HFEA code aims to bring an end to triplet births

The UK's Human Fertilisation and Embryology Authority (HFEA) has published a revised Code of Practice, the sixth since the establishment of the authority in 1991. The code provides guidelines for HFEA-licensed fertility clinics on the provision of IVF and related services. The most significant addition to the new edition of the Code of Practice, which replaces the fifth code published in March 2001, concerns the numbers of embryos that can be transferred to a woman during IVF treatment. The new guidance stipulates that clinics should transfer no more than two eggs or IVF embryos at a time to women under 40 years old and no more than three eggs or embryos to women older than 40.

The HFEA says that there should be no exceptions to this rule and that clinics which fail to comply with the guideline may risk losing their licence. The new Code is accompanied by an information leaflet designed for patients, aiming to highlight the medical and psychological problems associated with multiple births. Jane Denton, Director of the Multiple Births Foundation and member of the HFEA, emphasised this, saying: 'Multiple births are associated with premature and low birth-weight babies and the risk of [a baby's] death before birth or in the first week of life is significantly greater. Compared with one baby, the risk of long term disability like cerebral palsy is around five times higher for twins and 18 times higher for triplets.'

Statistics show that nearly half of all triplet births in 1999 were as a result of fertility treatment and there continue to be large numbers of twins and triplets born from IVF. Previous HFEA recommendations, issued in August 2001, that three embryos should be transferred to the womb only in exceptional circumstances, have started to reduce multiple birth rates. However, Suzi Leather, chair of the HFEA, said that the HFEA's aim 'is to bring the number of multiple births from fertility treatment closer to that which occurs naturally'. She added 'In most women, limiting the amount of embryos [transferred] has a significant impact on the number of multiple births without reducing their chance of having a baby'.

These new restrictions have been welcomed by the British Fertility Society, Multiple Births Foundation and Royal College of Obstetricians and Gynaecologists (RCOG). Professor Allan Templeton, honorary secretary of the RCOG, said that because multiple births involve risks to both mothers and children, and place a burden on neonatal care services, 'every attempt should be made to avoid multiple births, particularly triplets, in IVF treatment'. He added that the RCOG would also like 'more work done to reduce the number of twins born'.

But not everyone welcomes the new guidelines. Dr Mohammed Taranissi, director of the Assisted Reproduction and Gynaecology Centre in London told the BBC: 'This is not a law. These are only guidelines. If I believe honestly that this is not in the best interest of patients I will do what I think is fit.' Professor Ian Craft, director of the London Fertility Centre, said 'I'd say that a significant number of women will be prevented from having their own biological child as a result of this code of practice'. 'That is a serious accusation', he added. The Code of Practice, which was laid before parliament on 6 January, will come into effect on 1 March 2004.