Government funding of IVF is the most important factor that could maintain low rates of multiple pregnancies following treatment and reduce associated complications for mothers and babies, as well as costs to the NHS, according to a Scientific Impact Paper published by the Royal College of Obstetricians and Gynaecologists today.
Multiple pregnancy following IVF treatment occurs from the practice of transferring more than one embryo into the uterus. It is the most common adverse outcome of IVF treatment and is often performed to reduce costs for patients who pay for their own treatment.
In 2013, the NICE guideline on fertility problems recommended government funding for three full IVF cycles, but the availability of funding varies across the country. Currently, six out of ten IVF cycles in the UK are funded by patients themselves.
There are substantial health risks for both mothers and babies, as well as costs to NHS services, associated with multiple pregnancies. Mothers may have a higher risk of pregnancy-induced high blood pressure, gestational diabetes, haemorrhage following birth, and postpartum depression and heightened symptoms of anxiety and parenting stress.
Multiple pregnancy is also associated with a six-fold increase in the risk of preterm birth, a leading cause of infant mortality and long-term mental and physical disabilities, including cerebral palsy, learning difficulties and chronic lung disease.
In addition, the estimated neonatal cost to the NHS for twins is 16 times higher than that for a singleton baby and multiple pregnancies from “fertility tourism” is also contributing to challenges facing maternity and neonatal services.
Despite these substantial risks, double embryo transfer (DET) during IVF treatment continues to be practiced. It is widely believed by patients and health professionals that the success rate of IVF treatment is higher following the transfer of two embryos rather than one embryo.
However, studies have shown that in women with a good prognosis, single embryo transfer is comparable to that of DET and with a significantly lower risk of multiple pregnancy.
The RCOG paper found that almost one in five (19.8%) IVF deliveries in the UK in 2011 involved a multiple birth. Meanwhile, the multiple birth rate in Sweden, a country with similar live birth rates, but a high proportion of single embryo transfer, during the same period was 4.9%.
However, there have been improvements in the UK and a report published last month by HFEA shows a reduction in the national multiple birth rate from 24% in 2009 to 11% today.
Mr Tarek El-Toukhy, consultant gynaecologist and specialist in reproductive medicine and surgery, and lead author of RCOG’s report, said:
“Multiple pregnancy is the greatest avoidable risk of IVF. The health and financial burden it places on women, families and the NHS cannot be overstated. To ensure rates of multiple births remain low, there is little doubt that the single most important factor that could enhance the acceptance of single embryo transfer among patients and practitioners is appropriate funding for IVF treatment.
“It is also clear from other European countries, such as Sweden and Belgium, that further reduction in the multiple pregnancy rate to single figures is feasible where generous IVF state funding arrangements have reduced the associated adverse implications of multiple pregnancies for both mother and baby.”
Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists, said:
“IVF is a cost-effective treatment and should be available on the NHS. Yet current access to treatment is a postcode lottery which is completely unacceptable for couples with infertility problems.
“Government funding for three full IVF cycles, as recommended by NICE guidelines, would provide a greater incentive for IVF centres and their patients to adopt single embryo transfer more regularly.
“A national commissioning policy is needed to remove the current variation in IVF funding around the country and increase the uptake of single embryo transfer to improve maternal, neonatal and child health. This will also ensure significant financial savings nationally by reducing multiple pregnancies after IVF treatment.”
Kate Brian, Chair of the RCOG’s Women’s Network, said:
“Infertility can be a devastating experience. It causes distress and isolation and can lead to depression and even the breakdown of relationships. It is vital that IVF treatment is appropriately funded as NICE recommends - where you live should not dictate whether you can access NHS-funded treatment. Effective funding policies and clear information about the benefits of single embryo transfer will help to ensure safer and more successful outcomes.”
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Scientific Impact Paper: Multiple Pregnancies Following Assisted Conception
Please cite this paper as: El-Toukhy T, Bhattacharya S, Akande VA on behalf of the Royal College of Obstetricians and Gynaecologists. Multiple Pregnancies Following Assisted Conception.
Scientific Impact Paper No. 22. BJOG 2018; DOI:10.1111/1471-0528.14974
Scientific Impact Papers advise on emerging or controversial scientific issues of relevance to obstetrics and gynaecology, together with the implications for future practice. These opinion papers are produced by the RCOG’s Scientific Advisory Committee.
HFEA report on rates of multiple pregnancies, published in December 2017.
NICE guidance on fertility problems.
About the RCOG
The Royal College of Obstetricians and Gynaecologists is a medical charity that champions the provision of high quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision.