UK women OK with multiple embryo transfer risks

NEW YORK (Reuters Health) - Women undergoing in vitro fertilization (IVF) would rather have twins -- and accept the risks that can come with a multiple pregnancy -- than not become pregnant at all, a study by UK researchers found.

One quarter of IVF pregnancies in Europe result in twins, Graham S. Scotland of the University of Aberdeen in Scotland and colleagues note in their report. Given the increased risks of twin pregnancies to both mother and children, they add, many European nations have shifted to a policy of single embryo transfer.

But in the UK, where local funding may only provide for a single round of IVF treatment, people have been less willing to accept this practice. Policymakers have debated about whether the decision to have more than one embryo implanted should be a patient choice, or a medical decision.

To investigate the perception of risks associated with twin pregnancies, Scotland and his team surveyed 74 women awaiting IVF, asking them about their relative preferences for having a child with physical impairments, cognitive impairments, visual impairments, early death, premature delivery, or no pregnancy at all.

Overall, women said they would rather have a child with physical impairment, cognitive impairment, or visual impairment than not become pregnant at all, but women preferred not becoming pregnant to having a child who died. Women also said they would prefer delivering a child prematurely to not becoming pregnant at all.

"Our findings seem to suggest that being made aware of these risks, explaining what they are and what they would entail, might not be necessarily enough to put people off having double embryo transfer," Scotland told Reuters Health.

While the absolute increased risk of problems with twin pregnancies compared to single births is relatively small, he added, at a population level the increased health care costs involved with multiple births are substantial.

Scotland pointed out that preliminary evidence from Europe shows that single embryo transfers are just as likely to result in pregnancy as transfers of two or more embryos. But to make single embryo transfer acceptable in the UK at this point, he and his colleagues say, it may be necessary to offer more rounds of IVF "so as to assure women that they have as good a chance of a live birth in the long run as they would with double embryo transfer."

But this recommendation may be hard to put into practice, Scotland noted. While the UK's National Health Service recommends funding three cycles of IVF for women younger than 40, he explained, tight budgets at local health authorities mean many women may only be offered a single try. "The guidance doesn't measure up to what's happening on the ground."

SOURCE: BJOG, August 2007.