NICE, the draft fertility guideline and dodging the big question

• IVF
• NICE
• cost effectiveness
• fertility treatment
• needs

In August of this year the National Institute for Clinical Excellence (NICE) made its draft guideline on fertility treatment available for consultation.1 As has been widely reported in the media the draft guideline recommends that the National Health Service (NHS) should provide publicly funded fertility treatment in a consistent way across England and Wales. The guideline recommends that three cycles of IVF should be available when “The woman is within the optimal range for in vitro fertilisation (that is, the woman is 23–39 years) and there is an appropriately diagnosed cause of infertility of any duration, or unexplained infertility of at least three years’ duration (including mild endometriosis and mild semen abnormality” (National Institute for Clinical Excellence,1 p 35).

Those who need fertility treatment will celebrate the guideline, as will many fertility clinics. The guideline does not, however, address key questions that will be obvious to many. Is fertility treatment the kind of thing that ought to be available on the NHS? Will the inevitable increase in demand mean that resources are directed away from other services? Is fertility treatment really the same kind of intervention as heart or hip replacement surgery?

My view is that there are good reasons for doing what we can to help people access fertility services. Most of us will start a family and for those of us who do it is probably the most important of all of our life projects. Given that social status and wealth can be significant obstacles to many of the things that people would like to do with their lives, the fact that most of us are able to pursue this important life project is good from an egalitarian …