Full state funding for IVF would reduce the risk of multiple pregnancies, which would be safer for women and their babies, and be cheaper for the NHS, according to a paper published today.
The Royal College of Obstetricians and Gynaecologists’ (RCOG) Scientific Impact Paper says that six out of ten IVF cycles in the UK are funded by patients themselves, which often results in multiple pregnancies.
However, these lead to several increased health risks for mothers, including pregnancy-induced high blood pressure, gestational diabetes, haemorrhage following birth, postpartum depression and heightened symptoms of anxiety and parenting stress.
They are also associated with a six-fold increase in the risk of preterm birth and long-term mental and physical disabilities, including cerebral palsy, learning difficulties and chronic lung disease.
The estimated neonatal cost to the NHS for twins is 16 times higher than that for a singleton baby, while multiple pregnancies from “fertility tourism” is also contributing to challenges facing maternity and neonatal services, says the RCOG report.
The paper found that almost one in five IVF births in the UK in 2011 involved a multiple birth, compared with 4.9% in Sweden, which has a high proportion of single embryo transfers. However, it acknowledged that the multiple birth rate in the UK has fallen to 11%, according to a recent report by HFEA.
Lead author Mr Tarek El-Toukhy, consultant gynaecologist and specialist in reproductive medicine and surgery, said: “Multiple pregnancy is the greatest avoidable risk of IVF. The health and financial burden it places on women, families and the NHS cannot be overstated.
“To ensure rates of multiple births remain low, there is little doubt that the single most important factor that could enhance the acceptance of single embryo transfer among patients and practitioners is appropriate funding for IVF treatment.
“It is also clear from other European countries, such as Sweden and Belgium, that further reduction in the multiple pregnancy rate to single figures is feasible where generous IVF state funding arrangements have reduced the associated adverse implications of multiple pregnancies for both mother and baby.”
Calling for NHS funding of IVF treatment, Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists, said it was “completely unacceptable” that access remained a postcode lottery.
“Government funding for three full IVF cycles, as recommended by NICE guidelines, would provide a greater incentive for IVF centres and their patients to adopt single embryo transfer more regularly,” she said.
“A national commissioning policy is needed to remove the current variation in IVF funding around the country and increase the uptake of single embryo transfer to improve maternal, neonatal and child health. This will also ensure significant financial savings nationally by reducing multiple pregnancies after IVF treatment.”
Kate Brian, chair of the RCOG’s Women’s Network, added: “It is vital that IVF treatment is appropriately funded as NICE recommends – where you live should not dictate whether you can access NHS-funded treatment. Effective funding policies and clear information about the benefits of single embryo transfer will help to ensure safer and more successful outcomes.”
El-Toukhy T, Bhattacharya S et al on behalf of the Royal College of Obstetricians and Gynaecologists. Multiple Pregnancies Following Assisted Conception. Scientific Impact Paper No. 22. BJOG 2 February 2018; doi:10.1111/1471-0528.14974 [abstract]
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