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


    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."

    But because the guidelines are "loose," each case can be evaluated individually, he says. "Sometimes we look at the embryos, and they are not growing as fast, don't look as likely to implant, so we might put back more," he says.

    Sergio Oehninger, MD, professor of obstetrics and gynecology at the Eastern Virginia Medical School and director of the division of reproductive technology at the Jones Institute for Reproductive Medicine in Norfolk, agrees with Goldfarb about the need to consider each case separately.

    He tells WebMD that the two embryo limit is "common in Europe. I think that is already the case in German and Sweden, and now the U.K. is taking the same approach." That approach may help explain why in vitro fertilization success rates in the U.S. tend to be better than the rates in Europe. "If you implant fewer embryos, the chances are that you will have fewer pregnancies," he says.

    Oehninger says the limit on embryos is one element in an overall "softer approach to stimulation than we have in the U.S. -- where we take an aggressive approach to stimulating the ovary to produce more eggs that can then be fertilized to produce more embryos."

    At the Jones Institute, which was the site of the first successful in vitro fertilization procedure in the U.S., Oehninger says there is now a shift toward "extending the culture of embryos from day 2 or 3 to day 5 so that we are actually transferring a blastocyst, or more mature embryo. This allows us to transfer only two and get a good success rate with very little risk of multiples." However, the blastocyst transfer is "not yet universally available," he says.

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