More IVF could be provided if only one embryo transferred
Dr. Kirsty Horsey
Progress Educational Trust19 January 2006
UK researchers say that an additional 10,000 cycles of IVF per year could be provided free on the National Health Service (NHS), if clinics took action to reduce the number of multiple births following IVF. It is common for women undergoing IVF to have two embryos implanted at a time, to increase their chance of becoming pregnant, and some women may even have three embryos implanted.
In July 2005, the UK's Human Fertilisation and Embryology Authority (HFEA) reviewed its guidelines on how many embryos can be implanted during IVF treatments. At the time, over 90 per cent of IVF cycles in the UK involved the transfer of two or three embryos. The HFEA was considering limiting IVF treatments to the transfer of a single embryo per cycle, as has been done in some other European countries. Current guidance, found in the HFEA Code of Practice, stipulates that clinics should transfer no more than two eggs or IVF embryos at a time to women under 40 years old and no more than three eggs or embryos to women older than 40.
Multiple births are associated with a number of medical problems in infants, the costs of which are picked up by the NHS. The rate of multiple births has risen by 20 per cent over the last 10 years. Twin and triplet babies have an increased chance of being born prematurely or with a very low birth weight, often meaning they are highly dependent on medical intervention and support after birth. If there were fewer multiple births, say the researchers, writing in the British Journal of Obstetrics and Gynaecology (BJOG), many of these medical costs could be saved, and the money ploughed back into treating infertile people.
The research was led by Professor William Ledger from the University of Sheffield. The study showed that the costs of an IVF pregnancy for a singleton birth, allowing for all costs incurred by both mother and baby, was ?3,313. However, when a woman had IVF resulting in a twin birth, these costs were almost tripled, rising to ?9,122. Even more startling were the costs associated with a triplet pregnancy, which rose to ?33,354.
On this basis, the research team said that there should be a move towards clinics transferring only one embryo per IVF cycle. If this was done, they calculated, an extra 10,124 cycles of IVF could be provided by the NHS each year. If each couple was funded for three cycles of treatment, this would amount to 3,374 couples being treated per year from the savings made on multiple birth costs, they said.
Clare Brown, Chief Executive of patient group Infertility Network UK, said that the group shares the medical concerns brought out in the research. But, she added, 'while there is still a severe lack of NHS funding for fertility treatment it is understandable that some couples are willing to take these risks. Patients who receive no NHS funding and can only afford to pay for one private cycle are often willing to risk twins or even triplets to allow them to have the family they so desperately want'. She continued: 'further research is needed to ensure that single embryo transfer does not compromise success rates for patients'. She also pointed out that in countries where single embryo transfer is the norm, such as Belgium and Denmark, couples are entitled to six and five free cycles of IVF respectively.
Reproduced with permission from BioNews, an email and online sources of news, information and comment on assisted reproduction and genetics.