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New UK strategy to reduce multiple births

10 December 2007
Appeared in BioNews 437

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. The call followed a public consultation launched in April this year to find the most effective way of preventing multiple births, while still giving women the maximum chance of IVF success.

Other fertility treatments have also been shown to contribute to a higher incidence of multiple births, including artificial insemination (IUI-intrauterine insemination), Gamete intrafallopian transfer (GIFT) and the use of drugs for ovarian stimulation. As some of these treatments fall outside the HFEA's current remit, it is calling for a national strategy, co-ordinated by the professional bodies to develop guidance on best clinical practice during the provision of any treatments which cause a higher rate of multiple births. Work on the strategy is due to begin in mid-December and progress is due to be discussed at the HFEA's open meeting in February 2008.

According to the HFEA, as IVF has become more successful, the number of multiple births has increased. Although IVF treatment accounts for only 1.2 per cent of all UK births, it accounts for nearly one in five of the multiple births in the UK. Currently around 40 per cent of IVF babies are twins, and therefore three times more likely than single babies to be stillborn. IVF twins are also at a greater risk of being born prematurely, require more specialist care at the start of their lives, and are at risk of experiencing poorer health throughout their lives. Multiple pregnancies also pose risks to mothers, including preeclampsia, diabetes and heart disease.

The HFEA consultation followed a report issued in 2006 by a group of experts, led by Professor Peter Braude, from Kings College London. They found that IVF children must be given a better chance of being born healthy and at full-term, as single babies, and at a normal birth weight. The group recommended the safest way to protect IVF babies from those risks was to move towards single embryo transfer (SET) in women with the best chance of IVF success.

In a speech (see 'Recommends'), Walter Merricks, Interim Chair of the HFEA, described the issue as being 'about improving baby health and safety'. He added: 'We are not in the business of intervening in the decisions made between a patient and their doctor or sacrificing women's chances of conception by asking clinicians to force women to have treatments that offer low chances of success. But this is a real problem that has to be addressed'.

Current guidance, found in the HFEA Code of Practice, stipulates that clinics should transfer no more than two eggs or IVF embryosat a time to women under 40 years old and no more than three eggs or embryos to women older than 40.

The HFEA does not propose restrictions on the transfer of multiple embryos. Instead, it has identified a voluntary approach by which professional groups will draw up guidelines on how to achieve fewer multiple births and has called on the Government to pay for more free cycles of treatment to make the strategy more effective. Mr Merricks has written to Dawn Primarolo, the Health Minister, to press the case for better access and funding for couples seeking IVF. The National Institute for Health and Clinical Excellence recommended that three cycles of IVF should be offered to all women under 40, but the Government has failed to implement this, and many PCT offer only one cycle and impose restrictions on which patients qualify. 'We always have in mind that still the greatest risk in the eyes of patients is the risk of not having a baby', said Mr Merricks. He added: 'Women with access to only one funded cycle of treatment are only acting rationally if they beg for a double embryo transfer in their single chance of becoming pregnant. The risk of a twin pregnancy seems nothing to the risk of no pregnancy'.

SOURCES & REFERENCES
British Fertility Society response to the HFEA calls for national strategy to reduce multiple births
BFS |  4 December 2007
Fresh drive to cut IVF twin toll
BBC News Online |  4 December 2007
HFEA calls for national strategy to reduce the biggest risk of fertility treatment - Multiple births
HFEA |  4 December 2007
IVF strategy to reduce number of hazardous multiple births
The Times |  5 December 2007
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