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.

One at a time

Many people are understandably very concerned about proposals to cut the number of multiple births after IVF, and there's a lot of online chat about the issue. Some patients are worried that everyone going through IVF is about to be forced into putting back just one embryo at a time.

What's actually happening is that clinics with very high multiple pregnancy rates are being asked to try to lower them. Putting back one embryo at a time is never going to be a good idea for everyone, but in the right patients it can mean reducing the risk of twins without reducing the chances of pregnancy.

One study estimated that at least 220 babies die each year in the UK as a result of multiple births after assisted conception, twins are far more likely to be born prematurely and there are often other complications for both mother and babies. This is why high twin rates are such a worry.

If you want to know more about the issue, there's a new website with all the relevant information on the subject, not just for patients, but also for professionals, too. It's www.oneatatime.org.uk