Huge rise in ICSI but half of all babies still come from multiple births
15 December 1998
The Human Fertilisation and Embryology Authority (HFEA) today published its 1998 Annual Report, revealing a steady rise in IVF treatments and success rates as a result of a technique introduced four years ago.
ICSI (Intra-Cytoplasmic Sperm Injection) involves a sperm being injected directly into an egg, and has enabled thousands of men to have their own children for whom it previously would not have been possible. Particularly helpful for men with low sperm counts or motility, the number of babies born has increased five-fold in the last year, with over 3,000 babies being born so far.
As the success of ICSI treatments is dependent to a very high degree on the skills and experience of its practitioners, the HFEA has introduced special competency assessment and licensing for them. Mrs Deech said:
"This revolutionary technique has enabled many men who previously would never have been able to have their own children to do so. A highly delicate procedure, its initial success rate of around 4% per treatment cycle has risen dramatically to 21.6%. New guidelines introduced this year will ensure the highest standards of treatment and facilities.
"Concerns have been raised regarding the genetic consequences of the use of ICSI and the development of infants conceived by ICSI. We have considered these issues, and this year issued information to clinics addressing the risks of ICSI and suitable information for patients. In addition the HFEA is keen to work with others to follow up children born as a result of this technique."
Multiple birth rates remain ‘too high'
Last year almost half of individual IVF babies (47%) came from a multiple birth. Although it is impossible to be exact, it would appear that at least half of triplets in the UK as a whole were a result of IVF treatment.
Multiple births are a common result of IVF because doctors normally put back two or three embryos (but not more) after fertilisation. Figures released today show only a marginal difference in live birth rate between two and three embryo transfer (20.0 to 22.5%), but a much increased multiple birth rate (from 22.4% to 32.2%).
Where more than four embryos were created in the IVF treatment, there is no difference at all in the live birth rates between two and three embryo transfers, but a jump in the multiple birth rates. Following the transfer of the maximum of three embryos, over 40% of live births to women under the age of 30 were multiples, and one in six of these were triplets.
Mrs Deech said:
"Multiple births can be the source of much stress and anxiety for parents. There is a greater risk of complications or even miscarriage, as well as long term disability, and they can cause considerable emotional and financial pressure. People undergoing IVF treatment should be aware that as the technique becomes more successful, so the risk of a multiple birth increases. We shall keep the issue under active consideration."
Interim Patients Guide to DI and IVF Clinics
Unlike previous editions of the Patient's Guide, the individual live birth rates of clinics have not been adjusted statistically to take account of the different types of patient treated. The rates in this interim guide are not therefore directly comparable. The main factors that determine the chances of a successful outcome are the age of the woman, the length of time the couple has been trying to have a family, previous ability to conceive, and the quality of the sperm. Some clinics have very different types of patient groups to others, and this can explain many of the differences in the data. Mrs Deech said:
"Some clinics pick patients who are most likely to conceive – for example by having an upper age limit. Also some clinics do much more ICSI than others, which has a higher success rate. It would therefore be wrong this year to compare directly the live birth rates of clinics.
"We are publishing the data this year because we have it and we cannot justify not giving it to patients who ask for it. The data is useful for patients because it shows detailed information about the treatment policies of each centre, such as the amount of ICSI they do, their multiple birth rates and their success with donated eggs and frozen embryo transfers.
"We are totally redesigning the Guide for next year and are considering showing the results by age and type of treatment. These would be much better indicators of individual clinics' performance."
On the subject of clinics with lower live birth rates, Mrs Deech said:
"Most clinics' live birth rates have increased every year. Low results do not necessarily mean that a clinic is poor. The Guide makes it very clear that outcomes may vary because of a clinic's policies on minimising the possibility of multiple birth, minimising the incidence of over-stimulation or for a number of other reasons. A feature in producing high success rates is often thought to be the length of time a clinic has worked together. Therefore a change in the team can have an impact on a clinic's results. We encourage patients to ask clinics about their most recent data."
Notes to editors
The HFEA safeguards and protects patients and the public in the field of licensed infertility treatments - still the only statutory body of its kind in the world. It monitors all licensed treatment centres and inspect them annually, requiring and helping all centres to achieve and adhere to the highest standards in our Code of Practice. The HFEA also licenses and monitors all human embryo research, and seeks to stimulate and lead national debates on key ethical areas.
Since this Annual Report went to print, five HFEA Members have been replaced:
- Professor Ruth Chambers,
- Liz Forgan,
- David Greggains,
- Richard Jones and
- Professor Anthony Thiselton
They have made way for:
- Professor Brenda Almond,
- Professor Henry Leese,
- Dr Sadia Muhammed,
- Sara Nathan and
- Sharmila Nebhrajani.
For furthur information please contact the HFEA press office.
Page last updated: 13 March 2009