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BMJ. 2007 April 14; 334(7597): 766.
PMCID: PMC1852009

HFEA wants greater use of single embryo transfers in assisted reproduction

The United Kingdom's Human Fertilisation and Embryology Authority (HFEA) has launched a consultation to examine four options to reduce multiple births after in vitro fertilisation (IVF).

Each year in the UK 126 babies born after IVF die as a consequence of multiple birth, and the risk of death in mothers, although low, is doubled in women who are expecting twins. Currently 24% of women who have had IVF have a multiple birth.

The HFEA wants to encourage the use of single embryo transfers in each treatment cycle in patients who are most likely to conceive (such as those who are relatively young and who have not had many failed IVF attempts). At the moment many of these women receive two embryos in a treatment cycle.

The HFEA has previously limited women aged under 40 to two embryos per treatment cycle, but this has failed to reduce the high percentage of births of twins.

It believes that the current rate of twin births of about 23% of all births after IVF needs to be brought down to below 10%. In its consultation paper it argues: “This [rate] has been shown internationally to be achievable without damaging patients' chances to conceive.”

In four policy options the HFEA proposes to:

  • Work with clinics, patients, and professional bodies to increase awareness of the risks of multiple births and to encourage greater use of single embryo transfer
  • Set a maximum rate of twin births of no more than 10% that each clinic must not exceed (which could be phased in over a number of years)
  • Develop code of practice guidance that defines the cases in which only one embryo should be replaced, which would be based on, for example, age, number of previous treatment cycles, medical history, and, possibly, embryo quality
  • Combine the second and third options—that is, clinics could initially be given an overall maximum rate of twin births; clinics that fail to achieve this target could have single embryo transfer criteria imposed on them by the HFEA.

Consultation will be for three months from April, and a report is due in autumn 2007.

The HFEA stresses that it has no remit to make IVF treatment funded on the NHS more widely available, which it acknowledges is the biggest obstacle to the acceptance of policy change. Evan Harris MP, the Liberal Democrats' science spokesman and member of the House of Commons Science and Technology Select committee, agrees that access to NHS IVF services is the main issue in the UK.

He said: “Seventy five per cent of IVF in this country is currently paid for by couples themselves because they simply have no other choice.

“Given their lack of options, couples forced to pay for their own treatment may resent being told they are now not allowed to choose multiple embryo transfer after having the risk explained to them, even if their doctor thinks it will improve their chances of conception.”

Notes

The Best Possible Start to Life is at www.hfea.gov.uk/en/483.html


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