Fertility experts have called for a dramatic cut in the number of twins born after IVF treatment.
Fertility experts have called for a dramatic cut in the number of twins born after IVF treatment.
IVF clinics in the UK will be expected to reduce the number of multiple births from a national average of one in four to 10% over the next three years.
IVF clinics in the UK will be expected to reduce the number of multiple births from a national average of one in four to 10% over the next three years.
It will mean increasing the proportion of women who have a single embryo transferred back into their womb.
It will mean increasing the proportion of women who have a single embryo transferred back into their womb.
But some warned the strategy could be unpopular with patients who may end up spending more on fertility treatment.
But some warned the strategy could be unpopular with patients who may end up spending more on fertility treatment.
Dr Mark Hamilton, chair of the British Fertility Society, who was involved with a host of other professional bodies in drawing up the guidelines, said NHS funding for IVF was "very patchy".
Dr Mark Hamilton, chair of the British Fertility Society, who was involved with a host of other professional bodies in drawing up the guidelines, said NHS funding for IVF was "very patchy".
It is absolutely imperative that funding issues around IVF are addressed Dr Mark Hamilton, British Fertility Society
It is absolutely imperative that funding issues around IVF are addressed Dr Mark Hamilton, British Fertility Society
The National Institute of Clinical and Health Excellence recommends women under the age of 40 receive three cycles of IVF on the NHS.
The National Institute of Clinical and Health Excellence recommends women under the age of 40 receive three cycles of IVF on the NHS.
But he said only 5% of health authorities in England offered three cycles with most only offering one cycle - a situation which left women feeling pressured to have more than one embryo implanted to maximise their chances of success.
But he said only 5% of health authorities in England offered three cycles with most only offering one cycle - a situation which left women feeling pressured to have more than one embryo implanted to maximise their chances of success.
"It is absolutely imperative that funding issues around IVF are addressed.
"It is absolutely imperative that funding issues around IVF are addressed.
"If patients did not have to worry about finding the money for their own treatment this would certainly be much easier to implement," he said.
"If patients did not have to worry about finding the money for their own treatment this would certainly be much easier to implement," he said.
Risks
Risks
Multiple births are more dangerous for the mother and babies due to health problems during pregnancy including miscarriage and a higher chance of premature birth.
Multiple births are more dangerous for the mother and babies due to health problems during pregnancy including miscarriage and a higher chance of premature birth.
There are also risks of long-term health or developmental problems for twins or triplets compared with singletons.
There are also risks of long-term health or developmental problems for twins or triplets compared with singletons.
Under the strategy all clinics will be expected to meet the national 24% average by January 2009, reducing to 10% by 2012.
Under the strategy all clinics will be expected to meet the national 24% average by January 2009, reducing to 10% by 2012.
This compares to a rate of one in 80 for naturally conceived multiple births.
This compares to a rate of one in 80 for naturally conceived multiple births.
Clinics will have to increase the number of single embryos they put back into women undergoing fertility treatment where appropriate - usually in younger women.
Clinics will have to increase the number of single embryos they put back into women undergoing fertility treatment where appropriate - usually in younger women.
And freezing of embryos should be made available to all patients - currently it is thought at least 30% of clinics do not offer this.
And freezing of embryos should be made available to all patients - currently it is thought at least 30% of clinics do not offer this.
Clinics should also work to increase the number of embryos they transfer at the blastocyst stage - day five to six - rather than at day two to three to improve the chances of success with a single embryo.
Clinics should also work to increase the number of embryos they transfer at the blastocyst stage - day five to six - rather than at day two to three to improve the chances of success with a single embryo.
EUROPEAN EXPERIENCE Belgium - patients are funded for six cycles but can only have one embryo transferred if they are under 36. Twin births account for 7%Finland - Single embryos transferred in 60% of cases. Number of twins born is falling year on year and triplets are rareSweden - in 70% of cycles only one embryo is transferred and the twin birth rate is 5%
EUROPEAN EXPERIENCE Belgium - patients are funded for six cycles but can only have one embryo transferred if they are under 36. Twin births account for 7%Finland - Single embryos transferred in 60% of cases. Number of twins born is falling year on year and triplets are rareSweden - in 70% of cycles only one embryo is transferred and the twin birth rate is 5%
Jane Denton, director of the Multiple Birth Foundation, said for many couples who have struggled to conceive the prospect of twins is very appealing.
Jane Denton, director of the Multiple Birth Foundation, said for many couples who have struggled to conceive the prospect of twins is very appealing.
"We need to help patients really understand which multiple pregnancies have high risks and the longer term consequences for their families."
"We need to help patients really understand which multiple pregnancies have high risks and the longer term consequences for their families."
Alun Elias-Jones, consultant paediatrician and member of the Royal College of Paediatrics and Child Health, said doctors had a duty to consider the long-term consequences of fertility treatment.
Alun Elias-Jones, consultant paediatrician and member of the Royal College of Paediatrics and Child Health, said doctors had a duty to consider the long-term consequences of fertility treatment.
"The risk of an adverse outcome for a multiple birth is much greater than for singleton births.
"The risk of an adverse outcome for a multiple birth is much greater than for singleton births.
"Some children have a traumatic start to life, extended stays in neonatal unit and others can have serious, long-term health problems."
"Some children have a traumatic start to life, extended stays in neonatal unit and others can have serious, long-term health problems."
Trish Davies, director of regulation at the Human Fertility and Embryology Authority (HFEA), backed the strategy and said they would be monitoring clinics' performance.
Trish Davies, director of regulation at the Human Fertility and Embryology Authority (HFEA), backed the strategy and said they would be monitoring clinics' performance.
But the Twins and Multiple Births Association reacted angrily to the proposals saying they flew in the face of what most patients and doctors wanted.
But the Twins and Multiple Births Association reacted angrily to the proposals saying they flew in the face of what most patients and doctors wanted.
Tamba chief executive Keith Reed said: "During the HFEAâs recent consultation, only 3% of respondents supported what the National Strategy Group are proposing.
Tamba chief executive Keith Reed said: "During the HFEAâs recent consultation, only 3% of respondents supported what the National Strategy Group are proposing.
"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."
"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."
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