01 August 2005
Chief Executive of Infertility Network UK and Chair of the National Infertility Awareness CampaignAppeared in BioNews 319
I agree with the statement made by Angela McNab, Chief Executive of the HFEA, when announcing the review - that the HFEA 'would not want to see any changes that would have a negative impact on the current fertility services in the UK or on the treatment of our patients' - neither would I. But, unless some things change, by adopting SET there will be a negative impact on both.
I know from the feedback I N UK receives from patients that most would be very concerned about the effect on the success rates of IVF/ICSI of reducing the number of embryos that could be transferred to one. It would be different if the success rates were currently 100 per cent for two embryo transfer and would, say, be reduced to 80 per cent - but they are not. The odds of a couple being successful are already stacked against them, and anything which makes those odds lower will worry patients.
The other reason patients will be worried is the continued lack of NHS funding for IVF treatment, despite the National Institute of Health and Clinical Excellence (NICE) guidance - and despite the statement by the then Secretary of State for Health, John Reid, that one cycle of IVF should be made available to all those eligible by April this year. Whilst some PCTs in England who were previously not funding are making some progress, there are others which are not, such as Hampshire, which recently announced that they will not fund fertility treatment (a decision I and my colleagues from the National Infertility Awareness Campaign (NIAC) will of course fight).
Many couples are still having no choice but to pay for their treatment and are therefore keen to make the most of perhaps the one cycle that they can afford. This is totally understandable. If this is your only chance of trying, the possibility of having twins or even triplets when you have tried for so long to have a family is something that many couples would welcome - this would be the family they have gone through so much to have.
But we have to look at every aspect of this treatment, including the safety of patients and the children conceived. We all know the risks of multiple births - both to the mother and to the children - the possibility of pre-eclampsia; premature births and low birth weight leading to possible health problems in the future; cerebral palsy. No-one would wish these problems on anybody, yet these are the risks we are taking when transferring more than one embryo. So what can be done?
For SET to be successful, it needs to be elective. Improving embryo selection is therefore vital. This was recognised by NICE, which recommended that further research was needed to improve embryo selection to facilitate single embryo transfers. I fully support that recommendation. Clinics also need to have a good cryopreservation programme to ensure the availability of good quality embryos for possible transfer. Patient selection is also important, with the number of available embryos, their quality and the age of the patient being determining factors. It is important therefore that the HFEA review looks at including some flexibility in the number of embryos to be transferred.
Finally, reducing the number of multiple births would mean significant savings on the cost of neonatal care to the NHS. These savings should be reallocated to enable more cycles of IVF to be provided on the NHS. Couples must be able to access the number of cycles which gives them a fair chance of success. In countries such as Belgium and Denmark where SET is the norm, couples are able to have six and five attempts respectively, fully reimbursed by their government. As I've already stated, this is not happening in the UK.
Again, I welcome this review, I welcome the opportunity for patients to participate and I hope it takes into account all I have suggested. All couples facing difficulties in conceiving want is to have a happy, healthy family. Is that too much to ask?