The Telegraph - Drive to cut number of IVF twins hampered by lack of NHS funding

The drive to reduce the number of dangerous twin pregnancies resulting from IVF is being hampered by a lack of NHS funding, experts warned.
The chances of conceiving twins or triplets is 20 times higher after having IVF treatment than naturally and the risks to both mother and children are much greater.
Mothers are more likely to suffer complications in pregnancy and to die if they are carrying more than one baby and the children are at greater risk of being born premature and small, requiring expensive intensive care, and have more birth defects and lifelong disabilities.
Fertility doctors and patient groups have launched a national strategy to reduce multiple pregnancies by implanting fewer embryos in the womb when treating some women.
The majority of women currently have two embryos implanted when undergoing fertility treatment and more should have just one, it was said.
Younger couples who have a good chance of achieving a pregnancy and who have several high quality embryos will be selected to have one embryo implanted in the womb.
The rest should be frozen and if the fresh cycle fails these can be thawed and implanted one at a time until a pregnancy is achieved.
It is vital that the NHS funds the full cycle, including all frozen embryo transfers, otherwise patients will not accept a move to single embryo transfer, it was warned.
Currently only 30 per cent of primary care trusts fund the full cycle of IVF and the more than 90 per cent do not meet current guidelines of providing eligible couples with three cycles.
Targets set by the fertility regulator the Human Fertilisation and Embryology Authority mean all clinics should ensure the proportion of multiple births should not exceed the current level of 24 per cent from 2009.
Around 40 per cent of clinics currently have a higher multiple birth rate than this.
After three years the HFEA expects the multiple birth rate to be brought down to 10 per cent and will inspect clinics to ensure they are working to reduce the rate of twins. In extreme cases clinics could have conditions put on their licence or have it revoked it they refuse to act to reduce multiple births, Trish Davies, director of regulation at the HFEA said.
Choosing the right patients for single embryo transfer, growing the embryos for longer in the lab and using sophisticated techniques to select the best quality embryo will reduce the number of twins without harming the chances of a successful pregnancy in those couples, it was argued.
Alun Elias-Jones, consultant paediatrician and Fellow of the Royal College of Paediatrics and Child Health, said the NHS should invest in funding three full cycles of IVF for couples which would reduce the number of multiple births as it would save money in the long run.
He said: "Every set of averted premature twins will fund many many cycles of IVF."
Dr Mark Hamilton, chairman of the British Fertility Society, said the success of bringing down the multiple pregnancy rate depends on improving NHS funding.
He said: "It is absolutely imperative that the funding issues are addressed in collaboration with initiatives like this."
Jane Denton, director of the Multiple Birth Foundation said: "While there a very understandable perception that twins are an absolute delight we very much underestimate things like bereavement and disability which is very much hidden.
"Through the One at a Time campaign and its website we hope to give professionals, patients and the public authoritative information about multiple pregnancy and birth to help them understand the risks and consequences."
Claire Brown, chief executive of the Infertility Network UK said: "Single embryo transfer is only for those patients most at risk of having a multiple pregnancy. We totally understand patients worry about anything that might affect their chances of a successful pregnancy and think twins means completing their family in one go and mean they don't have to go through IVF again. But we have to think about what is best for the mother and the child.
"If patients know they are going to get the three full cycles funded on the NHS they are going to be much more accepting of single embryo transfer."
Tamba Chief Executive Keith Reed said: “The views of patients and doctors have been completely ignored by the HFEA and the national strategy group. During the HFEA’s recent consultation, only 3 per cent of respondents supported what the National Strategy Group are proposing. In the face of such overwhelming opposition, it beggars belief that they have decided to carry on regardless.
“As a result of this deeply unpopular and misplaced strategy, patients will be left out of pocket and out of choices. They must think again.”