Still One at a Time

At our recent Human Fertilisation and Embryology Authority meeting, we took the decision to remove a condition that relates to our multiple births policy from all IVF clinics' licences. The decision came after two years of legal challenge from two London clinics arguing against the licence condition, which expects all clinics to reduce their multiple live birth rate to no more than 10 percent of all live births.

In stark contrast to the reasons given in the media, we have removed this particular sanction not because we have changed our mind about the pressing need to reduce the incidence of multiple births following IVF — that need remains and the policy stands. Nor was it because a recent court case ruled that it was an inappropriate use of our powers — that was a determination of when we should apply a licence condition, not whether.

Instead, we did it because we felt that it would be wrong to continue to spend significant amounts of public money defending a challenge which meant that two years from when the condition was first introduced, it does not appear on two clinics' licences. This is simply unfair to practitioners in all the other clinics, who have continually called for there to be a level playing field. And, with further legal challenge likely, this unfairness could have continued for some time to come.

The Authority members agreed that it would be far better to focus our scarce resources on more productive activities: helping and supporting the sector to continue its progress towards the 10 percent target.

So, how have they been getting on? Very well, in fact. Another inaccuracy in the media coverage was that we removed the sanction because IVF clinics are failing to meet our targets. This is simply not so. The IVF sector has risen to the challenge admirably — a particularly impressive feat, given that it is a sector where competition between clinics' performance is a key feature. Any slight advantage in terms of success rates gives the advantage to one's competitors.

Since the policy was implemented in 2009, the IVF sector has brought the multiple birth rate down from 24 percent of live births to 16 percent in 2012. Overall, it has reached the targets we have set year on year, and is heading strongly for the 10 percent target in place since October 2012. All this has been achieved without significantly impacting upon success rates overall. This, along with good information and consistent messages from clinic staff, has helped to turn patient views around from a largely hostile response in the early days to a much greater acceptance of single embryo transfer today.

So, the policy is working. And it is working largely because of the approach we have taken: working closely with professionals in the IVF field, patient groups, paediatricians and commissioners to build consensus on the need to reduce multiple births and taking steps to do just that. Without the close collaboration of the professional bodies in the field, it simply would not have worked.

Our approach is outcome-based: it is up to practitioners to use their clinical freedom to determine which patients are the most suitable for single embryo transfer. We cannot — nor should we — dictate individual clinical decisions. That's why a professional consensus on the need to reduce the incidence of multiple births — backed up by professional standards and the NICE guideline — has been so important. But, let us not kid ourselves. Without our commitment as the regulator it would not have worked. Using a combination of ongoing monitoring of individual clinics' outcomes, creating opportunities for sharing good practice and providing good information for patients and professionals through our One at a Time website, we have nudged clinics towards a target they would not have reached alone.

So, what next for multiple births? Well, in many respects it is business as usual. After all, the licence condition was only a small element of our policy. We will continue to enforce the policy through ongoing monitoring and inspection, backed up by best practice guidance and the existing requirement to have an effective multiple births minimisation strategy in place. We will continue to work with professional and patient organisations to support clinics and, most importantly, we will still expect clinics to comply with the policy.

We are not there yet, but we are well on the way to 10 percent. By continuing to work together — practitioners, professional bodies and the regulator — we can and will achieve that target, in the interests of mothers and their babies.

Multiple births policy will be discussed by a panel including the HFEA's Director of Compliance Nick Jones at the Progress Educational Trust conference 'Double Take: Twins in Genetics and Fertility Treatment', taking place in London on Wednesday 4 December 2013.