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U.K. Tries to Rein In Fertility Treatments by Limiting Embryo Implants to Two

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WebMD Health News

June 23, 2000 -- England, which gave the world the first 'test-tube baby' more than 20 years ago, now says that it's time to rein in fertility experts by limiting the number of fertilized eggs or embryos that are implanted into would-be mothers.

The limit comes in the form of a new fertility treatment guideline from the Royal College of Obstetricians and Gynaecologists, and the stated goal is to prevent unwanted triplets, quadruplets, and larger multiple births.

Mothers and babies both have greater risks during multiple births, according to a recent report in the CDC's Morbidity and Mortality Weekly Report. Mothers have a greater risk of excessive bleeding during and after delivery and a higher risk of needing a cesarean section -- a procedure that carries its own set of risks. Babies have a higher risk of lower birth weight, preterm delivery, and death. Other studies have shown that women carrying two or more babies are at increased risk of having high blood sugar and high blood pressure and that their babies are at increased risk for birth defects as a result of crowding and poor growth.

But at least one group of London-based fertility experts says the new guideline limiting implanted embryos to two could prevent some infertile couples from becoming parents, and leading U.S. experts agree.

Professor Ian Craft, MD, and colleagues from the London Gynaecology and Fertility Centre, make their case in a letter to the editor of the British Medical Journal. They write that the guideline is too broad. A better approach, they write, would be to develop a fertility index. The index should be based on a woman's risk of multiple pregnancy, and it could be developed so that those at high risk of carrying three or more babies could be implanted with one or two embryos, while those with low reproductive potential could receive "three or even more," they write.

They write that they have used a similar approach in their own clinic and have a very low rate of triplets even when they have implanted three embryos.

James M. Goldfarb, MD, MBA, director of in vitro fertilization, MacDonald Women's Hospital-University Hospitals of Cleveland, tells WebMD that he, too, thinks the U.K. limits are too restrictive. He says that the situation in the U.S. is very different than in the U.K. or Europe.

"In the first place, we don't have any legal requirements governing the number of embryos implanted," Goldfarb says. But he says that his center and others usually follow guidelines issued by the Society for Assisted Reproductive Technology .

"These general guidelines are based on age. If a patient is 30 or younger and has a good chance of becoming pregnant, the guidelines suggest a limit of two embryos," he says. "As you get towards age 35, the maximum becomes three, and then at 40, we would generally put back four."

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