Childless Couples To Face New IVF Hurdle

IVF clinics that produce twins and triplets in more than one in ten pregnancies will face disciplinary action under plans to cut multiple births announced yesterday. The cap proposed by the fertility watchdog would mean that about 50 per cent of women having IVF treatment, mostly first-time patients under 35, would be allowed to use just one embryo at a time.

{mosimage} It would virtually eliminate chances of having twins or triplets, which is the greatest health risk of the procedure, but could slightly reduce the prospect of a successful pregnancy at the first attempt. While the measure is backed by doctors and patient groups, it creates fresh pressure on the Government to improve funding of fertility treatment on the NHS.

Modern techniques mean that success rates with one embryo can be as good as with two for young women with a good prognosis, but only if a back-up cycle of treatment with a frozen embryo is offered should the first one fail. Very few NHS trusts currently provide this, and about 75 per cent of IVF patients pay for their own treatment.

Critics said the move would not be accepted by couples who want to maximise their chances of starting a family unless the Government agrees to fund three free cycles, in line with recommendations by the National Institute for Health and Clinical Excellence.

Infertile patients would be much more likely to agree to single embryo transfers if they knew that a second or third attempt would be paid for should the first one fail.

“Patients should not have to compromise on safety and quality of treatment because of financial pressures, which is why any move towards elective single embryo transfer must be accompanied by better access to NHS treatment,” said Clare Brown, of the charity Infertility Network UK.

IVF has traditionally involved transferring two or three embryos to a woman’s womb to maximise her chances of conception, but doctors have become increasingly concerned that this creates an unacceptable risk of multiple births.

Twins and triplets are much more likely than singletons to be stillborn, to die in the first week of life, to be disabled or to be born prematurely. The Human Fertilisation and Embryology Authority (HFEA) estimates that 126 IVF babies died in 2003 who would have survived had they been singleton births.

Mothers also have a greater risk of life-threatening conditions such as preeclampsia and heart attacks. The HFEA tried to tackle the problem in 2004 by limiting most women under 40 to two embryos, but 90 per cent of IVF procedures still involve two or three embryos and one in four results in twins or triplets.

The natural rate is one in 80. Under the new proposal, clinics would have to keep their twin pregnancy rates below 10 per cent, using their own medical judgement to decide which women are the best candidates for single embryo transfer.

Those that exceed the limit could be banned from using two embryos with first-time patients under 35, or have the number of IVF procedures they can perform restricted.

Serious or repeat offenders could lose their licences, and though the HFEA is not currently allowed to fine clinics, it would consider this if given new powers in the Government’s review of fertility legislation.

A public consultation begins today, but the cap is expected to be approved in October as it has already been backed by a coalition of 21 patient and medical groups.

Three other options for change were also presented in the consultation document. The main alternative to a cap would be to set strict criteria for patients who must first be treated with only one embryo. In practice, this is likely to mean women aged under 35 who have not tried and failed at IVF before, and many doctors object to this as it would limit their capacity to treat individual patients on their merits.

Such a policy could also be combined with the cap, and pressed only on clinics that exceed the 10 per cent rate. A fourth option is to improve patient awareness of the risks of multiple births, but most experts think this does not go far enough.

Multiple births

1 in 80
Proportion of multiple births after natural conception

1 in 4
Proportion of multiple births after IVF

Number of deaths that would be avoided if all IVF babies were singletons

11, 941
Number of babies born as part of multiple births in 1978

18, 395
Number of babies born as part of multiple births in 2003

Proportion of IVF babies that are twins

Source: HFEA