November 13, 2013

expert reaction to HFEA change of policy on multiple births

The Human Fertilisation and Embryology Authority decided that from January 2014, IVF clinics will no longer be subject to a condition on their licence that they keep their multiple births rate below the HFEA target.

Joint statement from The Association of Clinical Embryologists (ACE), the British Fertility Society (BFS), The Multiple Births Foundation (MBF) and the Royal College of Obstetricians and Gynaecologists (RCOG), said:

“The Association of Clinical Embryologists (ACE), the British Fertility Society (BFS), The Multiple Births Foundation (MBF) and the Royal College of Obstetricians and Gynaecologists (RCOG) are aware of the decision by the Human Fertilisation and Embryology Authority (HFEA) to withdraw the licence condition requiring UK IVF clinics to achieve the multiple birth target set by HFEA.

“The UK multiple births policy was developed by a stakeholder group comprising representatives of professional bodies and the HFEA. In 2008 a mission statement was published, and the ACE and BFS published joint guidelines to help clinics meet multiple birth targets. In January 2009 the policy came into force and in 2011, the HFEA introduced a range of initiatives with requirements to support clinics in the reduction of the overall multiple birth rates which includes guidance in the Code of Practice. The standard licence condition was introduced later to reinforce the policy.

“Since 2009, the HFEA and the Multiple Birth Stakeholder Group have continued to set the multiple-birth targets jointly. Since that time we have seen significant progress in the reduction of multiple births and the current target is 10%. In 2013 the principle of minimizing multiple births was given backing by the National Institute for Clinical Excellence, in their revised guidelines for management of infertile couples. There is broad international consensus among IVF practitioners that multiple births need to be reduced.

“The ACE, BFS, MBF and RCOG believe that advances in IVF over the last decade have shown that elective single embryo transfer (eSET) can be achieved without adversely impacting on pregnancy rates. They consider that eSET is now part of routine practice in the majority of clinics and that responsible professionals will continue do all they can to minimize multiple births through good clinical practice.”

Dr Mohamed Taranissi, Director of the Assisted Reproduction and Gynaecology Centre, said:

“There is no argument in the IVF community about the need to reduce multiple births.  However, I believe this is the right decision by the HFEA because imposing a condition requiring no more than 10% multiple births on clinics was unworkable, as the HFEA has belatedly come to accept, and it did not allow for the large variation between patients.  It is my understanding that many clinics are not able to meet this target, and that it has already had an adverse impact on pregnancy rates.  Clinics with a higher percentage of patients who are over 40 and who have had several failed IVF attempts would have fallen foul of the HFEA’s 10% condition even though they are simply providing universally recognised standard treatment by transferring two embryos – advice so widely accepted that it even appears on the HFEA website. 

“All of us share the HFEA’s goals around reducing multiple births but we can now go forward and work positively together to achieve this aim in a less punitive way, and in a way which allows the clinicians to make these decisions in the best interests of individual patients on a case by case basis.”