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Eeyore

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  • "Eeyore" started this thread
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Wednesday, April 4th 2007, 7:07am

HFEA - Twin IVF births 'need to be cut'

BBC NEWS

The number of twins born from IVF needs to be cut because of risks to mothers and babies, a watchdog has said.

The Human Fertility and Embryology Authority (HFEA) says as treatment has become more successful the number of multiple births has increased.

Some 40% of IVF babies are twins, but many are born prematurely and more than 100 die every year.

The HFEA has begun public consultation on a range of options which could lead to fewer multiple births.

Avoidable risks

At least half of twins are born prematurely with a lower weight. They are far more likely to need specialist care in the first few months and also are at a greater risk of poor health throughout their lives.

The chances of severe disability such as cerebral palsy are also higher in babies born in twins.

HFEA chairman Shirley Harrison said these risks are avoidable, as are the deaths of some premature babies.

"Doing nothing is not an option. The latest figures show 126 IVF babies die each year because they have been born as twins not single babies. We can't let that continue," she said.

Flexible treatment

The consultation sets out four options for change, including simply making women more aware of the risks of multiple births.

The HFEA is also considering whether there should be a gradual move towards a maximum for each fertility clinic of 10% of births being twins.

An alternative could be setting out guidelines for which patients should only be given one embryo.

The HFEA says any change needs to be flexible to take account of the wide range of patients seeking fertility treatment.

Older women or those who have already been through several unsuccessful IVF cycles would be very unlikely to be restricted to one embryo transfer.

'Numbers game'

Susan Morgan is one patient who has benefited from having two embryos transferred.

She now has twin daughters Hannah and Olivia, after many years of stressful and expensive fertility treatment.

"I was very aware of the risks, but it was a numbers game. If I hadn't had multiple embryos I wouldn't have had children," she said.

Most fertility specialists support change and some clinics are already trying to increase the number of patients implanted with just one embryo.

Mr Yacoub Khalaf, the head of the assisted conception unit at Guy's and St Thomas' Trust said: "We are already achieving great successes by replacing only single embryos in many of our suitable patients.

"In the last year our overall pregnancy rate has risen and our multiple pregnancy rate has been reduced."

Success rates
Despite the consensus it could be hard to bring about change. The vast majority of fertility patients pay for their own treatment as access to NHS funding is extremely patchy.

With an average cost for one cycle of IVF of £5,000 it is no surprise that couples seeking treatment are very interested in success rates.

Each clinic is legally obliged to publish the number of pregnancies and live births per cycle of IVF.

There is a level playing field as the regulations allow a maximum of two embryos to be implanted in women under 40 years old, and a maximum of three for women over 40.

Fertility experts have warned about the combination of patients funding their own treatment and a virtual league table of success rates.

Patchy provision

Three years ago, the government said the NHS should be offering one cycle of IVF to suitable patients by April 2005.

It was seen as a stepping stone towards implementing the guidance from the National Institute for Clinical Excellence (Nice) of three NHS funded cycles.

In many areas that simply has not happened, and the criteria for receiving NHS-funded treatment can differ widely from one area to another.

The Department of Health says it is working with the charity Infertility Network to look at the patchy provision of IVF.

A spokesman said: "We recognise that infertility causes pain and distress. It is important that infertile couples have access to IVF regardless of where they live and we would encourage trusts to work towards providing this."




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Wednesday, April 4th 2007, 8:44am

I started a thread about this in the pub hon - you can delete if you wish ?

Im not sure if this is a good or bad thing reading the above..?

Obviously we want the highest sucess rate as poss but I didnt reallise the stats on babies that die ..

Whats everyone else's views on this ?

xx

kski

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Wednesday, April 4th 2007, 9:08am

There are a number of issues -

firstly this is a BBC report and given their recent track record in IVF reporting - I wouldn't believe any of thier stats !
"Some 40% of IVF babies are twins, but many are born prematurely and more than 100 die every year. "

According to the HFEA the figure is 30%. 100 babies die - but at what stage and what is that figure in relation to ? How many "natural " twins die ?? How many singletons die?

Is the next step to reduce all twin pregancies - as they pose higher risk & incur elevated cost. Will IVF clinics still implant two eggs - if the parent opt to go to a private hospital ?

This whole argument seems to be focusing on the cost to the country -
rather than looking at what is acheivable -
1 - Focus on improving IVF treatment to reduce the current failiure rate of 70%
2 - Improve pre & neo natal care to reduce the incidences of Mortality above.

Is seems very odd that in a country with a mature population, we are penalising those who want to have children. Will similar studies limit the Pregnancies available to smokers, High drinkers, disabled, Lower socio economic groups or the obese - given they all pose an increased risk -

this seems to be an attempt to massage the hospital figures rather than address the real issues...

No doubt given the reduced success rate that will result ( Number of live births per cycle) the ACUs will reduce their charges accordingly !!

think not

K

This post has been edited 1 times, last edit by "kski" (Apr 4th 2007, 9:10am)


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Wednesday, April 4th 2007, 9:19am

I was also wondering seeing as how you are aiming to have just 1 embryo transferred, whether they'd half the costs. I had 2 transferred and have a singleton. So if they had transferred just the one that didn't make it .....hmmm :(

They need to compare stats with natural twins and IVF twins to really see what difference this makes surely?

I agree with Kski - why penalise the very people who want to have a family and will nuture their children to their very best potential?


Caz xxx

Lcli

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Wednesday, April 4th 2007, 10:04am

Kski,

Very well put.

I agree that these reports are NOT a good reflection on the truth. These reports often fall on ignorant eyes and lead to nothing more than a false concern to panic. I agree that is all all about money and little thought is really on the people suffering from infertility.

But obviously the report succeeds in frightening ppl into thinking twins pose a risk factor and by quoting such statistics about the death rate .. well that is both unfair and not well explained.

Who is writing these reports? To they have any sound knowledge to be allowed to do so?

annie

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Wednesday, April 4th 2007, 11:33am

i quite agree with you kski & lisa. The authors of these articales are def. of questionable authority on the subject - the headline in one of the papers (Independent or Guardian, can't remember which) that caught my eye (and nearly caused me to cry!) was "Donor eggs to be rationed"..... the article then proceeded to talk about twins & limiting ET to just one embie from two, but made no mention whatsoever of donor eggs - so how misleading is that? At least get the headline right!
It also did go on to say that in cases where chances of success are considered to be "less good", 2 embies might still be an option but how on earth could such a policy be implemented in practice? Every couple will feel that they are deserving of having 2 put back in and clinics will still obviously want the best stats and be in favour of 2, so who would independently be making that massive decision?
The whole things sucks hugely and hasn't remotely been thought through by the sounds of it. Let's just hope it gets knocked on the head during the consultation stages.

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Wednesday, April 4th 2007, 11:44am

I agree with all that is said above.

We are put under enough pressure to concieve as it is, without adding to it.

I take it this would only be done in this country? If so I think it would push more people to go abroad for thier treatment, at least it would be cheaper and you'd get a holiday out of it!!

JENSQUI

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Wednesday, April 4th 2007, 12:10pm

Hi there,

I don't think it is just this country. I've been reading a thread by user Penguin (who I beleive lives in Iceland) and she was only allowed to put one embryo back (thankfully she got a BFP last week) for exactly this reason. So, it looks like we may be lucky in the UK as this directive isn't in palce yet.

I could be wrong about this - hopefully Penguin will log in soon and read this thread to confirm!

Jensqui x

kski

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Wednesday, April 4th 2007, 1:50pm

report from the telegraph


Currently three-quarters of patients have two embryos transferred during treatment and 25 per cent of IVF births in the UK result in twins (NOTE THIS IS A MASSIVE DIFFERENCE FROM THE REPORT ABOVE ??). Patient groups yesterday pointed out that the main reason women request the transfer of more than one embryo is the refusal of most primary care trusts to fund a Government promise that all women under 40 should be entitled to three full cycles of treatment on the NHS. In Belgium, couples are entitled to up to six free cycles of IVF treatment on the condition that in women under 36 only one embryo is transferred. The Netherlands, Finland and Sweden have all moved towards single embryo transfer in recent years.


Some Interesting facts - Not Very nice but at least they have the info out in the public domain !

One in 80 women who give birth naturally have twins, while around 23 per cent of mothers who have IVF have twins. Around 3,600 IVF twins were born in the UK in 2004. Compared with single babies, twins are three times more likely to be stillborn, five times more likely to die soon after birth and four times more likely to develop cerebral palsy. Half are born prematurely and underweight (thought this is Obvious ) and identical twins have a significantly increased risk of congenital abnormalities. Mothers of twins are also at greater risk of miscarriage, pre-eclampsia, diabetes and heavy bleeding. They are twice as likely as the mothers of single babies to develop heart disease and around 10 times more likely to die from cardiovascular causes. Currently, clinics are free to implant up to two embryos per cycle in women under 40 years of age. For women over 40, they can implant three embryos if this is thought to be necessary.


K

kar1

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Wednesday, April 4th 2007, 2:08pm

I think this would be unfair...what with most of us having to pay for tx we should be allowed every possible sucess.....me for one would be chuffed to be pg with twins and not being able to get pg by any other means i would stop there

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Wednesday, April 4th 2007, 2:22pm

The full consultation about this is on the hfea website and makes an interesting read

http://www.hfea.gov.uk/en/483.html

I can see that reducing infant mortality is a public health issue but for those of us faced with pretty poor stats in the first place and the prospect or remortgaging our houses in the quest for a single baby I can't see how this move is in the individual patients interest.

I am very scared about the risks my babies face being twins but I know so many mums of singletons that have had very hairy times with premature births that having a single baby doesn't exempt you from the risks. I personnaly feel double blessed to be having twins and wouldn't want it any other way.

foxyuk

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Wednesday, April 4th 2007, 4:50pm

Does anyone know when this will come into force? Will it effect my treatment now? The amount of twin pregs that i have read about on these boards is minimal compared to singltons. I dont think its fair because i think it will just mean more treatment.

kar1

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Wednesday, April 4th 2007, 5:02pm

hopefully this will take a long while to come in.........i think i might go for it if we could get more goes on the nhs!!!

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Wednesday, April 4th 2007, 5:35pm

I think the consultations open for another few months , then the HFEA will issue 'guidance' - though whether this guidance will be compulsary or not remains to be decided. Your treatment shouldn't be affected in the next few months if your clinic are pro 2 embryo transfer -some clinics in the UK are already only putting one back in.

The people recommending the single embryo transfer approach do say it will only be acceptable if the department of health follow the NICE guidelines and fund 3 fresh (+3 Fet) IVFs per couple. But, the HFEA don't have much sway with the department of health so the guidelines may come into place without changes to funding which would not be good news.

bah!

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Wednesday, April 4th 2007, 6:09pm

Those reports worry me because it gives people who have no experience of ttc and all the problems involved an even more clouded view of it. The BBC seem to forget when they report on issues like IVF that there are people personally involved and it always seems one-sided. If people were naive about IVF etc they would get a very unfair view of IVF just based on that report. I know that personally because of my thyroid condition I have been told already that multiple births for me are not to be encouraged. If misguided acquaintances of mine who know what I'm ttc and how heard that they would jumping to all sorts of conclusions about it. I just think BBC should think before they report on it. I agree with all of the views above.

xxx Lorraine xxx

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Reg: Feb 22nd 2007

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Thursday, April 5th 2007, 2:55am

You have made many good and valid points and I agree with you all.

Jensqui is right, it isn't only Britain. These guidelines are at least being applied in Scandinavia as well. Many countries are trying to save some money by going this route. Sweden has national laws about only transferring one embryo in most cases (I think they subsidize the following FET instead) . Here in Iceland they pressure for single embryo transfers, for example they didn't allow me to have double transfer (even though I begged for it and nothing special indicates personal risks in my case). They thought my chances for twins were too high considering that I'm young and the embryos were strong. That's why we didn't get what we wanted.

They simply want to reduce twin births at a national level. Here they haven't fine tuned this policy as we didn't pay any less than others who got double transfer! If our single embryo hadn't stuck then we would have to pay full price for FET. I think that's ridiculous and really unfair for those of us young and "too healthy and likely to get twins"! Actually it's unfair in the first place that the choice is not ours.

Just wish the media would handle this issue differently. I think they are too often using brainwashing tactics to support prejudice in this matter.

JenC

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Tuesday, April 10th 2007, 3:18pm

I agree and expecially kar as it is very unfair to reduce the transfer to one as myself can only rely on IVF to get pregnant and I would be over the moon if we had twins. I personally think this should be upto us on whether we want one or two embies as we are aware of the risks. But thats my view.
xx




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