Multiple births and single embryo transfer review

 

 

Why did we carry out this review?

The single greatest health risk for women following IVF, and any children they carry, is a multiple pregnancy with, on average, one in four IVF pregnancies being a multiple. By comparison, the figure is one in 80 for women who conceive naturally. 

With the number of IVF babies born per year being approximately 11,000, this contributes significantly and disproportionately to the national multiple birth rate and therefore presents a significant public health concern.

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About the HFEA review

In order to deal with the unacceptably high multiple birth rate following IVF, the HFEA carried out a detailed review and public consultation to identify the most suitable policy for reducing these rates.

The aim of this work was to find ways of encouraging clinics to reduce their multiple birth rate without diminishing patients' chance of having a baby.

As part of the review, the HFEA gathered together a group of experts, who produced a report, 'One child at a time'. The Expert Group argued that this risk can be avoided if only one embryo is transferred to those IVF patients who have the highest chance of conceiving (and therefore the highest risk of conceiving twins).

Best possible start consultation documentThe HFEA then launched a public consultation on the issue of multiple births after IVF in April 2007.

 

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HFEA decision

The Authority concluded that an outcomes based policy would be the most appropriate approach.

Key elements of the policy:

  • To bring down the UK IVF mulitple birth rate to 10% over a staged period;
  • The HFEA will set a series of interim targets over approximately 3 years towards the 10% goal. These targets will be an ´upper limit´ that will apply to all clinics. The first target will be 24% (the national average*) and will apply  from January 2009;
  • All clinics will be responsible for devising a ´multiple pregnancy minimisation strategy´ to lower their multiple birth rates, which should not exceed the interim targets set by the HFEA.

It is important to note that, even lower multiple birth outcomes have been achieved in various countries that have moved towards SET, such as Sweden and Belgium.

* 2005 statistic (the latest available figures)

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How is the new policy being implemented?

This policy is being implemented in partnership with professional bodies, patient groups and clinics and will form part of a broader ´National Strategy´ to reduce multiple pregnancies from all fertility treatments.

A National Strategy Stakeholder Group was established in December 2007.

The group is currently working on:

  • The development of professional body guidance on identifying appropriate single embryo transfer (SET) eligible patients and embryo grading
  • Organising training workshops for all clinical staff
  • The development of Communication campaigns (for patients, clinicians, nurses and counsellors)
  • An HFEA review of how it represents clinics' performance, including live birth ´success rate´ data on the ´Find a Clinic´ search on the website.
  • Addressing the inconsistent provision of NHS treatments

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Latest news

  • The second meeting of the National Strategy Multiple Births Group was held on 28 March.  
  • HFEA Chief Executive wrote to NHS Directors of Public Health in January 2008 to outline the public health challenge of multiple births, including with it a briefing note on the issues around multiple births.

Read the letter and briefing note to Directors of Public Health (900 Kb)

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Timeline of key events

This is a long-term project, during which the scientific and medical evidence -along with the views of patients, clinics and other relevant professionals - is being very carefully considered. Key events and decisions include:

  • October 2005-September 2006  An Expert Group reviews the evidence on multiple births and single embryo transfer (SET) and makes recommendations to the HFEA.
  • October 2007  The Authority considers the evidence and conclusions from the Expert Group´s report, "One child at a time".
  • April - July 2007  The Authority carries out a public consultation, setting options for reducing the incidence of multiple births following IVF and potential regulatory actions to support this.
  • May 2007  ´Consensus statement´ published by professional bodies, patient groups and other stakeholders.
  • October and November 2007  The Authority considers the evidence and conclusions from the public consultation and decides on an outcomes based policy decision. They also called for the establishment of a National Strategy Multiple Births Group to help implement the policy. For more information see the October 2007 Authority meeting report. 
  • December 2007   First meeting of the ´National Strategy Stakeholder Group´
  • January 2008  HFEA Interim Chief Executive writes to NHS Directors of Public Health to outline the public health challenge of multiple births.
    Read the letter and briefing note to Directors of Public Health (PDF)
  • February 2008  An Authority Open Meeting clarified various policy details, including a January 2009 start date and that interim targets should operate as an ´upper limit´ that will apply to all clinics.

    The Authority approves plans for a ´root and branch´ review of how the HFEA collects and presents data from clinics. This will include a review of how it presents live birth ´success rate´ data (which currently doesnt always distinguish between singleton and multiple birth rates). 
  • March 2008  Second meeting of the ´National Strategy Stakeholders Group´
  • April and May 2008  The Authority decides on a Year 1 interim target of 24%.

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Background information and statistics

Unlike natural conception-where the chance of having a multiple birth is relatively low (1 in every 80 deliveries is of twins) - assisted conception brings with it a high chance of a multiple birth (roughly 1 in 4 IVF deliveries is of twins).

Although most twins are well in the end, the chance of complications during pregnancy and delivery is much greater than with a singleton. The high incidence of multiple births following IVF is largely due to the fact that more than one embryo is usually transferred to the woman's womb during an IVF cycle. This is done to increase the chance of conception.

Multiple births - Background and statistics (29 Kb)

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Public meetings

As part of the consultation, the HFEA held two public meetings, one for practitioners and one for patients, where the issues raised by this consultation were discussed. These meetings were held on the following dates:

  • Practitioners meeting -  Monday 11 June 2007, 1 - 5pm, London
  • Patients meeting - Saturday 23 June 2007, 10am - 3pm, London

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The Expert group

The Expert group was chaired by Professor Peter Braude of the Royal College of Obstetricians and Gynaecologists. The membership of the Expert group was broad-based and included representatives from clinical IVF, embryology, the patient perspective, data collection, multiple births, neonatology and NHS commissioning.

 

one child at a time reportThe Expert Group has completed and published its final report at the Authority meeting on 18 October 2006.

The report reviews the available evidence and discusses possible solutions to the problem of multiple births after IVF.

 One Child At A Time - Report of the Expert Group (482 Kb)

Executive summary (49 Kb)

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Further information

If you have further questions about the multiple births and single embryo transfer review or would like to make a suggestion about an area of work, please contact:

Jessica Watkin
Policy Manager 
Tel: 020 7291 8229
Email: bestpossiblestart@hfea.gov.uk

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Last updated: 12 June 2008