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29 January 2010

Multiple births policy

I am writing to thank centres for their hard work over the past year in implementing their multiple births minimisation strategies and to let centres know what will happen next.

 

Year 2 maximum multiple birth rate

After evaluating the first year of the policy, the Authority decided at their meeting on 20 January 2010, to set the Year 2 maximum multiple birth rate at 20%. In making this decision, the Authority reviewed feedback from centres and patients, including from the Multiple Births Stakeholder Group, and analysed the likely impact on centres and on overall live birth rates. The Authority decided that 20% would maintain the momentum that centres have built up in the past year whilst allowing centres time to review and improve their strategies to lower their multiple rate further.

I attach the revised Multiple Births General Directions, which will become effective on 6 April 2010. The new maximum rate means that no more than 20% of a centre’s annual live birth events (from treatment started between 6 April 2010 and 5 April 2011) should be multiple births. This includes all IVF, ICSI and GIFT treatment using fresh and frozen embryos/eggs, from patients’ own eggs and donor eggs. It does not include live births from IUI or DI. In April 2010 the Code of Practice will be updated to include guidance stating that centres should not exceed the Year 2 maximum multiple birth rate of 20%. We will also begin monitoring centres’ multiple pregnancy and embryo transfer rates in ‘real-time’.

 

Evaluation of Year 1 and auditing your strategies

The Authority wishes to acknowledge what centres have achieved in rising to this public health challenge. All centres now have a strategy in place to reduce multiple births in their centre, which we will actively monitor adherence to. Two thirds of centres are predicted to be within the Year 1 maximum multiple birth rate of 24% for treatment started in 2009, with many being significantly below this. The majority of centres have shown that they are committed to reducing the risk of multiple pregnancies to the health and welfare of patients and children born after IVF, and feel confident about lowering their multiple birth rate in the future.

We appreciate that this year has been a steep learning curve, with many centres making changes to clinical practice, training staff and updating patient information. Now is the time, if you have not already done so, to audit and evaluate the effectiveness of your multiple births minimisation strategy. The HFEA is committed to supporting clinics as they work to improve their strategies. To help centres in this, please find attached the key findings and the national data analysis from our evaluation of the first year of the policy.

We understand that centres who are making efforts to reduce risks and to improve their practice want to be reassured that the HFEA will take action against centres that are not.

Staff from centres that have not audited the effectiveness of their strategy or made efforts to implement corrective actions will, as a first step, be asked to attend a management review meeting. This is part of the HFEA’s overarching Compliance and Enforcement policy. The meeting will provide an opportunity for centre staff to explain any difficulties they have experienced in achieving a reduced multiple birth rate and for HFEA staff to share good practice. For example it may involve making recommendations about patient information or an external peer review of the centre’s strategy.

Over the next few months, we will be assessing individual centres’ performance against Year 1 of the policy. We will analyse centres’ clinical pregnancy and single embryo transfer rates from 2009 compared to previous years. As with all new policies, we understand that as you review your practice you may have identified problems that will have led to changes in your strategy. So that we can take the facts as well as the figures into account when assessing your centre’s performance, every centre is asked to complete a short online questionnaire about how they have implemented and audited their strategy by 28 February 2010.

Please log into the Clinic Portal to access the questionnaire: https://portal.hfea.gov.uk/ClinicPortal/Login.aspx.

By the end of May 2010 we will report to centres individually about how we have assessed their performance against Year 1 of the multiple births policy and outline any next steps we will be taking.

 

Sharing best practice

The HFEA will continue to work closely with the professional bodies and engage with the sector to review and share best practice around minimising multiple births. We will make information available to centres through the One at a Time website, through future reviews of professional body guidance and through a series of four regional workshops we are holding for centres in March and May this year (details of workshops are attached).

If you have any further questions about the content of this letter, please contact your inspector.

Yours faithfully,

Professor Lisa Jardine CBE
Chair - Human Fertilisation and Embryology Authority

Page last updated: 17 August 2012

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