Health leaders order crackdown on unproven fertility treatments

Many women are offered unnecessary add-on treatments when they seek fertility care.

Several popular “add-on” treatments should not be used in fertility care, health leaders have said.

The National Institute of Health and Care Excellence (Nice) said too many people are being “offered expensive treatments that simply don’t work”.

People going through fertility treatment are often willing to “try anything” but the unproven treatments can offer patients “false hope”, experts said.

Earlier this year, the fertility regulator warned that almost three-quarters of fertility patients are being offered unnecessary add-on treatments.

The Human Fertilisation and Embryology Authority (HFEA) said the finding was “concerning” because almost all additional tests, treatments or emerging technologies “are not proven to increase the chance of having a baby for most patients” after releasing its 2024 national patient survey of 1,500 patients in the UK.

Only half (52%) of patients had the effectiveness of the add-on treatments explained to them, with fewer (37%) told about any risks linked to add-on care.

New draft guidance from Nice specifically advises against:

– Endometrial scratch, when the lining of the womb is scratched before an embryo is implanted

– Men with healthy semen should not be offered intracytoplasmic sperm injection (ICSI) – where a sperm is directly injected into an egg in a lab – but it can still be used where a man has unhealthy semen or when a couple’s IVF cycle has failed.

– A test known as a hysteroscopy – which allows medics to look inside a woman’s womb – as a pre-treatment to improve IVF success.

– Tests on the lining of the womb as an add-on treatment for embryo transfer, also known as endometrial receptivity testing.

“Too many people hoping to start a family are being offered expensive treatments that simply don’t work,” said Professor Jonathan Benger, chief medical officer and interim director of the centre for guidelines at Nice.

“These add-ons can give false hope and put people through unnecessary procedures at what is already a very difficult time.

“Our guidance makes it clear that fertility clinics should only offer treatments that are proven to help patients achieve their aim of having a baby.”

Dr Fergus Macbeth, chairman of the fertility problems guideline committee, added: “People going through fertility treatment are often willing to try anything that might help them conceive.

“This makes them vulnerable to being offered treatments that sound promising but haven’t been properly tested.

“Our recommendations are designed to protect patients and ensure they only receive care that we know works.

“Clinics should focus on providing proven treatments rather than offering unproven add-ons that may do more harm than good.”

The draft guideline also reiterates IVF eligibility for NHS patients.

In the past there have been claims about a “postcode lottery” of care, with some NHS services reducing the service provided to patients.

Nice said that its guideline committee “found stronger evidence than has previously been available that three full cycles of IVF give couples a good chance of a baby, and the treatment represents good value for the NHS”.

It recommends that women under 40 with fertility problems should be offered three full cycles of IVF, if they meet certain criteria.

One full cycle should be offered to women age 40-41, if they have fertility problems and meet certain criteria.

Prof Benger added: “The evidence considered by our committee demonstrates that providing three IVF cycles to women under 40 with fertility problems offers them a good chance of a successful pregnancy.

“We recognise the NHS faces significant financial challenges, and integrated care boards must weigh up local priorities when determining how many IVF cycles to fund.”

Meanwhile, the guidelines have broadened the number of people who should be able to access NHS fertility preservation services.

These were mainly offered to cancer patients previously to give them a chance to have families in the future.

But the new draft guidelines suggest these services should be offered to anyone facing medical treatments or conditions that could harm their ability to have children in the future.

This includes people with conditions affecting their reproductive organs such as severe and recurrent endometriosis; patients having treatments such as chemotherapy or radiotherapy, or anyone whose medical situation poses a risk to their fertility.

Dr Macbeth added: “These updated recommendations represent a significant step forward in making fertility preservation more accessible and equitable for everyone who needs it.”