Last week the Human Fertilisation and Embryology Authority (HFEA), which oversees all UK fertility services, wrote to the NHS Directors of Public Health to outline the importance of ensuring that commissioning strategies are consistent with the HFEA's new multiple births policy. The policy aims to 'more than halve the rate of IVF multiple births from its 2006 level of 23 per cent to 10 per cent over the next 3 years', according to the letter from Alan Doran, Interim Chief Executive of the HFEA.
The letter sets out the key elements of the policy, including the requirement that no centre should exceed a multiple birth rate of 24 per cent during 2009, decreasing to a maximum limit of 10 per cent over the next three years. It also highlights that, under the new policy, individual centres should have their own policy in place detailing how they intend to meet that target and in which patients single embryo transfer (SET) will be favoured.
Bill Ledger, Professor of Obstetrics and Gynaecology at the University of Sheffield, welcomed the letter: 'It's an excellent letter which emphasises the need to be selective with SET and not to adopt a blanket approach. It highlights the nonsense of the current system of decision making in the NHS whereby every PCT or group of PCTs makes its own decision about policy', he told BioNews.
Clare Lewis-Jones, Chair of the National Infertility Awareness Campaign, also welcomed the letter, but emphasised the need to urgently address the current UK 'postcode lottery' in the provision of IVF. 'Whilst the level of NHS funding in England is improving, there are still far too many inequities in relation to the level of funding for fertility treatment. It is vital that all PCTs implement the full NICE (National Institute for Health and Clinical Excellence) guideline, that is three full cycles, as quickly as possible so that those patients who are most at risk of having a multiple pregnancy and therefore are having single embryo transfer are at least given a very real chance of having a baby by being able to access the appropriate number of cycles recommended by NICE', she said.
Lewis-Jones emphasised that the letter was not a mandate to adopt SET for all IVF patients. 'We know that there are parts of England who are saying that all patients in their area must have single embryo transfer. They must recognise that this is not what is being recommended, not clinically appropriate for some patients and is therefore not a cost effective use of the PCTs resources and should be reviewed urgently'.