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