End of the IVF twins: New restrictions mean only one embryo can be used in fertility treatment

12 April 2012

Embryo cap: New proposals aim to limit women to one embryo wherever possible

Under plans that could spell heartache for thousands of childless couples, regulators want to cap the number of multiple births.

Clinics are currently permitted to return two or even three embryos to a woman's womb during IVF treatment.

This maximises the chances of at least one of the embryos resulting in a successful pregnancy.

But proposals - from the Human Fertilisation and Embryology Authority - aim to limit women to one embryo wherever possible.

The regulator says this will cut the number of multiple births and reduce the health complications associated with them.

One in four IVF babies is a twin or triplet. They are more likely to die before or during birth or to be premature, underweight or disabled.

It is estimated that if all IVF children were single births, 126 fewer babies would die each year.

Critics claim, however, that limiting the number of embryos would reduce the chances of a successful pregnancy and make fertility treatment even more costly for desperate couples.

Health Service funding usually covers just one cycle of treatment, explaining why three out of four couples pay thousands to go private - and have more embryos implanted.

Keith Reed, chief executive of Tamba, the Twins and Multiple Births Association, said publicly-funded treatment must be made more widely available.

"It would be unfair of the HFEA to proceed with their proposals in the current climate," he said.

"Instead of enacting new guidance which will potentially reduce patients' chances of conceiving, they must first work with the Government to ensure publicly-funded treatment is more widely available.

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One in four IVF babies is a twin or triplet. They are more likely to die before or during birth or to be premature, underweight or disabled

"If they carry through their plans, then they could shatter the dreams of thousands of patients."

Tamba has as many as 2,000 members who conceived multiples following fertility treatment.

The fertilisation authority says there is a consensus among doctors, clinics and patient groups that multiple births have to be curbed on safety grounds. It has been consulting since April on a range of options.

Multiple pregnancies are also more dangerous for mothers, who are at increased risk of miscarriage and complications.

At present more than 90 per cent of IVF procedures performed in Britain involve two or three embryos.

Among options being considered is a target 10 per cent maximum twin rate from IVF treatment which would be phased in over several years.

The authority is believed to have backed away from a hard-and-fast limit and accepts that the emergence of a "target-driven" culture could disadvantage some patients.

If a clinic hit the 10 per cent twin target half way through the year, some couples might have to settle for one embryo or even "shop around" for a double transfer elsewhere.

The success rate for IVF is 21.6 per cent and there are fears this figure could fall under the new policy.

The HFEA admits it does not know what impact a 10 per cent cap will have on success rates but said women would be able to freeze spare embryos for further attempts. This would come at extra cost.

Julia Bartlett, a Tamba member from Shropshire who conceived twins via by IVF, said: "The HFEA must understand that you want the best chance of having your own baby and if that means having two embryos implanted and developing into a twin pregnancy, then you roll with it.

"The decision of whether two embryos get put back should remain between the patient and the clinic, based on individual cases.

"These are babies that are desperately wanted, have been dreamt about for so long and will always be cherished."

A spokesman for the British Fertility Society said: "In the early days the desire to help patients meant more than one embryo was frequently used but the evidence shows this leads to health problems caused by multiple birth.

"Clearly having one embryo and one baby is much closer to nature. We are moving towards agreement about using one embryo wherever possible."

Powerful hormonal drugs used to stimulate the ovaries during IVF led to the deaths of four women, says a report by the Confidential Enquiry into Maternal and Child Health.

It found the women - three of whom were pregnant and one of whom may have been - died after developing complications.

But it warned that the deaths "would have gone unnoticed" without its three-year inquiry into maternal fatalities.

Conventional IVF uses injections of high levels of ovary-stimulating drugs to mature them faster for collection.

But if the ovaries are over-stimulated, known as ovarian hyperstimulation syndrome, it can endanger the woman's life by leaking excess fluid into other parts of the body, leading to blood clots.

Women having IVF should be monitored for the syndrome and if it happens, the transfer of an embryo to the womb should be cancelled.

This is because it is extremely dangerous to become pregnant while undergoing the symptoms of the condition.

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