Unlike the UK, the United States does not have national legislation regulating IVF practice. American fertility clinics are subject to a range of rules, but compliance with most of them is not mandatory. As a result, good medical practice is often encouraged through professional guidelines rather than enforced through national legislation. The latest data from the US on multiple birth rates seems to suggest that the ASRM guidance on embryo transfer has had an effect. However, there seems to be some way to go. Whilst the rate of triplets and higher order multiple pregnancies from IVF has reduced in the US, the proportion of twins remains high. Further, although a high proportion of fertility clinics report their outcomes to a national body, data reporting is not mandatory there. So there remains the possibility that those clinics with higher multiple birth rates are preferring not to tell their peers.
There is much to learn from the American experience, both in what to do and what not to do. But the multiple birth rate story raises a more fundamental question about what the balance should be between legislation and professional standard-setting. What should be the role of regulation? Should it be to enforce best practice or simply to guarantee minimum standards? In the field of reproductive medicine, should regulation just provide basic protections for patients or should it promote ethical behaviour or even ideal outcomes?
This is one of the questions that the House of Commons Science and Technology Committee will be considering during its enquiry into human reproductive technologies and the law.
Juliet Tizzard is the Founder of BioNews and was formerly Director of the charity that publishes it, the Progress Educational Trust (PET). She is coauthor of Key Issues in Bioethics (buy this book from Amazon UK or Amazon USA) and Designer Babies: Where Should We Draw the Line? (buy this book from Amazon UK or Amazon USA).
