How much regulation of assisted reproduction is needed?

This week's New England Journal of Medicine publishes a report into the outcomes of assisted reproduction in the United States. One major finding is that the rate of multiple pregnancies following IVF treatment has reduced over the past few years. The authors of the study say that the fall in the multiple birth rate is the result of practitioners transferring fewer embryos to the woman during IVF treatment. They also say that the most marked fall in the number of embryos transferred occurred in the period immediately following the publication of guidelines by the American Society for Reproductive Medicine (ASRM) in 1999.

Unlike the UK, the United States does not have national legislation regulating IVF practice. American fertility clinics are subject to a range of rules, but compliance with most of them is not mandatory. As a result, good medical practice is often encouraged through professional guidelines rather than enforced through national legislation. The latest data from the US on multiple birth rates seems to suggest that the ASRM guidance on embryo transfer has had an effect. However, there seems to be some way to go. Whilst the rate of triplets and higher order multiple pregnancies from IVF has reduced in the US, the proportion of twins remains high. Further, although a high proportion of fertility clinics report their outcomes to a national body, data reporting is not mandatory there. So there remains the possibility that those clinics with higher multiple birth rates are preferring not to tell their peers.

There is much to learn from the American experience, both in what to do and what not to do. But the multiple birth rate story raises a more fundamental question about what the balance should be between legislation and professional standard-setting. What should be the role of regulation? Should it be to enforce best practice or simply to guarantee minimum standards? In the field of reproductive medicine, should regulation just provide basic protections for patients or should it promote ethical behaviour or even ideal outcomes?

This is one of the questions that the House of Commons Science and Technology Committee will be considering during its enquiry into human reproductive technologies and the law.