Multiple births and single embryo transfer review
The single greatest health risk for women following in vitro fertilisation (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.
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).
The HFEA then launched a public consultation on the issue of multiple births after IVF in April 2007.
- Multiple birth consultation document (465 Kb)
HFEA decision
A new policy was created to minimise rates of multiple birth.
Key elements of the policy:
- to bring down the UK IVF mulitple birth rate to 10% over a staged period
- to set a series of interim targets over approximately three 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 were applied as of 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.
* 2005 statistic (the latest available figures)
For more information on the Authority's decision, see:
An expert group was set up to discuss suitable ways to decrease the number of multiple births following IVF. The group, headed by Professor Peter Braude of the Royal College of Obstetricians and Gynaecologists, published it's findings to the Authority meeting on 18 October 2006.
- One Child At A Time - Report of the Expert Group (482 Kb)
- Executive summary (49 Kb)
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.
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.
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, contact:
Helen Richens
Policy Manager
Phone: 020 7291 8236
Email: helen.richens@hfea.gov.uk
Page last updated: 07 April 2009
Have more questions about who we are and what we do? 