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04 December 2007

The HFEA have today called for a professionally led, coordinated national strategy to reduce the number of multiple births that occur following fertility treatment which contribute to significant numbers of premature and low birth weight babies.

An increased rate of twin births represents IVF's biggest risk for mothers and babies because they significantly raise the chances of mortality, prematurity, low birth weight and cerebral palsy for babies. It can also cause life-long term problems for children and risks to mothers, including preeclampsia, diabetes and heart disease.

Following the HFEA's public consultation on the best outcome for IVF babies, the Authority have concluded that they expect to see the multiple birth rate to fall to 10% following a 3 year national strategy.

The Authority have now called on the relevant professional bodies to lead on developing guidance on the best way to achieve this change across all types of fertility treatment, including those which fall outside the HFEA's regulatory system.

A recent study has shown that the rate of multiple births and the risks they bring to women and babies is disproportionate for all types of fertility treatment, but especially IVF. Although IVF treatment accounts for only 1.2% of all UK births, it accounts for nearly 1 in 5 of the multiple births in the UK.

Other fertility treatments have also been shown to contribute to a higher incidence of multiple births, including IUI and drugs for ovarian stimulation. As some of these treatments fall outside the HFEA's remit, the Authority are calling for a national strategy, co-ordinated by the professional bodies to set out guidance on best clinical practice during treatments which cause a higher rate of multiple births.

Work on this strategy is due to begin in mid December, to begin the challenge of finding the best long term strategy for clinics to bring down their multiple birth rates. The progress of this work will be discussed at the Authority's open meeting in February 2008.

Walter Merricks, Interim Chair of the HFEA said:

"This issue is about improving baby health and safety. Maximum safety means the way the body was designed, one baby at a time. As many as 126 IVF babies die each year as a result of being born as part of a multiple birth and many more can face serious health problems which can last a lifetime.

"We are not in the business of intervening in the decisions made between a patient and their doctor or sacrificing women's chances of conception by asking clinicians to force women to have treatments that offer low chances of success. But this is a real problem that has to be addressed.

 "The HFEA's latest clinic data has shown a slight increase in 2005 in the proportion resulting in both twin and triplet births following IVF, compared to 2004. It is clear that the increasing success of IVF is driving the number of multiple births up instead of down.

"But the issue of multiple births and the problems that they can provide is bigger than just IVF and, therefore, bigger than just the area which the HFEA can influence. IUI and drugs for ovarian stimulation also contribute to a higher incidence of multiple births. This is why we are calling for a co-ordinated, long term, national strategy to tackle this issue over time.

"The principles of good medical practice in this country are that it is evidence-based and professionally led. This issue is no exception - the profession needs to lead the way and the HFEA will do everything it can to support that.

"This approach means that the experts in this sector who treat patients every day will be able to decide on the detail of how this risk is reduced in a way that is workable for clinics and patients. This will take time, but we applaud the commitment shown already by the professional bodies and look forward to working closely with them to improve baby safety following IVF."

Ends

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Notes to editors

The HFEA consulted on measures to tackle the problem of multiple birth at the start of 2007, including meetings with patients, professionals and their representative groups. This work followed the publication of the report 'One Child At A Time' which was published by the expert Group on multiple births after IVF, chaired by Professor Peter Braude of the Royal College of Obstetricians and Gynaecologists.

Read more information about the consultation and the Braude report

• Of all babies born in the UK 1.2% are twins or triplets. Around 1 in 5 (18%) of these are IVF babies
• With approximately 24% of IVF births being multiple births, this means that of all the IVF babies 40% are twins or triplets.
• Ill health and death are significantly increased for twins compared with singletons, mostly due to twins being born prematurely or under weight. 

Premature and underweight babies account for half of all neonatal deaths.

• Between 40-60% of all IVF twins are transferred to neonatal units when they are born, compared to around 20% of singleton IVF babies.  8% require assisted ventilation and 6% suffer from respiratory diseases, whilst a small minority will also have ongoing health and developmental problems, including cerebral palsy.
• The risks also extend to mothers of multiple births with around 20% suffering from induced hypertension.  The risk of pre-eclampsia increases threefold for mothers of twins and is nine times higher for those with triplets.  Furthermore, the incidences of mothers developing gestational diabetes are two to three times higher than singles pregnancies resulting in longer periods in hospital.

Download the speech

• Improving baby safety by reducing multiple births (31Kb)
  Walter Merricks, interim Chair, HFEA, Speech to BFS winter conference

Page last updated: 14 April 2009

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