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Single embryo transfer must go hand in hand with adequate funding

1 August 2005
By Clare Lewis-Jones MBE
Chief Executive of Infertility Network UK and Chair of the National Infertility Awareness Campaign
Appeared in BioNews 319
The Human Fertilisation and Embryology Authority (HFEA) has announced that it will be reviewing the clinical practice around the number of embryos transferred during fertility treatment. It will look at whether the UK should follow the practice of other European countries that have a single embryo transfer (SET) policy. Infertility Network UK (I N UK) welcomes the review and looks forward to playing a full and active part.

I agree with the statement made by Angela McNab, Chief Executive of the HFEA, when announcing the review - that the HFEA 'would not want to see any changes that would have a negative impact on the current fertility services in the UK or on the treatment of our patients' - neither would I. But, unless some things change, by adopting SET there will be a negative impact on both.

I know from the feedback I N UK receives from patients that most would be very concerned about the effect on the success rates of IVF/ICSI of reducing the number of embryos that could be transferred to one. It would be different if the success rates were currently 100 per cent for two embryo transfer and would, say, be reduced to 80 per cent - but they are not. The odds of a couple being successful are already stacked against them, and anything which makes those odds lower will worry patients.

The other reason patients will be worried is the continued lack of NHS funding for IVF treatment, despite the National Institute of Health and Clinical Excellence (NICE) guidance - and despite the statement by the then Secretary of State for Health, John Reid, that one cycle of IVF should be made available to all those eligible by April this year. Whilst some PCTs in England who were previously not funding are making some progress, there are others which are not, such as Hampshire, which recently announced that they will not fund fertility treatment (a decision I and my colleagues from the National Infertility Awareness Campaign (NIAC) will of course fight).

Many couples are still having no choice but to pay for their treatment and are therefore keen to make the most of perhaps the one cycle that they can afford. This is totally understandable. If this is your only chance of trying, the possibility of having twins or even triplets when you have tried for so long to have a family is something that many couples would welcome - this would be the family they have gone through so much to have.

But we have to look at every aspect of this treatment, including the safety of patients and the children conceived. We all know the risks of multiple births - both to the mother and to the children - the possibility of pre-eclampsia; premature births and low birth weight leading to possible health problems in the future; cerebral palsy. No-one would wish these problems on anybody, yet these are the risks we are taking when transferring more than one embryo. So what can be done?

For SET to be successful, it needs to be elective. Improving embryo selection is therefore vital. This was recognised by NICE, which recommended that further research was needed to improve embryo selection to facilitate single embryo transfers. I fully support that recommendation. Clinics also need to have a good cryopreservation programme to ensure the availability of good quality embryos for possible transfer. Patient selection is also important, with the number of available embryos, their quality and the age of the patient being determining factors. It is important therefore that the HFEA review looks at including some flexibility in the number of embryos to be transferred.

Finally, reducing the number of multiple births would mean significant savings on the cost of neonatal care to the NHS. These savings should be reallocated to enable more cycles of IVF to be provided on the NHS. Couples must be able to access the number of cycles which gives them a fair chance of success. In countries such as Belgium and Denmark where SET is the norm, couples are able to have six and five attempts respectively, fully reimbursed by their government. As I've already stated, this is not happening in the UK.

Again, I welcome this review, I welcome the opportunity for patients to participate and I hope it takes into account all I have suggested. All couples facing difficulties in conceiving want is to have a happy, healthy family. Is that too much to ask?

5 December 2011 - by Dr Rebecca Robey 
Progress Educational Trust (PET)'s annual conference, 2011, 'The Best Possible Start in Life: The Robust and Responsive Embryo', started with two fantastic sessions chaired by Dr Virginia Bolton, consultant embryologist at the assisted conception unit at Guy's Hospital, London, UK....
1 November 2009 - by Sarah Pritchard 
Transferring only one embryo during IVF treatment significantly reduces the risk of multiple births without considerably altering a woman's chances of conceiving and having a baby, report Swedish researchers....
1 September 2009 - by Antony Starza-Allen 
Leading fertility and adoption experts have called upon the Canadian government to fund three cycles of IVF for women under 42 in the state of Ontario. The Ontario Expert Panel on Fertility and Adoption, which released its report last week, recommended the province should fund IVF as well as including proposals to reform the adoption system....
2 March 2009 - by Clare Lewis-Jones MBE 
I welcome the letter from Alan Doran, Interim Chief Executive of the Human Fertilisation and Embryology Authority (HFEA) to all Directors of Public Health in England on the subject of multiple births and commissioning IVF services. Why? Let's be honest! In England, even before the move to single embryo transfer...
14 July 2008 - by Clare Lewis-Jones MBE 
Louise Brown, the world's first IVF baby, will be 30 years old on 25 July 2008. Here Clare Brown, who was among those to speak at a reception organised by the All Party Parliamentary Group on Infertility to mark next week's National Infertility Day 2008, reflects on three decades of...
29 July 2005 - by BioNews 
The UK's Human Fertilisation and Embryology Authority (HFEA) is to review its rules on how many embryos can be implanted during IVF treatments. Currently, over 90 per cent of IVF cycles in the UK involve transferring two or three embryos to increase the chances of success. However, this also leads...
21 June 2005 - by BioNews 
BioNews reporting from ESHRE conference, Copenhagen: IVF babies born after single embryo transfer (SET) are healthier than those born after more than one embryo is transferred, say researchers, in two studies presented at the annual conference of the European Society of Human Reproduction and Embryology in Copenhagen this week. In...
28 February 2005 - by BioNews 
According to the UK's Sunday Times newspaper, a high proportion of couples seeking fertility treatments ask the clinic to help them have twins, rather than have one baby at a time. The Sunday Times describes this as producing 'an instant family with just one pregnancy'. One clinic that the newspaper...
18 February 2004 - by BioNews 
Figures published by the UK's Office for National Statistics (ONS) show that the number of multiple births in England and Wales rose by 20 per cent over the 10 years between 1992 and 2002. It is thought that increases in the use and availability of fertility treatments, such as IVF...
7 January 2004 - by BioNews 
The UK's Human Fertilisation and Embryology Authority (HFEA) has published a revised Code of Practice, the sixth since the establishment of the authority in 1991. The code provides guidelines for HFEA-licensed fertility clinics on the provision of IVF and related services. The most significant addition to the new edition of...
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