The question is for local purchasers to answer, not for NICE The National Institute for Clinical Excellence (NICE) was established in 1999 to provide authoritative advice to the NHS on the clinical and cost effectiveness of medical technologies, to devise and approve guidelines for the use of such technologies, and to contribute to improvement of quality in the NHS. In late 2000 it was asked by the then secretary of state for health, Alan Milburn, to consider treatment of fertility in the NHS. It has now produced draft guidelines for consultation.1 By far the largest part of this guideline is an exemplary series of evidence based recommendations about particular techniques and protocols used in the management of infertility. Most media attention has been paid, however, to the proposed recommendation about the level of service to be provided to couples experiencing difficulties in conceiving. NICE proposes that all couples meeting certain clinical criteria should have up to three complete cycles of in vitro fertilisation free on the NHS. Central to the rationale of NICE is the view …