Updated NICE fertility guidance includes specific path for endometriosis

NICE has included a new section for individuals with endometriosis in an updated guidelines on managing fertility issues.

Despite impacting around 1.5 million women in the UK, many patients have historically faced confusion and inconsistency when trying to access fertility treatment, NICE said.

The update sends a ‘clear signal’ that once endometriosis is diagnosed, patients should no longer face additional barriers when trying to start a family, it added.

It comes after Endometriosis UK and others warned in the consultation phase that endometriosis was being grouped with unexplained infertility, despite it being a diagnosed condition.

Respondents also told NICE that terms such as ‘mild’ and ‘severe’ endometriosis were clinically ambiguous and did not reflect the complexity of the condition or its impact on fertility.

Clinicians are advised to discuss a range of options with patients with endometriosis who are trying to conceive, taking into account individual factors including how long they have been trying for a baby, the severity of their symptoms, their age, their ovarian reserve, and any male fertility issues.

Patients can be offered time to try to conceive naturally or surgical treatment to address their endometriosis.

After two years of this approach, fertility treatment options including intrauterine insemination or IVF can be discussed, the guidance adds.

Updated guidelines on diagnosis and management of the condition were published by NICE in November last year with the aim of speeding up diagnosis and providing clearer guidance on referral.

Eric Power, interim director of the Centre for Guidelines at NICE, said: ‘We listened carefully to what patients, clinicians and patient groups told us during consultation. 

‘They described how complex endometriosis is, how they felt existing labels were misleading, and that the condition needed its own pathway.’

He added: ‘By creating a dedicated section for endometriosis, we are giving clinicians a clear, evidence-based framework to have better, more personalised conversations with their patients, ensuring that everyone, regardless of the cause of their fertility problems, has access to the right care at the right time.’

Public health minister Sharon Hodgson said: ‘This landmark guidance will ensure women can access a clear, personalised pathway to fertility care that leads to clearer conversations with clinicians and fewer barriers.

‘We’re committed to giving every woman the support she deserves, and today’s guidance is a significant step towards ending the inconsistency that has let down too many, for too long.’

The update also warns against using anti-Müllerian hormone (AMH) measurement as a predictor of clinical pregnancy through spontaneous conception.

And it suggests considering serological testing for coeliac disease in people with unexplained subfertility.