. By strengthening the recommendation and restating the evidence, NICE is making a powerful case: three cycles should be the national standard, not a privilege for the few. Research shows that the chance of having a baby increases with cumulative cycles, and patients who are given a proper course of treatment have better outcomes and less emotional strain.

We hope that this updated guidance will give fresh weight to the campaign for equitable IVF provision and put pressure on local commissioners to follow the science.

Building on the 2013 Guidance

The draft guidance doesn’t stand alone - it builds on the principles set out in the 2013 NICE guidance, which remains the backbone of fertility care recommendations.

1) Assessment of Infertility:

Couples should be offered a clinical assessment if they’ve been trying to conceive for one year with regular, unprotected sex. For women over 36, or those with a known cause of infertility, earlier referral to a specialist is advised.

2) Lifestyle Factors:

The guidance continues to stress the impact of lifestyle on fertility. Maintaining a healthy weight (BMI between 19 and 30) is important, as being significantly over- or underweight can reduce fertility and affect treatment outcomes. Avoiding smoking, excessive alcohol, and drug use is also key.

3) Treatment Options:

The 2013 guidance recognised the role of intrauterine insemination (IUI), noting that about half of women under 40 will conceive within six cycles. IVF has been the cornerstone of treatment for those who meet the criteria, and the reaffirmation of three cycles under the new draft guidance strengthens this.

4) Fertility Preservation:

The importance of fertility preservation for people undergoing cancer treatment is also carried forward. Freezing eggs, sperm, or embryos before treatment that may impair fertility remains a vital option.

Why This Matters

For patients, these updates are not abstract policy changes - they are about fairness, protection, and hope.

• Fairness: No one should face a postcode lottery when it comes to IVF. By recommending three cycles nationally, NICE is pushing for consistent, evidence-based care.

• Protection: Removing unproven add-ons protects patients from financial and emotional strain. Fertility treatment is already a huge investment, both personally and financially - people deserve to know that what they are being offered is supported by science.

• Hope: For many, three full IVF cycles could be the difference between giving up and finally having the family they long for.

The HFEA Response

The HFEA has welcomed the draft guidance. Peter Thompson, Chief Executive, said:

“We welcome the proposed recommendations that three full cycles of IVF should be offered to women under 40 if they have fertility problems and meet certain criteria, as it represents value for money for the NHS. Birth rates from fertility treatment have risen over time, and around one child in every classroom (1 in 32 UK births) is now born from IVF. We also welcome the proposed broadening of access for those who need fertility preservation.

As NICE have said, for some treatment add-ons there is not enough evidence to show that they are effective at improving treatment outcomes, and the HFEA supports the view that add-ons without sufficient evidence shouldn’t be offered to patients. We publish information about treatment add-ons and have a ratings system on our website.

It was disappointing to see in our National Patient Survey that a significant number of patients are still using add-ons and emerging technologies, and particularly disappointing that only half of patients had the effectiveness explained to them, let alone the risks. We regularly remind clinics that, according to our Code of Practice, they must give patients a clear idea of what any treatment add-on involves, how likely it is to increase their chance of a successful pregnancy, cost, risks, and link to our public ratings system.

In 2023, 27% of IVF cycles across the UK were NHS-funded. Funding for IVF continues to vary across the UK, and disparities in outcomes still exist. In recent years, Asian and Black patients have had lower birth rates than White patients and patients from a mixed ethnic background. Female same-sex couples and single patients were also less likely than opposite-sex couples to receive NHS funding.

While the HFEA does not regulate funding, we encourage those who commission fertility services to review their eligibility criteria and consider whether these have an adverse impact on access to treatment.”

This response echoes what patients have been telling us for years: access is inconsistent, add-ons are poorly explained, and inequalities remain.

Our View as The Fertility Show

At The Fertility Show, we bring together thousands of people each year - patients, doctors, embryologists, counsellors, advocates, and policy leaders. These conversations show us the real-world impact of guidelines like this.

We welcome NICE’s draft guidance, and we welcome the HFEA’s strong response to it. Both highlight the need for transparency, evidence, and equality.

This doesn’t solve every problem - access for those over 40, for same-sex couples, and for people using donor conception still needs attention. Disparities in outcomes for different ethnic groups must also be tackled. But this draft guidance sends the right message: fertility care should be based on evidence, equity, and compassion.

Looking Ahead

The draft guidance is open for consultation, with the final version expected in 2026. Until then, we encourage our community to stay engaged. Patients, clinics, and advocates all have a role to play in shaping this conversation.

As always, The Fertility Show will provide a platform where voices can be heard and information can be shared. At our next event, this topic will be front and centre, and we expect it to spark lively debate among both patients and professionals.

For anyone trying to build a family, our message is this - you deserve care that is fair, transparent, and based on the best available evidence. NICE’s draft guidance - and the HFEA’s support for it - is a promising move in that direction.