RCOG Guidelines to limit IVF embryo numbers

The Royal College of Obstetricians and Gynaecologists (RCOG) has issued guidelines for infertility treatments. The guidelines, entitled 'The management of infertility in tertiary care', suggest the need to establish an 'equity of access to treatment' in the fertility service and to develop a National Service Framework to help achieve this. However, there is much debate following one of the RCOG recommendations.

The recommendations state that with regard to IVF treatment, 'the current high multiple births rate can be reduced by restricting the number of embryos replaced to two'. The RCOG wants to cut the number of triplets and twins born following fertility treatment, which it believes to be 'unacceptably high' following research undertaken by the RCOG secretary, Professor Allan Templeton. His conclusions are also that women who have only two embryos implanted have the same chance of pregnancy as those with three or more implanted.

Professor Ian Craft said in response to the recommendations that research undertaken at the London Fertility Centre has shown that not all women bear the same risk of multiple pregnancies and therefore that 'to introduce a blanket rule would seriously affect the chances of success for many deserving women'. Professor Craft believes that the women can be given a 'fertility score' which would indicate their risk of having a multiple pregnancy. Factors including age, response to fertility drugs and egg quality would be taken into account. Those at high risk should only have two embryos replaced per cycle, but those at low risk, suggested to be women under thirty who produced more than 15 eggs per cycle 'could have five or more'.