Last month was the 40th anniversary of the first IVF birth. Louise Brown was born in Oldham General Hospital in 1978 (BBC, 2018). Since then, more than 300 000 babies have been born as a result of IVF treatment, giving precious life to thousands of childless couples. IVF techniques have come a long way since then, and statistics from the Human Fertilisation and Embryology Authority (HFEA) show that fertility treatments in the UK are becoming much safer (HFEA, 2018a). Birth rates have significantly improved, with one in three treatment cycles now resulting in a birth for couples under the age of 35 (HFEA, 2018a), but one thing has remained the same: the desire and hope to have a child.
In 2006, however, HFEA became increasingly concerned about the growing number of multiple pregnancies resulting from IVF treatment and the effects that this was having on maternal and neonatal health. HFEA launched the One at a Time campaign (HFEA, 2018b) to improve the safety of IVF treatment for both mothers and babies by reducing the number of multiple pregnancies (Braude, 2006).
Compared with singleton births, multiples are more likely to be born prematurely and to be admitted to the neonatal unit. Twins are six times more likely to have cerebral palsy, according to the Twins and Multiple Births Association (TAMBA) (2018). There are also significant maternal morbidities associated with multiple pregnancies, including pre-eclampsia, haemorrhage and sepsis attributed to miscarriage.
In 2008, one in four pregnancies from IVF resulted in a multiple pregnancy. Since the One at a Time campaign, the national multiple birth rate has reduced from 24% in 2008 to 11% today, with no reduction in birth rates (HFEA, 2018a). HFEA has worked closely with individual clinics, service users and stakeholders to implement guidance and regulations to reduce the number of multiple pregnancies. Several European regulators of human reproduction and embryology have also addressed the problem of multiple pregnancies by recommending the use of elective single embryo transfer (eSET).
‘I have noticed a worrying trend of women seeking IVF treatment outside of the European Union […] returning with triplets and quadruplets‘
In recent months, I have noticed a worrying trend of women seeking IVF treatment outside of the European Union (where IVF treatment is not strictly regulated) and returning with triplets and quadruplets, resulting in adverse maternal and neonatal outcomes. This recently made mainstream news, with some experts suggesting that couples travel abroad because of the rising costs of private treatment in the UK (Armstrong, 2018). Whatever the reason, there needs to be access to safe fertility treatment within the UK; however, the NHS's finances are finite, and there needs to be a balance of resources. This will of course encourage couples to travel abroad. When they do, these clinics are not overseen by HFEA and may not be regulated to the same high standards as the UK.
I have been thinking about how we can raise awareness for women considering having IVF abroad. In 2016, there was a big drive to warn people about having cosmetic surgery abroad, following a series of adverse outcomes after people had travelled from the UK to countries where cosmetic surgery was not strictly regulated. I think that the UK should do a similar campaign for couples considering IVF treatment abroad. Alternatively, maybe the clinical commissioning groups (CCGs) should look at increasing the number of NHS cycles to stop couples travelling abroad. Perhaps this is controversial, but this could be cost-effective if the number of multiple births from IVF outside of the UK is reduced.