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.'