Fertility
NICE issues fertility guidance for people with endometriosis

NICE has updated fertility guidance with a new endometriosis section for people struggling to conceive.
This follows feedback received during public consultation, recognising for the first time that the condition requires its own tailored approach to fertility care, separate from other causes of infertility.
Emma Cox, chief executive of Endometriosis UK, said: “This year’s Endometriosis Action Month theme is ‘Endometriosis Doesn’t Wait’ and our new State of Endometriosis Care report shows just how urgently change is needed.
“With average diagnosis times now standing at 9 years and 4 months, and 11 years for those from ethnically diverse communities, many have already waited far too long by the time they reach fertility services.
Today’s guidance marks a step change in the fertility support that anyone with endometriosis should receive.
“For years, those with endometriosis have told us they felt invisible within the fertility system, grouped with unexplained infertility despite having a diagnosed condition.
“We welcome NICE’s decision to listen to patient voices during consultation, to create a dedicated pathway, and to remove misleading labels like ‘mild’ and ‘severe’ endometriosis.”
“Endometriosis doesn’t wait. And now, at last, neither will the guidance.”
Endometriosis UK and others told NICE during consultation that endometriosis was being grouped with unexplained infertility, despite it being a diagnosed condition.
The committee agreed this was inappropriate and that endometriosis requires a distinct fertility pathway.
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.
The committee agreed and those terms have been removed from the final guideline.
Under the new recommendations, clinicians will 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 to conceive, the severity of their symptoms, their age, their ovarian reserve, which is a measure of remaining egg supply, and any male fertility factors.
The guideline sets out a treatment pathway. Where appropriate, expectant management, meaning time to try to conceive naturally, may be offered, or surgical treatment to address endometriosis, in line with NICE’s existing endometriosis guideline (NG73).
If neither approach is suitable or successful after 2 years, fertility treatment options including intrauterine insemination (IUI), where sperm is placed directly into the womb, or IVF will be discussed.
The new guidance supports the ambitions set out in the NHS 10 Year Health Plan, which commits to shifting care closer to home and empowering patients and professionals to make the best choices about treatment.
Setting out a clear, personalised pathway in the guideline for endometriosis helps ensure fertility services are better tailored to individual need, reducing variation in care and supporting equitable access across England.
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. The committee agreed and acted on that feedback.”
“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: “Every woman with endometriosis deserves fertility care that recognises the complexity of her condition.
“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.”
Insight
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Fertility
UPFs linked to fertility issues in men, study suggests

Men who eat more ultra-processed food may be more likely to face fertility issues, a study suggests.
Ultra-processed foods, or UPFs, include bread, cakes, pastries, fried foods and salty snacks.
They contain artificial ingredients and high levels of fat, sugar and salt. Previous studies have linked UPFs to at least 32 serious health conditions, including heart disease, cancer and dementia.
Romy Gaillard, an epidemiologist at Erasmus University Rotterdam and lead researcher of the study, said: “Our findings suggest that a diet low in UPFs would be best for both partners, not only for their own health, but also for their chances of pregnancy and the health of their unborn child.
“We should move away from the idea that only the health and lifestyle of mothers-to-be is important for pregnancy and offspring outcomes, and recognise that the health and lifestyle of both the mother- and father-to-be play an important role.
“Our results highlight the need to pay more attention to male health in the preconception period, which has traditionally been overlooked.”
The Dutch study tracked health data from 831 women and 651 men who were trying for a baby.
On average, women said about a fifth of their diet consisted of UPFs, while men said roughly a quarter did. More than one in ten couples said more than a third of their diet was made up of UPFs.
Researchers at Erasmus University Rotterdam found that men with the highest UPF intake were at a 75 per cent greater risk of subfertility, where it takes longer for a partner to become pregnant, than those with an average diet.
Just under 40 per cent of the men surveyed experienced subfertility overall, but among those consuming the most UPFs this rose to nearly 70 per cent.
The study also found that the unborn children of women with UPF-heavy diets were slightly more likely to experience developmental issues.
These unborn children had slightly smaller yolk sacs, one of the earliest structures to form in pregnancy during the first six weeks.
They also took marginally longer to develop from a fertilised egg into an embryo, a process known as embryonic growth that generally happens in the first two months of pregnancy.
Previous studies have suggested slower embryonic growth can sometimes be linked to premature birth, miscarriage and an increased risk of heart and blood problems in childhood.
The authors said further research was needed, particularly because the study was observational, meaning it cannot prove that UPF consumption directly led to these fertility issues.
However, the researchers said the findings suggest couples, but particularly men, trying for a baby should avoid UPFs where possible.
Experts welcomed the findings but urged caution over the study’s limitations on such a sensitive subject.
Channa Jayasena, a professor of reproductive endocrinology at Imperial College London, said the results were ‘interesting, but there are several reasons to be cautious interpreting them’.
He said: “First, we have no way of knowing whether it is UPF itself, or some other behaviour that is linked with the things they observed.
“Secondly, the differences observed are tiny, and hardly significant compared with measures such as weight loss.
“This means that even if UPF are causing reproductive problems, their impact on individuals appears very small indeed.
“We know from previous research that in general all couples should prioritise a healthy diet, exercise, and smoking cessation when trying to get pregnant.
“Whether avoiding UPF will offer additional benefits remains unresolved.”
Gunter Kuhnle, a professor of nutrition and food science at the University of Reading, said ‘fertility is an important but very sensitive topic and should therefore be handled accordingly’.
He raised concerns about the questionnaire used in the study, which he said ‘does not appear to have been developed or validated for ultra-processed food’.
Kuhnle added: ‘Given that the assessment of ultra-processed food intake has severe limitations, the conclusions of the study, and the recommendations, need to be interpreted carefully.”
Fertility
Peers push to pardon women criminalised under abortion laws

Peers are set to debate abortion law changes that would pardon women in England and Wales already criminalised and halt active police investigations.
Last summer, MPs voted to end the criminalisation of women who terminate pregnancies outside the legal framework through a new clause in the crime and policing bill.
The House of Lords will consider its own series of amendments to the legislation on Wednesday, including two that would end active police investigations into suspected illegal abortions and pardon women who have already been criminalised.
Liberal Democrat peer Elizabeth Barker, who has put forward one of the amendments, said: “When I heard how the system has treated these women and girls when they are at their most vulnerable, and how they may have to explain this every time their [disclosure and barring service] check gets renewed, it was clear this cruelty had to be stopped.”
“Although there are far fewer who have been convicted, that conviction is a life sentence, it prevents them getting jobs, and even when renewing their car insurance every year they’ll have to explain they have a lifelong criminal record.”
Becca was 19 and working as a healthcare assistant in a hospital in the north of England when she realised she was pregnant.
She had had no signs of pregnancy over the prior months and assumed she had only just conceived.
She went to a clinic and saw a doctor who gave her abortion pills, but when she did not experience the bleeding she had been warned to expect, she called NHS 111 and was advised to go to A&E.
A scan then showed she was six months pregnant, and Becca gave birth to her son Harry within an hour.
Because Harry was born at 28 weeks, meaning very prematurely, he was moved to a hospital better equipped to care for premature babies, and then to a third hospital.
“And that is the hospital that ended up calling the police on us,” Becca said.
A few weeks after Harry was born, police arrived at Becca’s home and arrested her for attempted child destruction. Her partner was arrested at the hospital where he had been visiting their son.
Their electronic devices were confiscated. Social services told the couple they were not allowed any unsupervised contact with their son for several months, and it was not until 15 months later that the police investigation was dropped.
Because abortion offences are classed as violent crimes, the fact of an arrest can still be disclosed on a disclosure and barring service check even without a conviction. A disclosure and barring service check is a background check often used by employers.
Becca, now 21, said: “You don’t want to have to tell such a traumatic event to a random stranger who’s going to be your boss.”
If the law was changed so that her arrest records could be erased, she said: “I think it would just be almost like a release from it.
“We could just be able to live a normal life, because it’s having an impact on job applications and plans for the future.”
Her mother, Anne, said: “She’s thinking of training to be a nurse or a midwife, and all of that, I mean it’s possible now, but it’s going to be awkward because she’s going to have to declare it. If that’s gone, she can just carry on just like any 21-year-old making plans.”
Nikki Packer, who was last year cleared of carrying out an illegal abortion, said: “The lasting effects on myself and other women placed under investigation aren’t something I can simply ‘get over’. The current law is ancient, it’s time it reflects modern society.”
Dr Alison Wright, president of the Royal College of Obstetricians and Gynaecologists, said the college was calling on peers to follow the House of Commons and support clause 208, “ensuring that women are no longer at risk of investigation or prosecution for decisions about their own healthcare”.
She added: “It is also vital that the harm already caused is addressed.
“That is why we are also urging peers to support amendment 426B, which would pardon women previously prosecuted under outdated and unjust abortion laws.
“Women who have faced investigation or conviction should not have to continue living with the consequences of this archaic legislation.”
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