- Major new report reveals safety and financial costs of twinned births, which are at least five times more likely in IVF pregnancies
- Chair of HFEA said poorer outcomes are “unwitting consequence” of CCGs limiting IVF funding
- Leading fertility charity said more people are now seeking treatment abroad due to IVF cuts, which can result in riskier pregnancies
Commissioning restrictions on IVF treatment are putting the lives of mothers and babies at risk, according to a report commissioned by the official regulator and three major fertility organisations.
The Human Fertilisation and Embryology Authority, the sector regulator, has jointly published a report into the safety and financial costs of twin births – which are widely associated with in vitro fertilisation.
It found the rate of stillbirth is approximately seven times higher, and maternal mortality 2.5 times higher, in women carrying two or more babies, compared to singleton births. Eight per cent of multiple pregnancies end in death or disability for one or more of the babies.
About 11 per cent of IVF assisted pregnancies result in two or more babies, compared to between 1 and 2 per cent of naturally conceived pregnancies.
The report, shared exclusively with HSJ, was jointly commissioned by HFEA, the British Fertility Society, the Multiple Births Foundation, and Fertility Network UK. It was compiled by the National Guideline Alliance, which is part of RCOG.
It said: “Multiple pregnancy is widely recognised as associated with IVF… because of the trend to transfer two or more embryos to the womb during treatment”.
If parents are limited to one cycle of IVF, or are forced to fund it themselves, they may choose to implant multiple embryos in the hope it increases the chances of pregnancy.
Sally Cheshire, chair of the HFEA, said poorer outcomes are an “unwitting consequence” of commissioners who are “limiting IVF to one or no cycles”.
She added: “These [IVF] decisions are about life and death… the commissioner [must] understand the cost of making those [funding] decisions. This report is intended to inform commissioning decisions so that the risks to patients and costs to the NHS are minimised.
“There isn’t enough funding going into IVF [and] what is spent we don’t believe is being spent effectively. We understand CCGs are cash-strapped [but] funds that aren’t directly spent by them may come back to their local area through increased costs on local trusts because of multiple births, or through mental wellbeing [needs] in people who are denied a family.”
Increased health risks from carrying more than one baby include a greater likelihood of miscarriage, hypertension, diabetes, pre-eclampsia and caesarean section for the mother. Frequent prematurity and lower gestational weight of foetuses also contribute to poorer outcomes in babies.
The report also revealed the average cost of a twin pregnancy is £14,000, which includes increased costs during pregnancy, birth, neonatal care, and some elements of any resulting long term disability. For a single pregnancy, the cost is nearly two-thirds less, at £4,900.
Professor Lesley Regan, president of Royal College of Obstetricians and Gynaecologists, said funding three full cycles, where embryos can be frozen and stored for later pregnancies, is “the most important factor in maintaining low rates of multiple pregnancies and reduce(s) associated complications”. She said it would “provide greater incentive for IVF centres and patients” to adopt single embryo transfer.
Since October 2017, 61 per cent of clinical commissioning groups in England have offered one round of IVF. The vast majority of those did not offer a full IVF cycle. Seven CCGs did not offer any IVF treatment. Restrictions are generally put in place due to financial pressures on CCGs.
Julie Wood, chief executive of NHS Clinical Commissioners, said: “Unfortunately the NHS does not have unlimited resources and ensuring patients get the best possible care against a backdrop of spiralling demands, competing priorities and increasing financial pressures is one of the biggest issues CCGs face. We would encourage commissioners across the country to look carefully at the information in today’s report to ensure… the most effective use of the limited NHS pound.”
Dr Jane Stewart, chair of the British Fertility Society, said self funding patients were often more inclined to “take a risk” by choosing to implant multiple embryos or seeking treatment in foreign IVF clinics, which are often cheaper than the UK but do not have restrictions on the number of embryos implanted.
Jane Denton, director of Multiple Births Foundation, said: “Good quality embryos are, you could almost say, being unethically wasted. We feel very strongly [full cycles] should be offered to women on an equitable basis, rather than continue with the variation we see between CCGs.”
HFEA said 60 per cent of IVF patients in England have to fund some or all of their treatment.
Aileen Feeney, chief executive of leading patient charity Fertility Network UK, said: “As NHS services are cut further you’ll see more people going abroad so chances are that the [current rate of UK multiple births] will go up from 10 per cent.”
NHS England did not wish to comment. The Department of Health and Social Care pointed to the long term deal which will increase NHS funding by 3.4 per cent each year in real terms. It did not say how much more would be invested in IVF.
HSJ interviews; Twin pregnancy costing report
4 September 2018