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