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UK expert group recommends one embryo at a time

21 October 2006
Appeared in BioNews 381

An expert panel commissioned by the UK's Human Fertilisation and Embryology Authority (HFEA) has issued a report recommending that new guidelines should be introduced to limit the number of embryos which can be implanted during IVF cycles.

The HFEA last reviewed its guidelines on how many embryos can be implanted during IVF treatments in July 2005. At the time, over 90 per cent of IVF cycles in the UK involved the transfer of two or three embryos. This meant that one in four cycles of IVF resulted in the birth of twins or triplets, more than 10 times greater than natural occurrence of multiple births. The HFEA was considering limiting IVF treatments to the transfer of a single embryo per cycle, as has been done in some other European countries. The most recent guidance, found in the HFEA Code of Practice, stipulates that clinics should transfer no more than two eggs or IVF embryos at a time to women under 40 years old and no more than three eggs or embryos to women older than 40. Implanting more than one embryo can increase the chance of having a successful outcome - but it also increases the incidence of twin births, which puts increased strain on intensive care and neonatal units.

The new report from the Expert Group on Multiple Births after IVF, entitled 'One Child at a Time: Reducing Multiple Births after IVF', recommends that for patients under the age of 35, the number of embryos that can be transferred should be reduced from two to one. It also states that sanctions should be taken against clinics that exceed a 'cap' placed on the number of twin births allowed. Clinics which routinely exceed a twin birth rate of 5 to 10 per cent, for example, may be placed under further restrictions regarding the number of embryos they can transfer, or may even face problems renewing their licence.

The HFEA claims that limiting the number of twins and triplets born through IVF each year would relieve pressure on the health care system, which is required to care for children born in multiple births as a result of fertility treatment. Twin and triplet births are usually premature and babies are correspondingly underweight. It is estimated that limiting to one the number of embryos able to be transferred during IVF treatment could save the NHS up to £15 million per year. Patricia Hamilton, the president of the Royal College of Paediatrics agreed, stating that 'the capacity at the present time is just not there to deal with the burgeoning number of premature babies'.

Professor Peter Braude of King's College London, who chaired the expert group, said that 'women should ideally be having healthy babies, one at a time'. He added that patients are often unaware of the financial and emotional costs of having more than one child at a time, and many would choose a multiple birth in order to avoid subsequent cycles of fertility treatment - often because of how much this might cost. 'What parents don't see and don't wish to the prematurity and disablement as a result of multiple pregnancies', he said.

Clare Brown, Chief Executive of patient support group Infertility Network UK said that the group shares medical concerns regarding multiple births, and would support a move towards single embryo transfer (SET). But, she stressed, for single embryo transfer to be effective, the National Institute for Health and Clinical Excellence (NICE) fertility guideline must be implemented in full, so that couples can receive up to three full cycles of IVF on the NHS, and that 'full cycle' should include frozen embryo transfer. She added that savings that would be made on the cost of neonatal care should be put towards implementing the three cycles recommended by NICE giving patients a much greater 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', she said. Mark Hamilton, speaking for the British Fertility Society, also agreed that a 'cycle of IVF should include not only the transfer of the fresh embryo but also the subsequent opportunity to replace any additional stored embryos'.

Fertility experts call for one embryo per IVF cycle
New Scientist |  18 October 2006
IVF experts recommend single embryo transfer
Reuters |  18 October 2006
One Child at a Time: Reducing Multiple Births after IVF
Expert Group on Multiple Births after IVF |  18 October 2006
Women having IVF to be allowed one embryo at a time
The Times |  18 October 2006
20 October 2008 - by Sarah Pritchard 
A study into the potential effects of transferring a single embryo (SET) into the womb during IVF treatment has revealed that success rates are likely to drop as a result. The study, published in the journal Human Reproduction, was undertaken by Dr Daniel Brison and his colleagues...
10 December 2007 - by Dr Kirsty Horsey 
The UK's Human Fertilisation and Embryology Authority (HFEA) called last week for a new national strategy designed to reduce the number of multiple births from fertility treatments, as a result of which it expects to see the multiple birth rate to fall to 10 per cent...
20 August 2007 - by Ailsa Stevens 
Women with fertility problems would rather take the risks associated with multiple pregnancies than risk not becoming pregnant at all, reveals research published in BJOG: An International Journal of Obstetrics and Gynaecology (BJOG) this month. Researchers from the University of Aberdeen surveyed a total of 74 women...
10 April 2007 - by Katy Sinclair 
The UK's Human Fertilisation and Embryology Authority (HFEA) has launched a consultation to find the best way to reduce problems experienced by IVF children arising from multiple births. According to the HFEA, as IVF has become more successful, the number of multiple births has increased. Currently around...
29 October 2006 - by Antony Starza-Allen 
The American Society for Reproductive Medicine (ASRM) and the US Society for Assisted Reproductive Technology (SART) have issued new guidelines limiting embryo transfer during IVF procedures to reduce the occurrence of multiple births. Announced at the annual ASRM meeting, held in New Orleans last week, the revised...
16 October 2006 - by Dr Jess Buxton 
The interim chairman of the UK's Human Fertilisation and Embryology Authority (HFEA), Lord Harries of Pentregrath, has said that there should be no upper age limit for women seeking IVF treatment. In an interview with the Times newspaper, the former Bishop of Oxford, Richard Harries, said...
25 September 2006 - by Dr Kirsty Horsey 
The UK's fertility treatment regulator, the Human Fertilisation and Embryology Authority (HFEA), is likely to recommend that women undergoing IVF treatment should only be allowed to have one embryo transferred at a time. The HFEA last reviewed its guidelines on how many embryos can be implanted...
6 February 2006 - by BioNews 
A new study on the effect of single embryo transfer (SET) on pregnancy rates has triggered further calls for the UK's Human Fertilisation and Embryology Authority (HFEA) to stick with its existing policy on this issue. The research, published in the journal Human Reproduction, shows that imposing a single embryo...
16 January 2006 - by BioNews 
UK researchers say that an additional 10,000 cycles of IVF per year could be provided free on the National Health Service (NHS), if clinics took action to reduce the number of multiple births following IVF. It is common for women undergoing IVF to have two embryos implanted at a time...
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