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IVF women prefer risky pregnancy to no pregnancy

20 August 2007
Appeared in BioNews 421

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 who were awaiting IVF treatment to find out their preference for having children with the severe disabilities associated with multiple births, including physical impairments, mental impairments, visual impairments, stillbirth or death in early infancy and premature birth, compared to not becoming pregnant at all.

'Today a growing proportion of women conceive via assisted reproduction, yet there is limited appreciation amongst the general population regarding the risks involved with multiple births for both mother and child', said Professor Philip Steer, BJOG editor-in-chief. He added: 'This study reveals that a significant number of prospective parents value the experience of parenthood ahead of the risk of significant disability to their child'.

The UK 'postcode lottery' for heath care extends into fertility treatment. While UK guidelines recommend funding three cycles of IVF for women younger than 40, limited resources mean that many women are only offered a single try. 'A more appropriate way to minimise risks without risking poor outcomes would be to encourage uptake of single embryo transfer in a climate which permits a greater number of funded treatments to couples', suggests lead researcher Graham Scotland, Research Fellow of the University of Aberdeen. However, he admits that limited resources may make this recommendation hard to put into practice.

Two or more embryos are transferred into some women undergoing IVF, depending on guidelines issued under the Human Fertilisation and Embryology Authority (HFEA)'s existing Code of Practice. However, the Authority launched a consultation in April this year aimed at finding the best way to reduce problems experienced by IVF children arising from multiple births and is expected to make a policy decision on the basis of the evidence and the consultation responses sometime in autumn 2007.

The HFEA last reviewed its guidelines on how many  embryos can be transferred 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. Current guidelines say that clinics can transfer up to two embryos per cycle for women under 40 and up to three for women over 40. Transferring multiple embryos means women are 20 times more likely to have twins and 400 times more likely to have triplets, compared to natural conception. As well as representing a significant risk of mortality to mother and child, this pronounced increased in multiple births puts added pressure on an already stretched National Health Service.

Preliminary results from European research suggests that transferring single embryos may be as effective as transferring of two or more embryos, raising the question of whether this decision should be made by the doctor or by the patient. Regardless of who decides, good information is the key, say the researchers. 'Our results suggest that, at the present time, information on the risks associated with twin pregnancy may not be enough to deter some women in the UK from choosing double embryo transfer, given their perception that it will improve their chances of a live birth', said Scotland.

SOURCES & REFERENCES
Safety Versus Success In Elective Single Embryo Transfer: Women's Preferences For Outcomes Of In Vitro Fertilisation
Medical News Today |  31 July 2007
UK women OK with risks of multiple embryos
MSNBC |  17 August 2007
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