UK-IVF multiple embryo use reviewed

[k]

Just read this on teletext;

"The UK's fertility watchdog is to consider whether women undergoing IVF should only be able to have one embryo implanted at a time.
The Human Fertilisation and Embryology Authority is to review if the UK should follow other European countries which only transfer one embryo.
Clinics in the UK usually transfer two or three.
But many doctors say the resulting multiple births can carry risks for both mother and child."

What does everyone think of this? I know that if I go through IVF again I would risk having twins rather than none at all. I dont know the exact % but I know chances are much more reduced with only one been implanted. Surely with the chances of IVF working each cycle been as low as what it is this is ridiculous. From been on this website I dont think that I know of anyone who isnt happy when they find out they are having multiples. I think if women want one replacing, then fine, but why take the choice away from others who would be more than happy to be blessed with more than one. As long as everyone knows the risk, why take away our choice.

Kim

[DebraP]

Yes I saw it too, this time online. Here's the text from the bbc health site. The text starts with the same opening paragraph that Kim quoted, then goes on:

.......But many doctors say the resulting multiple births can carry risks for both mother and child.

There is still a severe lack of NHS funding for fertility treatment and we understand that some couples are willing to take these risks

Clare Brown, Infertility Network UK

The children's health and development can be affected, they have an increased risk of cerebral palsy and they are more likely to die around the time of their birth.

Twins or triplet births also lead to increased costs for their families and the NHS.

The HFEA says it can cost 10 times more to care for a set of triplets in the first year of their lives than a single baby.

In 2002 to 2003 only 9.1% of IVF cycles involved a single embryo transfer. Just over three quarters involved the transfer of two embryos transferred back to the woman and the remainder received three.

Three quarters of births following IVF treatment resulted in a single child, 23.6% were twins and 0.5% were triplets.

Patient opinion

In January last year the HFEA launched a policy limiting clinics to transferring two embryos to women under 40 and a maximum of three to those over 40, which will have seen a further reduction in three-embryo transfers.

Couples undergoing fertility treatment often want to have more than one embryo implanted to increase their chances of a successful pregnancy with a cycle of costly IVF treatment.

The HFEA has said it will canvass the views of fertility doctors and other professional organisations, plus patient groups.

Angela McNab, chief executive of the HFEA, said: "We know that the biggest risk from fertility treatment is caused by multiple births - having twins or triplets - and this is a risk both to the mother and to the children born."

She added: "Women are designed to have healthy babies, one at a time, and with natural conception this is what usually happens.

"The HFEA wants to see the results of fertility treatment come closer to what occurs naturally."

But she added: "We would not want to see any changes that would have a negative impact on the current fertility services in the UK or on the treatment of our patients."

A spokeswoman for the Royal College of Obstetricians and Gynaecologists said it welcomed the HFEA review.

Success

She added: "There is no doubt that this is the way for the future and if we are serious about reducing the risk of multiple pregnancy it is the only option in practice.

"Ten years ago the RCOG strongly supported a reduction in the number of embryos transferred to two and more recently has supported work on single embryo transfer.

"There is now considerable experience from Finland, Sweden, Belgium and Holland where the introduction of single embryo transfer has been associated with a marked reduction in twin pregnancy rates but with no reduction in overall success rates."

Clare Brown, chief executive of Infertility Network UK, warned: "There is still a severe lack of NHS funding for fertility treatment and we understand that some couples are willing to take these risks, particularly where they receive no NHS funding and can only afford to pay for one private cycle.

"They are willing to risk twins or even triplets to allow them to have the family they so desperately want."

She said couples often thought that their chances of success were higher when more than one embryo was transferred, and continued research was needed to help improve success rates.

[lumi]

I read quite a bit on this over the last few weeks but dont know where now!

I got the impression that first of all grading assessment needs to be improved and be uniform. At the moment it is very vague and changes from clinic to clinic. If this is improved it is more likely to get a BFP with just one transfered.

For example , a coupe of years ago experts thought that fragmention was a bad thing. However there is now evidence to suggest that up to 20% doesnt effect outcome at all.

I also read that there is evidence that putting 1 or 2 back had a small effect on +ve outcome, but a drastic effect on numbers of twins. So long as a good grading assessment is done.

I will try to find this info again.

Lumi xx

[lumi]

Not found it but got a quote from Oxford Journals

Selecting embryos with high implantation potential is one of the most important challenges in the field of assisted reproductive technology. Previous studies have suggested a relationship between pronuclear morphology and implantation ability.

[k]

Hi everyone

The teletext article was the only one I have read, so thanks for additional info Debra. I dont understand though why in Europe they are so restrained but in the US they put 3 or 4 back in younger women which is a lot riskier. I had 2 3 cell embryos put back, but they didnt discuss grading or anything. Maybe with blastocyst transfer when they have more idea on the embryo quality then that could be the way to go, but a lot of people dont get this choice (and also many embryos dont get this far-but may have done if transfered at 2 dys?). I know its a difficult subject and of course they have to reduce risks to mother and baby(s) but until IVF chances improve (and they have more idea why embryos do or dont implant) it just seems to reduce chances further.
I know ive been very lucky, but seeing on this website how many women go through failed cycles, it just seems unfair to remove the choice.
Anyway, sorry for ranting thats just my opinion!

kim

[Ellie]

As someone who has been through numerous cycles of ivf and had a successful outcome with twins I am in favour of 2 embryos being put back. I am hoping to have anither go soon and wouldn't hesitate to have 2 put back and would love another set of twins! I would hate to only have one put back. I know there are risks and additional costs but in my opinion they are worth it.I do agree that triplets is a significant risk to both mother and baby though and support the restriction to 2 embryos.
I have to say on my 4th attempt we had 9 embryos of varying quality none good enough to freeze and I would have happily had all of them put back in as I was so desparate!!! That time we got our twins so glad I didn't!!!!!!!!!!!

[nes]

Today was the first time that I read or heard anything about the proposed reductions, but I am in favour of the couples undergoing the treatment to be given the option of whether they have one or two embryo's transfered.

I am about to start my first IVF cycle . I have been undergoing various forms of investigation into my infertility for the last 4 years with my current partner, even though I have known that I would have trouble concieving due to my PCOS, and a previous miscarriage.

If I have learned anything about infertility during my history, it is that unless you also have been diagnosed with some form of infertility or know how destructive all the mental, physical and emotional turmoil is for someone who is trying to start a family of there own - you are in no position to pass judgement or make comments.

I can understand the medical reasons of trying to prevent multiple births, but in my experience, most of the people who make these decisions are not people who have infertility issues.

People who are going through treatment, unless they already have children, or have reasons why they don't want more than one embryo transfered, would be quite happy to have two embies put back if it meant that all there struggles proved to be worth it - with one baby or two.

[Katie12563]

Hi ladies this is Katie from the US,
I really hope this does not happen in the UK. I would mean that so many wonderful UK ladies may need more IVF treatments to acheive pregnancy.
We already know how stressful, emotional, and costly this can be...not to mention the time off work that working ladies will need for all the scans and bloodwork. It may also delay treatment for those who are on waiting lists in the UK. What about the over 40 ladies that need to acheive pregnancy as soon as possible for better chances of a healthy full term baby?????????

I hope you guys rally agaisnt this!

[DebraP]

Earlier this week I found a scientific report (via Google that I didn't keep so can't refind it now ) that said a negative aspect of multiple embryos was that the body reacts in a less-than-optimal way than if it receives 1 (as per regular conceptions). That the immediate response to nuture and accommodate the embryo has to be widened to include both/all 3/more and that this means a less-than-ideal start. In short, there's 'n' amount to go around, if more than 1 embryo is to be nuturered then it's n/2 not n x 2. Does that make sense? Boy can you tell I'm no scientist.

It didn't make for happy reading.

Debra.

[jag]

Hi Ladies JAG from NZ
I hope that the UK doesn't change to single embryo transfer.

Debbie our clinic has told us similar things as well. Multiple pregnancies = increase in risk of miscarriage, increase in premature birth, increase of death of an infant after birth etc.

Here in NZ we are offered 2 cycles of government funded (GF) IVF's, after meeting various criteria. However if it is a GF IVF then they will only transfer one embryo on your first transfer of each cycle. One of the reasons they say is that twins in neonatal care are more expensive, I guess therefore it is more expensive for the government. However the strange thing is that if the first transfer fails and you have lots of frozen embryos from the first collection then they will transfer 2 embryos next time around and on subsequent transfers from the first collection. This is still classed as part of the first free cycle. Confusing I know and I probably haven't explained it well. Surely if its a BFP on the second or subsequent transfers then the babies are stilll going to be costly to the government!!

If however you pay for your own treatment they will transfer a maximum of two embryos.

I will read this thread with interest. I hope they don't change their criteria in the UK.

JAG

[Tracyk]

I am from Australia and here some clinics use multiple and some just one. My doctor has one of the best success rates in the country and only puts in one embryo for someone my age (almost 30). I got my BFP on July 27 and so far so good. 1st treatment. I was very concerned about the 1 embryo at first but it gives the baby the best chance of survival as there is a much higher risk with multiples.

A friend of mine is 33 and she has had 2 embryo's put in for her last two treatments. All embryo's took but unfortunately she lost one of the first twins at about 14weeks (kept the second fortunately). Is now still trying for her second but unfortunatelt lost twins again at 16wks. She is obviously devestated and will hopefully get the courage in teh future to try again but next time she only wants to use one emby, since all seem to be embedding quite nicely.

I think it depends on a few factors to the number they use. The main one being your age and also the reason for IVF.

[Sand]

I never thought of it in that way Debra, but Yes, what you read does make sense I suppose.

Congrats Tracy on your first cycle BFP ! That's the way to do it !

Sandra x

[clair55]

Hi all

Yesterday at my clinic i was given some lit. to take home and read. Apparently my clinic is one of five in the country that is doing a research project into "Efficacy and cost effectiveness of selective single embryo transfer" by university of aberdeen. It will only involve 700 women!

Criteria for entry is age under 37, 1st or 2nd cycle of ivf, previous ivf pregnancy and 4 or more good quality embryo's are available on ET day.

The trial is randomised so it's like flipping a coin if you have single transfer or two. If you don't fall pregnant all remaining embryo's will be frozen and transfered over the next twelve months (singually or two depending on your original transfer, if you are NHS these transfers will be done without charge.

There will also be no charge to extra single egg replacements resulting from study if paying for treatment.!!!

Has anyone else been given this information? I'm at centre for reproductive medicine at Coventry and Warwick hospital. Any thoughts???