Multiple births and single embryo transfer review

Background

The single biggest risk of fertility treatment is multiple pregnancy. It increases the risk of stillbirth, neonatal death and disability in children born. It also increases the risk of dangerous complications to the mother, such as late miscarriage, high blood pressure and pre-eclampsia.

On average, one in four IVF pregnancies are a multiple pregnancy compared to one in 80 for women who conceive naturally. With approximately 11,000 IVF babies being born each year this contributes significantly and disproportionately to the national multiple birth rate and presents a significant public health concern.

Consultation process

In 2005, the HFEA commissioned a group of fertility and public health experts to report on the risks of multiple births from fertility treatment.

The Expert Group published the 'One child at a time' report in October 2006. They concluded that the risk of multiple births could be minimised, whilst maintaining patients’ overall chance of becoming pregnant, by transferring one embryo in the IVF patients who have the highest chance of conceiving and therefore are at the highest risk of conceiving twins. This is known as elective single embryo transfer (eSET).

Following this report, we launched a public consultation in 2007 on the most suitable policy to reduce multiple births and promote eSET in appropriate patients. We ran an online consultation alongside a wide range of stakeholder events for clinic staff, patients and professional groups.

Consultation outcome

In October and November 2007, after careful evaluation of the consultation responses, the Authority made a decision to adopt an outcome-based policy, which allows centres the flexibility to develop their own eSET strategy that is appropriate for them and the patients they treat.

Key elements of the policy:

Overall aim to reduce the UK IVF multiple birth rate to 10% in stages over a period of years
The HFEA will set a maximum multiple birth rate that clinics should not exceed, which will be lowered each year
All centres will devise their own ‘multiple births minimisation strategy’ setting out how they will not exceed the maximum multiple birth rate
The HFEA policy will form part of a wider national strategy to reduce the risk of multiple births from fertility treatment involving professional bodies, patient groups and NHS-funding bodies

Year 1 of the multiple births policy

The policy was introduced in January 2009. The Authority set the Year 1 maximum multiple birth rate at 24% (the national average at the time). This means that no more than 24% of a centre’s annual live birth rate should be multiple births.

All centres are required to have a strategy in place stating how they would identify patients who should have elective single embryo transfer in order to reduce the centre’s multiple birth rate.

Year 2 of the multiple births policy

In December 2009 we evaluated the first year of the multiple births policy, by analysing the available 2009 pregnancy data along with feedback from patients and clinics.

On the basis of this, in January 2010 the Authority set 20% as the Year 2 maximum multiple birth rate. The Authority decided that 20% would maintain the momentum that centres built up in 2009, whilst allowing centres time to review and improve their strategies to lower their multiple rate further.

The Year 2 maximum multiple birth rate came into force on 6 April 2010, and means that no more than 20% of a centre’s annual live birth rate from treatment started from this date should be multiples.

Monitoring and enforcing the policy

We are committed to supporting centres implement the policy and to help share best practice across the sector. We are continually monitoring clinics’ performance and the impact of the policy on multiple and overall pregnancy and birth rates.

We will support centres as they evaluate and improve the effectiveness of their multiple birth minimisation strategies. Staff from centres that have not audited their strategy or made efforts to implement corrective actions will, as a first step, be asked to attend a management review meeting with HFEA staff to discuss recommended actions. This is in line with our overarching Compliance and Enforcement Policy.

Further information

The HFEA policy works alongside the Multiple Births Stakeholder Group as part of a co-ordinated national strategy to reduce the risk of multiple births from fertility treatment. The stakeholder group represents professional bodies, patient organisations and NHS-funding bodies and works to:

share best practice and develop professional body guidance around eSET
provide information to patients and professionals about multiple births and eSET
advance NHS provision of fertility treatment