Full Government funding of IVF treatment would lower rates of multiple pregnancies and their associated risks of complications for mothers and babies, health experts have said.
Multiple pregnancy following IVF treatment occurs from the transferral of 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, the Royal College of Obstetricians and Gynaecologists (RCOG) said.
In 2013 the National Institute for Health and Care Excellence (Nice) recommended Government funding for three full IVF cycles, but funding still varies across the country.
Six out of 10 IVF cycles in the UK are funded by patients themselves, said the RCOG, which has published a Scientific Impact Paper.
Multiple pregnancies involve substantial health risks for mothers and babies, as well as costs to NHS services.
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.
There can also be a greater risk of complications for mother and baby, and increased burden on NHS maternity and neonatal services.
Multiple pregnancy is associated with a six-fold increase in the risk of pre-term birth, a leading cause of infant mortality and long-term mental and physical disabilities, including cerebral palsy, learning difficulties and chronic lung disease.
The estimated neonatal cost to the NHS for twins is 16 times higher than for a single baby.
“Current access to treatment is a postcode lottery which is completely unacceptable for couples with infertility problems."”
- RCOG president Professor Lesley Regan
Despite these risks, double embryo transfer (DET) during IVF treatment continues. It is widely believed by patients and health professionals that the success rate of IVF treatment is higher following the transfer of two embryos than with one embryo.
The RCOG said 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 report’s lead author, Tarek El-Toukhy, consultant gynaecologist and specialist in reproductive medicine and surgery, 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.”
RCOG president Professor Lesley Regan 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.”
Keith Reed, chief executive of the Twins and Multiple Births Association (Tamba), said: “The Government needs to mandate fair access to fertility treatment across the country.
“For many, taking the affordability question out of the equation will make it less likely they will opt for treatments which increase their chances of having twins.
“However, the majority of UK twins and triplets are conceived without IVF intervention and healthcare organisations need to step up their efforts to address the risks associated with multiple birth pregnancy.
“There is a growing body of evidence that good care and following multiple birth guidance during maternity reduces the poor outcomes and need for neonatal care which put pressure on NHS services.”
A Department of Health and Social Care spokesperson said: “As this report itself highlights, we have made great progress in improving patient safety by lowering the national multiple birth rate in IVF from 24% in 2009 to 11% today.
“We know fertility problems can have a serious and lasting impact on families—and the Government has been clear that the NHS should provide access to IVF for all patients that meet the criteria set out in NICE guidance.”
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