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IVF cuts encourage risky multiple pregnancies, warns UK report

10 September 2018
Appeared in BioNews 966

Cuts to fertility treatments in the UK are putting women at higher risk of having multiple pregnancies, and increasing costs to the NHS, according to a new report.

The report commissioned by a group of fertility organisations states that about 11 percent of IVF-assisted pregnancies result in multiple births, compared with 1-2 percent of naturally conceived pregnancies. Multiple embryos are sometimes transferred during a cycle to save costs and boost success chances, especially if couples are limited to one IVF cycle.

According to Fertility Network UK, just 61.5 percent of Clinical Commissioning Groups (CCGs) in England offer either one full or partial round of IVF. And although the National Institute for Health and Care Excellence (NICE) recommends three fully-funded IVF cycles for all patients who meet set criteria, the number of CCGs offering three cycles has dropped from 16 percent to 11.5 percent in a year.

Aileen Feeney, chief executive of Fertility Network UK, urged the government to commit to funding the recommended three full cycles for women under 40.

'We are concerned that further progress will be limited if the lack of access to NHS fertility services in England continues to drive patients overseas for fertility treatment – where different regulations around the number of embryos that can be transferred means the risk of multiple pregnancies is much higher,' she said.

Professor Lesley Regan, president of the UK's Royal College of Obstetricians and Gynaecologists (RCOG), said: 'Transfer of multiple embryos is often performed during IVF due to a perception that this will increase the chances of success. However, developments in IVF technology and practice have improved the live birth rate for single embryo transfer, allowing success rates to increase while lowering the multiple birth rate and associated complications.'

Multiple pregnancies pose risks to both mothers and babies. The recent report found maternal mortality is 2.5 times higher in mothers with multiple pregnancies, and the rate of stillbirth is about seven times higher in twins than in singletons. In addition, eight percent of multiple pregnancies end in death or disability for one or more of the babies.

The report also found the cost of multiple births to the NHS were, on average, almost three times as expensive as single pregnancies. It concluded that for every 10 percent reduction in the current rate of multiple births, £15 million could be saved by the NHS.

Dr Jane Stewart, chair of the British Fertility Society, said the report has 'for the first time demonstrated the financial benefits to the NHS and commissioners of obstetric care of the one-at-a-time strategy embraced by fertility specialists and patients in the UK'.

Jane Denton, director of the Multiple Births Foundation, added: 'While this report focuses on the financial cost of multiple births, it is the cost to the health of mothers and babies which is paramount.'

The report was commissioned by the Human Fertilisation and Embryology Authority, the British Fertility Society, the Multiple Births Foundation and Fertility Network UK. It was produced by the National Guideline Alliance, which is part of the RCOG.

SOURCES & REFERENCES
A report by the National Guideline Alliance about twin pregnancy costing
HFEA |  4 September 2018
IVF restrictions 'putting families at risk'
AOL (Press Association) |  4 September 2018
Joint statement on the NGA multiple pregnancy report
HFEA |  6 September 2018
Regulator says IVF cuts put mothers and babies at risk
Health Service Journal |  4 September 2018
Women and babies are being put at risk by IVF rationing
The Telegraph |  4 September 2018
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