What are the indications for offering in vitro fertilization (IVF) to patients in primary care?

Indications for offering in vitro fertilization (IVF) in primary care include:

• Women under 40 years who have not conceived after 2 years of regular unprotected intercourse or after 12 cycles of artificial insemination (with at least 6 cycles of intrauterine insemination) should be offered up to 3 full cycles of IVF treatment, with or without intracytoplasmic sperm injection (ICSI).
• Women aged 40 to 42 years who have not conceived after 2 years of regular unprotected intercourse or 12 cycles of artificial insemination (with at least 6 cycles of intrauterine insemination) may be offered 1 full cycle of IVF, provided they have never had IVF before, show no evidence of low ovarian reserve, and have discussed the additional implications of IVF and pregnancy at this age.
• Couples with unexplained infertility who have not conceived after 2 years of regular unprotected intercourse should be offered IVF treatment.
• Where investigations demonstrate no chance of pregnancy with expectant management and IVF is the only effective treatment, direct referral to a specialist team for IVF is indicated.

Additional considerations before offering IVF include informing patients about the risks and benefits of IVF in line with the Human Fertilisation and Embryology Authority (HFEA) Code of Practice, and ensuring female BMI is ideally between 19 and 30 to optimize success rates. Lifestyle factors such as limiting alcohol intake to no more than 1 unit per day, avoiding smoking, and reducing caffeine consumption should also be addressed as they affect IVF success.

These criteria and recommendations are based on the NICE guideline Fertility problems: assessment and treatment ¹ and supported by infertility management guidance ².