The UK has led the way over the past two decades in defining the relationship between IVF practice and society, through the intermediary of the HFEA, which regulates and licenses most fertility treatment across the UK. Since it was set up, in 1991, this has been a successful organisation, implementing largely sensible legislation. Many countries have later emulated both the legislation and the regulatory body itself.
However, the practice of IVF in the UK is beginning to look somewhat 'out-of-date' when compared with Northern European attitudes to multiple pregnancy and single embryo transfer. Results from Belgium and Sweden, amongst other countries, have shown that it is possible to achieve good pregnancy rates after single embryo transfer and that if subsequent replacement of frozen embryos is factored in, the overall chances of a couple having a child after a single cycle of IVF treatment appears little different whether one or two embryos are transferred in the fresh treatment phase.
We have shown that a move to single embryo transfer would be cost effective to NHS funders, including taxpayers, by reducing the financial medical costs of handicap following premature birth of twins and triplets. However, to implement a policy whereby single embryo transfer was the norm in IVF would require effort from all parties. The HFEA should consider using singleton live birth as its 'headline' figure for the comparison of clinic success rates and, in the longer term, an instruction that 'women under 36 having their first two cycles of IVF treatment should have a single embryo transferred' would solve the problem at a stroke.
However, PCTs can also act by contracting with provider clinics to replace one embryo in their purchased cycles and, further, should consider refusing to contract with clinics that do not adopt this policy across the board for all their patients. This is sensible, since the NHS invariably ends up paying the price for multiple pregnancies conceived after private IVF. Thirdly, re-educating patients - especially in the light of studies showing good pregnancy rates - is another way to help us progress towards a norm of single embryo transfer as the norm. We as a community interested in problems of infertility should strive to keep our patients informed of the debate and the possibilities of single embryo transfer, as many of them regard a twin pregnancy as their preferred outcome. Changing this perception will be difficult (as it may often be linked to cost), and requires a uniform message that 'one at a time is best' from all professionals - including the regulators - involved in the care of infertile couples.