Infertile couples to be given three shots at IVF
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《英国医生杂志》
London
Guidance aimed at raising infertility service provision in England and Wales to the standards enjoyed elsewhere in Europe has been published this week.
But concerns have been expressed that the funding and infrastructure needed to implement the guidelines across England and Wales will not be in place for several years.
The guidance was developed by the National Collaborating Centre for Women and Children's Health on behalf of the National Institute for Clinical Excellence (NICE), in a bid to rationalise NHS services and boost equity of access to treatment for the one in seven couples with fertility problems.
The publication of the evidence based guideline was delayed by several months, after an unprecedented volume of responses to the first consultation exercise.
Among its key recommendations is the provision of up to three free cycles of in vitro fertilisation (IVF) for couples who have been unable to conceive for three years because of an identifiable reason—provided that the woman is under 40 years old.
If the guidance is fully implemented, the demand for infertility treatment is estimated to increase by 80% at a projected additional cost to the NHS of ￡85m ($159m; 126m) in England and Wales.
In a statement issued by the Department of Health, the health secretary, John Reid, announced that all primary care trusts should offer at least one full cycle of IVF by April 2005, with priority given to childless couples.
"In the longer term I would expect the NHS to make progress towards full implementation of the NICE guidance," he said. He did not stipulate how long full implementation would take, however, and he did not mention additional funding.
Despite similar guidance issued in Scotland five years ago, wide variation still exists on the number of free IVF cycles offered to couples, because of the lack of central funding. Waiting times stretched to four years in some areas.
One cycle of IVF offers a 25% chance of pregnancy; three cycles offer a 50% chance.
Other key recommendations include:
Screening for Chlamydia trachomatis before testing for blocked fallopian tubes, and hysterosalpingography (outpatient procedure), instead of invasive tests such as laparoscopy, for those not at high risk of tubal problems
Six cycles of intrauterine insemination for couples with "mild" or unexplained fertility problems—but without ovarian stimulation, to cut the risk of multiple pregnancies
The transfer of a maximum of two embryos per cycle of IVF.(Caroline White)
Guidance aimed at raising infertility service provision in England and Wales to the standards enjoyed elsewhere in Europe has been published this week.
But concerns have been expressed that the funding and infrastructure needed to implement the guidelines across England and Wales will not be in place for several years.
The guidance was developed by the National Collaborating Centre for Women and Children's Health on behalf of the National Institute for Clinical Excellence (NICE), in a bid to rationalise NHS services and boost equity of access to treatment for the one in seven couples with fertility problems.
The publication of the evidence based guideline was delayed by several months, after an unprecedented volume of responses to the first consultation exercise.
Among its key recommendations is the provision of up to three free cycles of in vitro fertilisation (IVF) for couples who have been unable to conceive for three years because of an identifiable reason—provided that the woman is under 40 years old.
If the guidance is fully implemented, the demand for infertility treatment is estimated to increase by 80% at a projected additional cost to the NHS of ￡85m ($159m; 126m) in England and Wales.
In a statement issued by the Department of Health, the health secretary, John Reid, announced that all primary care trusts should offer at least one full cycle of IVF by April 2005, with priority given to childless couples.
"In the longer term I would expect the NHS to make progress towards full implementation of the NICE guidance," he said. He did not stipulate how long full implementation would take, however, and he did not mention additional funding.
Despite similar guidance issued in Scotland five years ago, wide variation still exists on the number of free IVF cycles offered to couples, because of the lack of central funding. Waiting times stretched to four years in some areas.
One cycle of IVF offers a 25% chance of pregnancy; three cycles offer a 50% chance.
Other key recommendations include:
Screening for Chlamydia trachomatis before testing for blocked fallopian tubes, and hysterosalpingography (outpatient procedure), instead of invasive tests such as laparoscopy, for those not at high risk of tubal problems
Six cycles of intrauterine insemination for couples with "mild" or unexplained fertility problems—but without ovarian stimulation, to cut the risk of multiple pregnancies
The transfer of a maximum of two embryos per cycle of IVF.(Caroline White)