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 see...is 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'.