One at a Time

Earlier this week, I spoke at a workshop in Bristol organised by One at a Time about patient views about single embryo transfer. I know many people are worried that having just one embryo put back during IVF treatment will reduce the chances of success, but all the research shows that when clinics are selecting the right patients for single embryo transfer, it is quite possible to cut risk of multiple pregnancies without reducing the pregnancy rate.

The speaker who made the most impact on me was paediatrician Alun Elias-Jones, who talked about the problems of prematurity that he had frequently seen with multiple births. We all know so many twins who are perfectly fine that it's easy to assume that problems are relatively rate, but it was made very clear that this was far from the case with half of all twins being born early and often having low birth weights too, which can lead to all kinds of problems including brain injury, lung disease and cardiovascular problems. He explained that twins were three times more likely to be stillborn, five times more likely to die during their first year and four to six times more likely to have cerebral palsy. It was his description of the longer term problems that they can face with disabilities, learning difficulties and behavioural issues which was particularly striking. It's all too easy for staff in fertility clinics not to think about these potential consequences, and to pass on an ambiguous message to patients.

Going through fertility treatment isn't easy and all anyone wants is for it to work as quickly as possible. If you've got a team treating you who are all clear that the best outcome would be one healthy baby, it's something you're going to believe yourself. If you are faced with divided opinions or with some staff seeming to suggest that multiple birth might not be a bad outcome, it is hardly surprising that we sometimes end up confused.

Of course, there's one thing which really would make a difference to patient opinion and that would be the full implementation of the NICE guideline, which says that all those who are eligible should receive up to three full cycles of IVF. With adequate funding, it would be far easier to convince patients that all those most at risk of multiple pregnancy should consider having just one embryo put back at a time.