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Cut Twin IVF Births ' HFEA Consultation


The number of twins born from IVF needs to be cut because of risks to mothers and babies. a watchdog has said. The Human Fertility and Embryology Authority (HFEA) says as treatment has become more successful the number of multiple births has increased. Some 40% of IVF babies are twins. but many are born prematurely and more than 100 die every year. The HFEA has begun public consultation on a range of options which could lead to fewer multiple births. (Reported BBC News April 4th 2007)
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At least half of twins are born prematurely with a lower weight. They are far more likely to need specialist care in the first few months and also are at a greater risk of poor health throughout their lives. The chances of severe disability such as cerebral palsy are also higher in babies born in twins.
HFEA chairman Shirley Harrison said these risks are avoidable. as are the deaths of some premature babies. "Doing nothing is not an option. The latest figures show 126 IVF babies die each year because they have been born as twins not single babies. We can't let that continue." she said. x
The consultation sets out four options for change. including simply making women more aware of the risks of multiple births. The HFEA is also considering whether there should be a gradual move towards a maximum for each fertility clinic of 10% of births being twins.
An alternative could be setting out guidelines for which patients should only be given one embryo. The HFEA says any change needs to be flexible to take account of the wide range of patients seeking fertility treatment. Older women or those who have already been through several unsuccessful IVF cycles would be very unlikely to be restricted to one embryo transfer.
'Numbers game' Susan Morgan is one patient who has benefited from having two embryos transferred. She now has twin daughters Hannah and Olivia. after many years of stressful and expensive fertility treatment. "I was very aware of the risks. but it was a numbers game. If I hadn't had multiple embryos I wouldn't have had children." she said.
Most fertility specialists support change and some clinics are already trying to increase the number of patients implanted with just one embryo. Mr Yacoub Khalaf. the head of the assisted conception unit at Guy's and

St Thomas ' Trust said: "We are already achieving great successes by replacing only single embryos in many of our suitable patients. "In the last year our overall pregnancy rate has risen and our multiple pregnancy rate has been reduced."
Success rates : Despite the consensus it could be hard to bring about change. The vast majority of fertility patients pay for their own treatment as access to NHS funding is extremely patchy. With an average cost for one cycle of IVF of 5.000 it is no surprise that couples seeking treatment are very interested in success rates. Each clinic is legally obliged to publish the number of pregnancies and live births per cycle of IVF.
There is a level playing field as the regulations allow a maximum of two embryos to be implanted in women under 40 years old. and a maximum of three for women over 40. Fertility experts have warned about the combination of patients funding their own treatment and a virtual league table of success rates.
Patchy provision : Three years ago. the government said the NHS should be offering one cycle of IVF to suitable patients by April 2005. It was seen as a stepping stone towards implementing the guidance from the National Institute for Clinical Excellence (Nice) of three NHS funded cycles. In many areas that simply has not happened. and the criteria for receiving NHS-funded treatment can differ widely from one area to another.
The Department of Health says it is working with the charity Infertility Network to look at the patchy provision of IVF. A spokesman said: "We recognise that infertility causes pain and distress. It is important that infertile couples have access to IVF regardless of where they live and we would encourage trusts to work towards providing this." Report taken from BBC News April 4th 2007)


HAVE YOUR SAY - A consultation for the HFEA - Opinion Leader
If you have conceived twins. after IVF. this is your chance to tell us what you think. The Human Fertilisation and Embryology Authority (HFEA) is reviewing their policy into multiple births. particularly twin births. after IVF. We would love to hear your views on multiple births after IVF.
The HFEA has asked Opinion Leader to run some group discussions with people who have had IVF treatment about their views on multiple births after IVF. These discussions will be part of a bigger consultation with the public.
The group discussion will be held in

Central London at the end of April/beginning of May from 6.30pm until 9.00pm and you will receive 70 as a thank you for taking part. Anything you say will be confidential.

If you are interested in taking part please send your contact details (including address and tel) by email to: multiplebirths@opinionleader.co.uk.
If you are experiencing infertility issues and would like information on the treatment options. then please also see our article 'Assisted Reproduction Technology - IVF & Assisted Conception'
For Fertility / Infertility advice and information. you can also find organisations under our Useful Links.

There has been much debate in recent years on the reduction of IVF multiple births. below there are some articles that may also interest you.


One embryo call for routine IVF BBC Wed Oct 18th 2006
Women undergoing routine IVF in the should only have one embryo implanted. fertility experts have recommended. They say this will drastically reduce the rate of multiple births. which are dangerous for both babies and mothers. Current practice is to transfer two embryos into the womb during treatment. but the group said success rates would remain the same if just one was used.
Infertility campaigners welcomed the report. compiled for the Human Fertilisation and Embryology Authority. Presently. one in four IVF pregnancies results in twins - this is more than 10 times higher than the rate of twins born from natural conception. But the expert group said twin births carry a number of risks compared with single babies:


· twins are three times more likely to be stillborn
· they are four times more likely to die after birth
· they are six times more likely to develop cerebral palsy
· Mothers are more likely to suffer high blood pressure and face a higher risk of morbidity

They also said that. because twins are 50% more likely to be born prematurely. their treatment costs place a heavy financial burden on the NHS. Professor Peter Braude. who led the working group. said: "Multiple birth is the single biggest risk to the health and welfare of a child born by IVF."
Present practice in the is to transfer two embryos in women under 40 and three embryos for women who are older than this. But the expert group said this should change. The group recommended the HFEA should redefine their guidelines so that single embryo transfer is used for the women most likely to become pregnant from IVF (based on age. embryo quality and the number of treatment cycles they have undergone). They also recommend clinics should have an upper limit for the number of twins that result from their treatment. bringing proportions down to 5-10%.

NHS savings
Professor Braude said reducing the number of embryos transferred in one cycle would not reduce the overall success rate in IVF. He pointed to other countries. such as . who have taken up single embryo transfer. and said studies showed the pregnancy rates had remained the same.
Professor Bill Ledger. a fertility expert from


Sheffield

University and another member of the committee. said: " The NHS could save a conservative 15m in the next financial year by moving to single embryo transfer." He said that if this money could be used to pay for more treatments. this could mean an extra 7.500 cycles of treatment a year. Professor Braude added: "We believe that we cannot as a country sit back as a country and do nothing about this."
Jane Denton. director of the Multiple Births Foundation. said: "The aim of all infertility treatment should be to have one live. healthy baby. "The anguish of watching one or more of your children die or living with a severe disability is a situation no parent would wish to face. yet it is a frequent consequence of multiple births that is so often underestimated."
But Dr Mohamed Taranissi. medical director of the Assisted Reproduction And Gynaecology Centre (ARGC).

London . said: "If the HFEA moved towards adopting single embryo transfer indiscriminately - it would probably result in a small decrease in twins but a larger number of people who do not become pregnant."
Clare Brown. chief executive of Infertility Network said: "We share medical concerns regarding the risks of multiple births. both to the mother and children born.
"We would support a move towards single embryo transfer. but would stress the need to ensure that the National Institute for health and Clinical Excellence fertility guideline is implemented in full. so that couples would be able to receive up to 3 full cycles of IVF on the NHS."
The HFEA said it would be considering the recommendations over the coming months before coming to a final decision next year.
Single IVF embryo 'just as good' Thurs 1st June 2006
Selecting one quality embryo is as likely to result in a successful IVF pregnancy in older women as in their younger peers. research suggests. The Finnish study suggests embryo selection is an option for some older women - rather than simply using more than one embryo in each IVF cycle. Using more than one embryo raises the chances of a risky multiple pregnancy.
Experts welcomed the Human Reproduction study. but said a culture change was needed. Traditionally. the use of multiple embryos has been more common among older women. who are thought to have less chance of becoming pregnant during IVF.
Currently. woman under the age of 40 should be offered one free cycle of IVF treatment on the NHS in under government recommendations. although the final decision rests with local primary care trusts. Ministers have so far refused to fund three cycles for each woman. as recommended by the National Institute for Clinical Excellence. At the


University of

Oulu clinic. where the latest study was carried out. four out of 10 women aged 36-39 are now treated with selected single embryo transfer. As a result. the clinic's rate of multiple pregnancy has been cut to less than 10%. Multiple pregnancy increases the risk of premature birth. and other complications.





Similar rates : The researchers compared the results of more than 2.000 IVF cycles carried out in women in the older age group with those from younger women. They found that. like younger women. a third of women aged 36-39 achieved pregnancy after a single IVF cycle using just one selected embryo. The live birth rate was also similar: 26% for the older age group. compared to between 27% and 30% for younger women. The chances of a pregnancy rose to 54% for women aged 36-39 who underwent more than one cycle of treatment using a single selected embryo each time.
The researchers also found that over several cycles of treatment single embryo transfer using selected embryos outperformed double embryo transfer. While the pregnancy rate over time was nearly 55%. the rate of multiple births was less than 2%. In contrast. the pregnancy rate among women who were treated with double embryo transfer was just 35%. while the rate of multiple births was 17%.
'Instant families' A spokesman for the Human Fertilisation and Embryology Authority said it had set up an expert panel to find ways to cut the number of multiple births resulting from IVF treatment.
Dr Allan Pacey. Honorary Secretary of the British Fertility Society. said most professionals agreed using selected single embryo transfer as often as possible would have a huge impact in reducing the number of twins and triplets born as a result of IVF. However. he said the success of single embryo transfer in countries such as had only been possible because IVF is so well funded by the state. "In the . where the majority of couples are paying for their own IVF treatment. twins and triplets are often still seen by couples as an "instant family" without the need for repeated cycles of treatment.
"We need to work hard to explain the risks of multiple births to patients and also to lobby for better state funding to allow couples the option for single embryo transfer without worrying about money." Dr Pacey added that older women were less likely to produce high quality embryos. and that assessing quality was still not an exact science.


Clare Brown. of the Infertility Network . said: "It is understandable that the vast majority of couples are deeply unhappy about any move to single embryo transfer whilst there is still a severe lack of NHS funding for fertility treatment. "
IVF multiple births 'drain NHS' Thurs 23rd June 2005
IVF multiple births cause considerable financial costs to the NHS. a fertility conference has heard. Triplets cost more than 32.000 compared to about 9.000 for twins and just over 3.000 for single births.


Sheffield

University experts claimed. Fertility specialists at a conference in called for laws to ensure just one embryo is implanted - the limit for most is two per IVF cycle. This would be better for mother and baby. and cost effective. they said.

Expense : Last May. the regulator said women under 40 can only have two embryos implanted per cycle. Women over 40 can have three implanted. the Human Fertilisation and Embryology Authority said. is one country where doctors are only allowed to implant one embryo per cycle of IVF treatment. Professor Bill Ledger and colleagues at

Sheffield

University calculated the costs associated with all babies born after IVF between 2000 and 2001 in the . The bulk of the 6.309 live births were single babies. while twins made up 27% and triplets 2%. Professor Ledger's team says this is still too many multiple births. when the related healthcare costs of the neonatal care are taken into account . Multiple pregnancies are more likely to run into complications that can require longer and more expensive treatments. they explained.
Political will : Currently. the NHS pays for only a quarter

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