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Multiple Births Minimisation Strategy: achievements and compliance

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Letter to UK fertility clinics - from Mr Nick Jones, Director of Compliance, HFEA

10 November 2010

Dear Person Responsible

Multiple Births Minimisation Strategy: achievements and compliance

I am writing to let you know how we have assessed your centre’s performance in the first year of the multiple births policy in 2009. I have also provided data to allow you to benchmark your performance nationally. We will be making the graphs and a full explanation of the analysis publically available on our website in the next few weeks.

National progress

In January 2009 we set the Year 1 maximum multiple birth rate at 24%. This was the first step in our policy to reduce what professional bodies and patient groups recognise as the single biggest, and avoidable, risk of IVF treatment.

The sector has responded encouragingly and made positive progress. There has been a decrease in the multiple pregnancy rate from 27.1% in 2008 to 25.0% in 2009. This has occurred alongside an increase in the overall national pregnancy rate.  There are many examples of good practice emerging with clinics successfully implementing strategies to avoid the risks of multiple pregnancy whilst maintaining their pregnancy rates.

Assessing individual centres

We employed an independent epidemiologist to fully analyse the data on centres’ progress against the target. As it is too early to report 2009 live birth rates, we reviewed centres’ multiple pregnancy rates against an equivalent multiple pregnancy rate target of 30%. The multiple pregnancy target was calculated to provide an indication of which centres are likely to meet the 24% multiple births target.  We reviewed the data analysis alongside your responses to the centre questionnaire earlier this year. 

I have enclosed details of your centre’s level of compliance and any actions required. Centres compliant with the policy will be monitored as part of the compliance cycle and themes for each inspection.  For centres not making progress with their strategy, the compliance team will follow a consistent approach to ensure a centre has recently reviewed and audited their strategy.  We will monitor multiple pregnancy and elective single embryo transfer (eSET) rates for signs of compliance. Centres statistically above the multiple pregnancy rate target will be subject to a management review.

Good practice

Spreading good practice is essential to achieving compliance across the sector. The data enclosed shows how your centre’s multiple pregnancy, eSET and pregnancy rates compare to other centres nationally. 

We appreciate that many centres found patient and team acceptance an issue and this made implementing strategies challenging.  We have enclosed leaflets designed by INUK and the One at a Time group to aid patient and staff acceptance of eSET. We have also included a summary of the One at a Time workshops held in early 2010. The One at a Time website has a section where clinics have shared their experiences of implementing strategies in their own clinics, which you may find useful.

As you are aware, regularly auditing and evaluating the effectiveness of your strategy will allow you to identify any modifications needed to lower your multiple rate further. In December 2010, the Authority will set the Year 3 maximum multiple birth rate. This will replace the current Year 2 target of 20% in April 2011. It will therefore be even more important to regularly audit your strategy in order to rise to this challenge and to keep up the good progress that the sector has achieved so far.

If you require any further information please contact your inspector.

Yours faithfully

Mr Nick Jones, Director of Compliance


Multiple Births Strategy - Year One national performance

The three graphs show centres’ multiple pregnancy, elective single embryo transfers (eSET) and overall pregnancy data from treatments carried out in January to December 2009.

The data is aggregated for all ages. Therefore it is not meaningful to directly compare centres’ eSET and overall pregnancy data as this will be affected by the age and medical history of the patients each individual centre treats.

To help interpret the graphs you can download the below document:

If you want to identify an individual centre you can download the following spreadsheet:


Early multiple pregnancies by centre 2009

Each dot represents a centre and shows the proportion of multiple pregnancies from treatment started in 2009.


Funnel graph: Early multiple pregnancies by centre 2009




Elective single embryo transfer (eSET) rate by centre 2009

Each dot represents a centre and shows the proportion of eSET that the centre carried out in 2009.

Funnel graph: eSET by centre 2009


 Pregnancies by centre 2009

Each dot represents a centre and shows the proportion of pregnancies from treatment started in 2009.

Funnel graph: Pregnancies by Centre 2009


Page last updated: 02 December 2010