30 June 2008
ByAppeared in BioNews 464
A campaign led by fertility professionals and patient groups in the UK has been launched to reduce the number of multiple births that follow IVF by introducing a general policy of single embryo transfer (SET). However, experts have warned that the impetus behind the 'One at a Time' campaign will be lost unless NHS funding issues are sorted out.
The majority of women currently have two embryos implanted when undergoing fertility treatment and more should have just one, the campaigners say, and particularly younger couples with several good quality embryos to choose from. However, without funding being provided for a full three cycles, as recommended by the National Institute of Health and Clinical Excellence (NICE) in 2004, it is likely that many couples will choose two embryos where they can, to maximize the chance of conception. The campaigners propose that frozen embryos from one attempt be frozen and if the 'fresh' cycle fails, the frozen embryos can be thawed and implanted one at a time - all as part of one 'cycle' of IVF. The NHS should fund the full cycle, they suggest, otherwise patients would not accept SET.
IVF increases the chance of having twins or triplets by 20 times - this is mainly because of the implantation of more than one embryo at a time or the use of fertility drugs to induce a woman to produce more than one egg per cycle. Although IVF treatment accounts for only 1.2 per cent of all UK births, it accounts for nearly one in five of the multiple births in the UK. Currently around 40 per cent of IVF babies are twins, and are three times more likely than single babies to be stillborn. IVF twins are also at a greater risk of being born prematurely, require more specialist care at the start of their lives, and are at risk of experiencing poorer health throughout their lives. Multiple pregnancies also pose risks to mothers, including preeclampsia, diabetes and heart disease.
Last December, the UK's Human Fertilisation and Embryology Authority (HFEA) called for a new national strategy designed to reduce the number of multiple births from fertility treatments, as a result of which it hoped to see the multiple birth rate to fall to 10 per cent in three years. HFEA targets say that all clinics should ensure less than 24 per cent of their treatments result in a multiple birth by 2009 - currently 40 per cent of clinics have a higher rate than this. Failure to comply - or even attempt to - could result in the worst cases in the revocation of a clinic's licence. The HFEA drive followed a public consultation launched in April 2007 to find the most effective way of preventing multiple births, while still giving women the maximum chance of IVF success.
The HFEA consultation followed a report issued in 2006 by a group of experts, led by Professor Peter Braude, from Kings College London. They found that IVF children must be given a better chance of being born healthy and at full-term, as single babies, and at a normal birth weight. The group recommended the safest way to protect IVF babies from those risks was to move towards SET in women with the best chance of IVF success.
Dr Mark Hamilton, chairman of the British Fertility Society (BFS), said that the success of the new strategy will depend on improved NHS funding. 'It is absolutely imperative that the funding issues are addressed in collaboration with initiatives like this', he added. Alun Elias-Jones, consultant paediatrician and Fellow of the Royal College of Paediatrics and Child Health, said that the NHS should invest in funding three full cycles of IVF for couples, as this would not only reduce the number of multiple births but would save the NHS money in the long term. 'Every set of averted premature twins will fund many cycles of IVF', he explained.
In opposition, Tamba Chief Executive Keith Reed said that 'the views of patients and doctors have been completely ignored by the HFEA and the national strategy group. During the HFEA's recent consultation, only three per cent of respondents supported what the National Strategy Group are proposing', adding: 'In the face of such overwhelming opposition, it beggars belief that they have decided to carry on regardless'.
New professional guidelines published by the BFS and the Association of Clinical Embryologists (ACE) and setting out professional best practice, will be published in the journal Human Fertility in the coming few weeks, aimed at supporting professionals as they work towards reducing multiple births.
Dr Kirsty Horsey is Contributing Editor at BioNews. She is coeditor of Human Fertilisation and Embryology: Reproducing Regulation (buy this book from Amazon UK) and coauthor of Tort Law (buy this book from Amazon UK) and Skills For Law Students (buy this book from Amazon UK).