Couples desperate for a child must be offered a way to have IVF treatment without the dangerous practice of implanting more than one embryo in the mother's womb, a group of Europe's fertility specialists said yesterday.
Backed up by research on the flood of twins and triplets being born as a result of IVF treatment, a significant proportion of them premature and underweight, they called for a reappraisal of the financing of assisted reproduction to encourage couples and clinics to use single instead of multiple embryos.
"The high risk of twins can't be ruled out by limiting the number of embryos transferred to two," Jean Luc Pouly, of Clermont-Ferrand University, France, told the European Society of Human Reproduction and Embryology in Vienna. "The urgent and next step is to move to single embryo transfer."
A study released at the conference by Dutch scientists showed that implanting up to two embryos in women in two separate cycles gave as much chance of making her pregnant as two embryos in a single cycle.
But two cycles cost twice as much as one - putting children further beyond the reach of less well off couples. Hence their desire to maximise the chances of success first time round by transferring more than one embryo.
Last year the human fertilisation and embryology authority, which regulates British IVF clinics, cut the maximum number of embryos doctors are normally allowed to implant in women in a single cycle from three to two.
The number of multiple births in England and Wales has risen from 6,277 in 1982 to 8,792 in 2000. The vast majority of multiple births resulted in twins.
In April the former chairwoman of the HFEA, Ruth Deech, said IVF clinics should be made to compensate the NHS for the estimated £60m it cost caring for extra twins and triplets born as a result of fertility treatment.
Twins are three times more likely to need intensive care after birth; triplets seven times more likely.
A French study presented at the conference, based on data from France's IVF monitoring organisation Fivnat, looked at the effects of multiple births in nearly 25,000 IVF pregnancies between 1986 and 1998.
Nearly 87% of the 1,772 triplets and more than 42% of the 11,905 twins were born prematurely. The triplets and twins were most likely to be underweight; triplets were five times more likely to die than single babies in the period immediately after birth.
In some countries with fewer restrictions, such as the US, IVF patients have more than three babies. "It's not a gift of God to have four babies. It's a disaster," said Karl Ny gren, associate professor of obstetrics and gynaecology at Sophiahemmet hospital in Stockholm.
"Although multiple pregnancies are driven by a number of factors they are essentially caused by doctors ... The medical profession should aim at a plan for self-regulation."
In the Dutch study, researchers from the university medical centre in Nijmegen divided IVF patients into two groups. One group of mothers had two embryos implanted in one session: the other had a single embryo implanted, and then, if that did not result in pregnancy, another one later. The results were identical - about a third of the women became pregnant in each case.
Dr Pouly said Europe needed to look at the costs of IVF treatment and care of children. If health systems were more willing to subsidise an extra treatment cycle for parents, they would save money in the long run on health care for twins and triplets.
