FAQs - Multiple births consultation

 

Why is the HFEA saying that twins are a problem? I would be happy to have twins

The twin birth rate after IVF is much higher than the naturally occurring twin birth rate. Currently around 1 in 4 IVF pregnancies results in the birth of twin or triplets (around 40% of IVF babies are twins). The natural twin rate is around 1 in 80 births (just over 1%).

If these twins were as healthy as singleton babies when they are born, there would not be any concerns about this. However, twins have much higher risks of ill health and death compared to singletons.

  • Around half of all twins are born prematurely or with low birth weight (around 90% of triplets)
  • Risk of death in the first week of life is 5 times higher for twins and 9 times higher for triplets
  • Twins have a 4 times higher cerebral palsy risk than singletons (around 8 in 1000 twins will be affected)

There are also risks for women carrying twins.

  • Risk of death is small, but doubled for women carrying twins
  • Increased risk of pre-eclampsia and diabetes
  • Increased risk of miscarriage, operative delivery and haemorrhage


Why are there so many twins born after IVF?

This is due to current embryo transfer practices, where almost all women have two embryos transferred during IVF. If both embryos implant, the result is a twin pregnancy with non-identical twins.

The rate of identical twins is also increased after IVF for reasons that aren't fully understood, but by far most IVF twins are non-identical and the outcome of two-embryo transfers.


What can be done?

The high twin birth rate is the result of putting back two embryos during IVF. The IVF twin birth rate can only be brought down by transferring one embryo to those fertility patients who are most likely to conceive after IVF and therefore most likely to have twins.

This does not suggest a complete ban on two-embryo transfers. The countries that have introduced single embryo transfer as normal clinical practice still restrict it to the fertility patients with the best prospect of success. In this way they managed to maintain good success rates.


Who would be suitable for single embryo transfer?

Single embryo transfer would only be recommended for fertility patients with a relatively good prospect of conceiving after IVF. They tend to be younger (under 35) and haven't had many failed IVF cycles before.

There are a number of other factors affecting implantation and success rates, for example embryo quality, endometriosis, tubal disease or whether a woman has been pregnant with IVF before.
 
For patients who are older than 35, have had many failed cycles or poor embryo quality, two embryo transfer should remain a treatment option. The risk of twin pregnancy and birth should be explained to all patients.


Will single embryo transfer halve my chances of getting pregnant?
 
No. Single embryo transfer should only be offered to patients who will have a good chance of conceiving. In this way, pregnancy rates will be comparable with two-embryo transfer.

An international data shows that success rates remain high even after single embryo transfer. For more information, see the HFEA Consultation Document and Expert Report.


Who will get single embryo transfer?

Experts say single embryo transfer to be given to women with the best prospect of success.

This will rely on factors such as:

  • the woman's age
  • the number and outcome of previous treatment cycles
  • the number of eggs produced in response to hormone treatment
  • the number of good quality embryos available for transfer.

 

Will I have to pay more for further treatment if I don't get pregnant after the first initial single embryo transfer?
 
Questions of funding and private sector charges are outside the remit of the HFEA because of the legislation that underlies the HFEA's powers (the HFE Act 1990).
However, the HFEA has raised the issue of NHS funding for fertility services with the Department of Health and local commissioners.

We are aware that cost pressures for patients are significant and better access to NHS funded treatment would make it easier to introduce single embryo transfer policies.

 

What is the HFEA doing about the issue of multiple births after IVF?

The HFEA is launching a public consultation on what should be done on the problem of multiple births after IVF. The purpose of this consultation is to hear your views about how the decision to use single embryo transfer should be made and who the use of single embryo transfer would be most appropriate for.

 

How do I respond to the consultation?

The consultation will run until 4 July 2007. You are invited to respond to this consultation by filling in an online questionnaire or you can send us a paper copy of your answers.

You can request a consultation document by calling 020 7291 8235.

For more information about this consultation and background research, please visit www.hfea.gov.uk/multiplebirths 

 

Last updated: 11 April 2007