New restrictions to cut multiple births in IVF treatments

Tough new restrictions to cut the soaring number of twin and triplet births following IVF treatment were announced yesterday by Britain's fertility watchdog.

Women under 40 will be limited to a maximum of two embryos per attempt at pregnancy, with no exceptions, under regulations contained in a new code of practice published by the Human Fertilisation and Embryology Authority (HFEA).

Women over 40 will still be allowed up to three embryos but they must be closely monitored and the situation "kept under review", the HFEA said.

It is the first time the HFEA has made a distinction based on age in regard to the number of embryos replaced. It reflects growing concern that some clinics are abusing the existing code that allows more than two embryos to be replaced but only in "exceptional circumstances".

The number of triplet and higher order births has risen fourfold since the early Eighties, having remained steady for the previous 50 years. The growth has been driven by the practice of replacing three or, in the early years of IVF, more embryos in the womb for each attempt at pregnancy. Multiple births are known to carry greater risks and impose an increased burden on the parents. The HFEA said yesterday there was no evidence that replacing more than two embryos increased the chances of success in women under 40.

Suzi Leather, chairwoman of the HFEA, said: "Women are designed to have babies one at a time and with natural conception this is what usually happens. But more than half of babies born as a result of fertility treatment are twins or triplets. The aim of the HFEA is to bring the number of multiple births from fertility treatment closer to that which occurs naturally."

Mothers of twins and triplets are more likely to suffer a miscarriage or high blood pressure and require a Caesarean delivery. Their babies are more likely to be born prematurely, need intensive care and die before their first birthday.

The incidence of serious disability, such as cerebral palsy, is about five times higher in twins and 18 times higher in triplets. The emotional and physical burden of coping with twins or triplets can also cause fatigue, illness and depression in the parents. Financial problems can add to the stress.

Maria Nicholas, 32, who had quadruplets after receiving fertility treatment, said she feared she could never give her four sons, now aged two, enough one-to-one attention.

"That does make me very critical of myself as a mother. I often worry that they may be missing out on an ordinary childhood," she said.

The strain of looking after the family and running a business - she has a beauty salon in Fishguard, Pembrokeshire - also told on her. "I became susceptible to illness and lost a lot of weight," Ms Nicholas said. "I can't count the number of times I ended up at the doctor's in tears. People were concerned about me but I knew the money had to come from somewhere and I had to carry on. Everybody said I would be able to cope but often I haven't."

For most of the past 20 years, doctors have believed that replacing three or more embryos increased the chances of success. The HFEA, which was set up in 1991 to license IVF clinics, accepted this argument at first, believing that the risk of a multiple birth was outweighed by the benefit of a successful pregnancy. But as the multiple birth rate rose, it moved to limit the number of embryos replaced, first to three and then, in August 2001, to two. But it left a loophole, allowing doctors to replace three embryos if, in their clinical judgement, the case warranted it.

That loophole is now to be closed. The HFEA said there was actually no evidence that replacing more than two embryos increased the chances of success in women under 40, although it did increase the risk of multiple birth.

In women over 40, transferring three embryos did increase the chances of success but led to only a small increase in the risk of a multiple birth.

A spokeswoman for the HFEA said most clinics had observed the existing code, with its two embryo limit, only breaching it in exceptional circumstances as stipulated. "But the concern is that some doctors in certain clinics are allowing any of their patients to have three embryos replaced," she said.

Figures show that of 25,000 cycles of treatment in 2000, there were 7,000 cycles - 28 per cent - in which three embryos were transferred.

Jane Denton, director of the Multiple Birth Foundation and a member of the HFEA, said: "For some parents the prospect of twins or triplets may seem the ideal way to have the family they long for. But the reality can be very different."

The Royal College of Obstetricians and Gynaecologists welcomed the announcement and said reducing the number of multiple births was of "national importance".

Allan Templeton, professor of obstetrics at the University of Aberdeen and honorary secretary of the college, said: "Multiple births increase the risks to the mother and her babies and can significantly increase the demands on neonatal intensive care cots. Every attempt should be made to avoid multiple births following IVF treatment."

He added that the college would like to see "more work done to reduce the number of twins born".

The Twins and Multiple Births Association (TAMBA) can be contacted at 0870 770 3305 or at www.tamba.org.uk.