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Dear Colleague

Multiple births policy: the final (Year 4) maximum multiple birth rate

I am writing to thank you for your hard work over the past few years in implementing your multiple births minimisation strategy and rising to this public health challenge.  Collectively, centres have ensured that serious risks to mother and baby have been avoided whilst maintaining the quality of their care and success rates. This letter outlines what will happen next.

The Authority met on Wednesday 25 January to consider options for introducing the next maximum multiple birth rate. After carefully reviewing the progress of centres so far, and taking into account the advice of the Multiple Births Stakeholder Group, the Authority decided to set the final (Year 4) maximum multiple birth rate at 10%, which is the rate we have been aiming for from the outset of the policy.  Ordinarily, we introduce a new target rate each year in April. However, we appreciate that the current 15% Year three target has been challenging; so when making the decision about the Year 4 target the Authority acknowledged that centres need time to refine their strategies and implement changes. Therefore, the 10% target will come into effect on 1 October 2012.

This means that no more than 10% of a centre’s annual birth events, from treatment started from 1 October 2012 onwards, should be multiple births. Births from IVF, ICSI and GIFT treatments using fresh and frozen embryos/eggs, from patients’ own eggs and donor eggs are included in this multiple birth rate. Births from IUI or DI are excluded.


Sector performance so far

The sector as a whole has responded very well to the drive to reduce multiple births. Since the introduction of the policy in January 2009, the proportion of eSET has increased, the multiple pregnancy rate has decreased and the overall pregnancy rate has remained steady. The pregnancy rates from elective single embryo transfer are similar to the pregnancy rates from double embryo transfer.

The national average data shows the sector as a whole was under the Year 1 (24%) and Year two (20%) maximum multiple birth rates and is predicted to be close to the Year 3 maximum multiple birth rate of 15%. The multiple pregnancy rate is currently at 19.9% (the equivalent multiple pregnancy target for Year 3 is calculated to be 19%).

We will revise the Multiple Births General Directions 0003 to reflect the new target. These revised Directions will be issued to centres in July 2012 and will come into effect on 1 October 2012.

Ongoing monitoring

Your multiple births minimisation strategy is critically important, as are your arrangements for reviewing and auditing the strategy. At inspection, from October, we will look at evidence that your strategy and outcomes are reviewed in light of your performance with regard to the target.

Compliance with this new target will also be monitored on an on-going basis. We will continue to monitor clinical pregnancy rates using the latest performance information available through the risk based assessment tool. Where analysis of clinical pregnancy rates indicates that the resulting live birth rate is likely to be in excess of the target your inspector will alert you to this so you can review your multiple births minimisation strategy. We are also developing automated systems for communicating this information to you on a monthly basis and for giving you access to your own risk based assessment tool outputs through the clinic portal.


Sharing best practice

We will continue to work closely with the professional bodies and the wider sector to review and share best practice around minimising multiple births. We will continue to 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 centre staff in February and March this year (details of workshops are outlined in ‘Clinic Focus’).

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

Yours sincerely,

Alan Doran CB
Chief Executive

Page last updated: 24 August 2012