Fertility treatment using IVF and induction of ovulation are associated with an increased risk of multiple pregnancy. Every clinic is required to have a multiple births minimisation strategy to reduce this risk.
Although gonadotrophins and anti-oestrogens increase the risk of multiple pregnancy, appropriate administration and regular monitoring can greatly minimise these risks. A suitable protocol should include careful monitoring, minimising the dosage where appropriate, and ensuring patients understand the risks.
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As part of the multiple births minimisation strategy, an eSET policy based on the guidelines from the British Fertility Society (BFS) and Association of Clinical Embryologists (ACE) should be in place, and clinics should audit their strategy and outcomes against the standards on a regular basis. Patients should be given full information about the risks of multiple pregnancy associated with IVF and the rationale behind eSET and frozen embryo transfers.
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Stimulated IUI treatment should include targeting suitable patients and giving full information about the risks of multiple pregnancy and their link with stimulated IUI.
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Many other countries have already successfully introduced a single embryo transfer policy – the multiple birth rate has plummeted while birth rates have remained largely unaffected.