One embryo at a time

Should the U.K.'s government set a 10 percent limit on twins?

Published April 4, 2007 3:42PM (EDT)

In an intriguing headline, today's Telegraph reports that "IVF clinics may face multi-birth restrictions." The U.K.'s Human Fertilization and Embryology Authority (HFEA) is trying to figure out ways to "reduce the dangers associated with multiple births" -- which include higher risks for babies of being premature or stillborn, dying soon after birth, or developing cerebral palsy, cardiovascular problems or congenital defects. Whereas women conceiving without IVF have about a one in 80 chance of having twins, 25 percent of women who give birth as a result of IVF pop out doubles.

To address the issue, HFEA is launching a three-month public consultation about IVF and has put out a paper proposing four options: trying to increase awareness of the dangers of multiple births; setting a maximum twin rate of 10 percent for clinics; putting out guidelines recommending which women could have more than one embryo transferred; and applying those guidelines only if a clinic's twin rate was over 10 percent.

Should these limits be put into place, HFEA says the women most likely to be affected would be young, healthy women who have not yet tried IVF (older women and those who have already had problems with IVF would still be allowed to have two embryos implanted). This would be a change from the current policy, which allows up to two embryos to be implanted in all women under 40, and three for those over 40, if their doctors deem it necessary. And, as the article points out, the U.K. would not be alone in moving toward single embryo transfers -- Belgium, the Netherlands, Sweden and Finland have all done so, in various forms.

The issue raises all the usual sticky questions about how much control the state should have over women's reproductive health. On the one hand, obviously no one wants to have an unhealthy baby -- but is the state's place to put further limits on the number of embryos that can be implanted?

This would be less of an issue if IVF were covered for multiple treatments (i.e. if you fail to conceive with one embryo, you can give it another go), but the problem, as the Telegraph points out, is that most primary care trust funds fail to fund a government promise that women should be entitled to three rounds of IVF, courtesy of the National Health Service. In other words, women are supposed to be entitled to three tries, but are only getting one. Given the cost of IVF, why wouldn't you try to up your chances for success by implanting more than one embryo?

It seems to me that the most obvious solution is the following: educate people more on the increased health risks of having twins, and then keep your damn promise to pay for three rounds of IVF. Sure, it might be more expensive in the short term. But funding a system that encourages people to have babies with fewer health risks would pay for itself down the road.

By Catherine Price

Catherine Price is an award-winning journalist and author of Vitamania: How Vitamins Revolutionized the Way We Think About Food. Her written and multimedia work has appeared in publications including The Best American Science Writing, The New York Times, Popular Science, O: The Oprah Magazine, the Los Angeles Times, The San Francisco Chronicle, The Washington Post Magazine, Salon, Slate, Men’s Journal, Mother Jones, PARADE, Health Magazine, and Outside. Price lives in Philadelphia.

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