Doctors have become increasingly worried about the number of multiple births following in-vitro fertilisation (IVF).
Of almost 14,000 babies born thanks to IVF in Britain every year, one in four is a twin or a triplet.
As foetuses they are more likely to die during pregnancy, while those that survive are more likely to be premature, underweight or disabled.
Mothers of multiple-birth children are also more likely to suffer from pregnancy complications like pre-eclampsia.
Current rules from the National Institute of Clinical Excellence (Nice), drawn up in 2004, say that "no more than two embryos should be transferred" during any one IVF cycle "to balance the chance of a live birth and the risk of multiple pregnancy and its consequences".
But that could be tightened under a review looking at certain aspects of fertility treatment.
Nice and the Human Fertilisation and Embryology Authority (HFEA) have recently started to recommend that women at high risk of multiple births - those under 37 with good quality embryos - should elect for 'single embryo transfer' (SET).
However, Nice could go further by taking away the choice, a move already undertaken in Sweden.
Since 2002, women there have only been able to have single embryo transfer unless the risk of twins is small. SET rates have subsequently risen from 15 to 70 per cent.
Studies have shown a "significant fall in neonatal illness" according to Tony Rutherford, chair of the British Fertility Society, which he said "validated the policy of single embryo transfer".
However, women undergoing IVF could feel such a step would limit their options and unnecessarily force them to have more physically and mentally exhausting IVF cycles.
Susan Seenan, of Infertility Network UK, nonetheless gave the idea a cautious welcome.
She said: "We are supportive of SET for the right women, but it has got to come with full NHS funding."
All health authorities should fund three full cycles, she said, which included transplantation of a fresh embryo or embryos and - if needed - also frozen embryos at a later date.
She commented: "Without that, it's unfair to ask patients to elect for SET."
Mr Rutherford added: "A blanket ban [on multiple embryo transfer] would be wrong.
"The general shift in IVF is to try to create 'one baby at a time' but to do that we need a commitment from government to give us the money."
At present most IVF patients only received one cycle on the NHS, he said.
A shift to SET and what he termed a "milder" IVF approach could achieve the same pregnancy rate as conventional methods, he added, but this would require a "leap of faith" to fund three cycles.
In the end it was cheaper because the reduction in multiple-births saved more than the extra spent on additional cycles, he said a Dutch study showed.
The Nice review will also examine a number of other issues, but the principle of three full cycles will remain untouched.
It will ask whether women should be offered tests of their ovarian (egg) reserves, which give an indication of remaining fertility.
It will also look at when intrauterine (IUI) insemination should be available on the NHS.
Although this is currently recommended for mild male infertility, such as when a man has poorly-swimming sperm, success rates vary widely.
Nice could also recommend that clinicians wait for five to six days after fertilisation before implanting embryos - or blastocysts as embryos of that age are called - as new evidence shows this results in higher success rates. However, the method is more costly than implanting in two or three-day old embryos.
The final updated guideline is not expected to be published before 2012.
Via : telegraph
Of almost 14,000 babies born thanks to IVF in Britain every year, one in four is a twin or a triplet.
As foetuses they are more likely to die during pregnancy, while those that survive are more likely to be premature, underweight or disabled.
Mothers of multiple-birth children are also more likely to suffer from pregnancy complications like pre-eclampsia.
Current rules from the National Institute of Clinical Excellence (Nice), drawn up in 2004, say that "no more than two embryos should be transferred" during any one IVF cycle "to balance the chance of a live birth and the risk of multiple pregnancy and its consequences".
But that could be tightened under a review looking at certain aspects of fertility treatment.
Nice and the Human Fertilisation and Embryology Authority (HFEA) have recently started to recommend that women at high risk of multiple births - those under 37 with good quality embryos - should elect for 'single embryo transfer' (SET).
However, Nice could go further by taking away the choice, a move already undertaken in Sweden.
Since 2002, women there have only been able to have single embryo transfer unless the risk of twins is small. SET rates have subsequently risen from 15 to 70 per cent.
Studies have shown a "significant fall in neonatal illness" according to Tony Rutherford, chair of the British Fertility Society, which he said "validated the policy of single embryo transfer".
However, women undergoing IVF could feel such a step would limit their options and unnecessarily force them to have more physically and mentally exhausting IVF cycles.
Susan Seenan, of Infertility Network UK, nonetheless gave the idea a cautious welcome.
She said: "We are supportive of SET for the right women, but it has got to come with full NHS funding."
All health authorities should fund three full cycles, she said, which included transplantation of a fresh embryo or embryos and - if needed - also frozen embryos at a later date.
She commented: "Without that, it's unfair to ask patients to elect for SET."
Mr Rutherford added: "A blanket ban [on multiple embryo transfer] would be wrong.
"The general shift in IVF is to try to create 'one baby at a time' but to do that we need a commitment from government to give us the money."
At present most IVF patients only received one cycle on the NHS, he said.
A shift to SET and what he termed a "milder" IVF approach could achieve the same pregnancy rate as conventional methods, he added, but this would require a "leap of faith" to fund three cycles.
In the end it was cheaper because the reduction in multiple-births saved more than the extra spent on additional cycles, he said a Dutch study showed.
The Nice review will also examine a number of other issues, but the principle of three full cycles will remain untouched.
It will ask whether women should be offered tests of their ovarian (egg) reserves, which give an indication of remaining fertility.
It will also look at when intrauterine (IUI) insemination should be available on the NHS.
Although this is currently recommended for mild male infertility, such as when a man has poorly-swimming sperm, success rates vary widely.
Nice could also recommend that clinicians wait for five to six days after fertilisation before implanting embryos - or blastocysts as embryos of that age are called - as new evidence shows this results in higher success rates. However, the method is more costly than implanting in two or three-day old embryos.
The final updated guideline is not expected to be published before 2012.
Via : telegraph
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