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Fertility regulators issue guidelines for single embryo transfer in IVF

8 September 2008
Appeared in BioNews 474

The British Fertility Society (BFS) and the Association of Clinical Embryologists (ACE) have introduced new guidelines aimed at reducing the number of multiple births amongst IVF patients in the UK. The guidelines, published in the journal Human Fertility, recommend that a single embryo transfer (SET) policy should be adopted for women under 37. The policy is not mandatory and it will be left to patients to elect SET, but the professional bodies have joined the Human Fertilisation and Embryology Authority (HFEA) in a drive to ensure patients are given adequate information about the risks of multiple births to encourage the uptake of a SET policy.

Multiple births account for almost a quarter of all IVF births in the UK, more than the national average of little over one per cent. Risks include premature birth, low birth weight, an increased risk of death in the first week and an increased risk of cerebral palsy around four times that for singleton births. There is also a greater risk to the mother from complications both during pregnancy and birth.

In a statement issued last week, the BFS said: 'Single embryo transfer is the only effective method to reduce IVF multiple pregnancy rate, the single biggest health risk to both mother and child associated with fertility treatment.'

The policy is not without controversy, however, as many patients and some doctors, are opposing the policy citing the low success rates of IVF, the lack of provision on the NHS and the high private fees. Opponents claim that if it is so difficult to become pregnant using IVF, they should be given the best chances to conceive, even if this means implanting a number of embryos. Some studies refute such claims showing there to be no greater success rate in IVF from implanting multiple embryos. The debate persists, however, and in the guidelines the BFS and ACE have called upon the HFEA to review fees and improve the way it presents data to encourage patients to elect SET.

Also included in the recommendations, the BFS and the ACE have indicated that SET should be combined with an 'effective' frozen embryo replacement program so that viable embryos are not discarded and can be stored for further cycles, if necessary. The bodies also recommend employing standard grading schemes to help determine embryo quality ensuring only the best embryo is selected for implantation.

Crucial to the success of SET, say the BFS and ACE, is to increase funding for IVF on the NHS to ensure NICE (National Institute for Health and Clinical Excellence) guidelines of three cycles per women are met. At present, only nine of the 151 PCTs meet these guidelines. In the press statement Tony Rutherford, Chair of the BFS Policy and Practice Committee emphasised, 'The only way in which this strategy can be effectively implemented for the benefit of both mothers and babies is for the NHS to increase funding to allow full implementation of the NICE guidelines on fertility treatment.'

HFEA Statement on elective Single Embryo Transfer (eSET) guidelines
HFEA statement |  3 September 2008
Lack of IVF funding 'putting mothers at risk from dangerous multiple births'
The Daily Telegraph |  3 September 2008
Move to reduce multiple pregnancies
The Guardian |  3 September 2008
New guidelines for elective single embryo transfer in IVF treatment
BFS statement |  3 September 2008
New Guidelines For Elective Single Embryo Transfer In IVF Treatment
Medical News Today |  3 September 2008
Single embryo guidance to clinics
BBC News Online |  3 September 2008
26 January 2009 - by Shantal Rajah 
Elective single embryo transfer (eSET) policy implementation has raised many issues among patients, IVF experts and fund holders. The main concern in relation to this policy is that we do not know how much, and by what percentage, it will reduce the pregnancy rate in our patients. The policy says...
26 January 2009 - by Norbert Gleicher 
On the European side of the Atlantic single embryo transfer (SET) is increasingly becoming standard practice. As a consequence of legislation, as in Belgium, of professional dogma, as in most Scandinavian countries, or the product of the regulatory prowess of the Human Fertilisation and Embryology Authority (HFEA), as in the...
26 January 2009 - by Sandy Starr 
This month sees the coming into force of new regulations by the UK's Human Fertilisation and Embryology Authority (HFEA), which seek to ensure that elective single embryo transfer (eSET) for women under 40 becomes standard practice in IVF treatment in the UK. Under these regulations, public and private fertility clinics...
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...
22 September 2008 - by Ailsa Stevens 
The average age of women seeking fertility help in Australia has increased from 35.2 years old in 2002 to 35.6 years old in 2006, according to a report by the Australian Institute of Health and Welfare (AIHW). The report showed that record numbers of women over 40...
12 August 2008 - by Antony Starza-Allen 
Thirty years after the world's first IVF-baby was born commentators and reporters are assessing the gains made by the fertility treatment and the future that lies ahead. Although it seems IVF today has become the established and routine medical procedure its pioneers in 1978 probably hoped it would become, issues...
7 July 2008 - by Dr Kirsty Horsey 
BioNews reporting from ESHRE conference, Barcelona:By Dr Kirsty Horsey: Delegates at the annual meeting of the European Society of Human Reproduction and Embryology have been told that more mental health problems are faced by parents of twins than of singletons, no matter how the children were conceived. Dr Leila...
30 June 2008 - by Dr Kirsty Horsey 
A campaign led by fertility professionals and patient groups in the UK has been launched to reduce the number of multiple births that follow IVF by introducing a general policy of single embryo transfer (SET). However, experts have warned that the impetus behind the 'One at...
26 February 2008 - by Dr Rebecca Robey 
Scientists at a UK fertility clinic have reported that a new IVF technique may increase the rate of pregnancy whilst decreasing the risk of multiple births. The study, published in the British Journal of Obstetrics and Gynaecology, involved nearly 2500 women over a three-year period and found...
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...
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