NICE clinical guidelines
Issued: February 2013
CG156

Fertility: Assessment and treatment for people with fertility problems

This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg156

Introduction

This guideline updates and replaces 'Fertility' (NICE clinical guideline 11). The recommendations are labelled according to when they were originally published (see About this guideline for details).

This guideline offers best practice advice on assisting people of reproductive age who have problems conceiving.

It is estimated that infertility affects 1 in 7 heterosexual couples in the UK. Since the original NICE guideline on fertility published in 2004 there has been a small increase in the prevalence of fertility problems, and a greater proportion of people now seeking help for such problems.

The main causes of infertility in the UK are (percent figures indicate approximate prevalence):

  • unexplained infertility (no identified male or female cause) (25%)

  • ovulatory disorders (25%)

  • tubal damage (20%)

  • factors in the male causing infertility (30%)

  • uterine or peritoneal disorders (10%).

In about 40% of cases disorders are found in both the man and the woman. Uterine or endometrial factors, gamete or embryo defects, and pelvic conditions such as endometriosis may also play a role.

Given the range of causes of fertility problems, the provision of appropriate investigations is critical. These investigations include semen analysis; assessment of ovulation, tubal damage and uterine abnormalities; and screening for infections such as Chlamydia trachomatis and susceptibility to rubella.

Once a diagnosis has been established, treatment falls into 3 main types:

  • medical treatment to restore fertility (for example, the use of drugs for ovulation induction)

  • surgical treatment to restore fertility (for example, laparoscopy for ablation of endometriosis)

  • assisted reproduction techniques (ART) – any treatment that deals with means of conception other than vaginal intercourse. It frequently involves the handling of gametes or embryos.

The guideline will assume that prescribers will use a drug's summary of product characteristics to inform decisions made with individual patients.

This guideline recommends some drugs for indications for which they do not have a UK marketing authorisation at the date of publication, if there is good evidence to support that use. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. The patient should provide informed consent, which should be documented. See the General Medical Council's Good practice in prescribing medicines – guidance for doctors for further information. Where recommendations have been made for the use of drugs outside their licensed indications ('off-label use'), these drugs are marked with a footnote in the recommendations.