What the professional bodies say

Members of the National Strategy Stakeholder Group have produced a mission statement on reducing multiple pregnancies following fertility treatments, published in summer 2008.

The mission statement sets out the aims and principles behind the work of the National Strategy Stakeholder Group. It states that to minimise the health risks to both mother and child, "the aim of all fertility treatment should be the birth of a healthy, singleton child" and that this can be achieved by changes to clinical practice. These changes, however, require the active support and commitment of patients and clinicians.

To make these changes, the Group supports the development of the following aids to good practice:

  • Tools, such as professional guidelines.
  • Ways to share good practice (for example, training workshops).
  • Information materials that provide balanced, accurate information.

The Group is also focussing on removing obstacles such as financial disincentives both within the private sector and within the NHS.


Mission statement: Multiple Birth Stakeholder Group

As organisations involved in the provision; regulation; commissioning and oversight of fertility treatment, we believe that:

  1. The aim of all fertility treatment should be the birth of a healthy, singleton child. This is on the basis of maximising the long term outcomes for mother and child.
  2. Changes to clinical practice will increase the chances of fertility treatment resulting in the birth of a healthy singleton child.
  3. Changing clinical practice to improve outcome and reduce risk requires the active support and commitment of patients and all staff working in centres.
  4. Effecting change will be facilitated by improved funding for assisted conception treatment, and must include appropriate support for cryopreservation cycles.

These aims can be achieved through the committed, consistent and collaborative efforts of the full range of parties involved, particularly those organisations who support and inform patients, nurses, embryologists and clinicians.
 
We are committed to making these changes occur through a number of means including:

  • the development of tools, such as evidence-based professional guidelines.
  • developing mechanisms for sharing good practice (e.g. training workshops).
  • development of information materials that provide balanced, accurate information.
  • removing obstacles and disincentives to best practice, as far as is possible. This will involve removing financial disincentives both within the private sector and within the NHS, where improved commissioning and appropriate NHS funding can make a real difference. 

Background

The single greatest health risk for women conceiving following fertility treatment is a multiple pregnancy. On average, 1 in 4 IVF births is a multiple birth and other fertility treatments also present the risk of a multiple pregnancy. For example, the likelihood of a twin pregnancy resulting from clomifene treatment is approximately 10%.

By comparison, only 1 in 80 for women who conceive naturally have a multiple birth. Fertility treatment contributes significantly and disproportionately to the national multiple birth rate and therefore presents a significant public health concern.

The risk of an adverse health outcome for twin pregnancy is greater than for singletons. A significant number have a traumatic start to life, with approximately half of twins requiring hospitalisation and care in neonatal units.

Some children have serious, long term health problems or, in a tragic minority of cases, die. The risks for mothers are also greater, with some enduring dangerous complications during pregnancy some of which can cause ongoing health problems.

The risks of multiple pregnancy can be avoided or reduced through changes to clinical practice. This, in turn, will require the development of various tools and the removal of various obstacles. This programme of work requires the concerted and collaborative efforts of a range of parties including clinicians, embryologists; nurses; professional and regulatory bodies; patient organisations; the HFEA and NHS bodies.

This work can be termed a ´National Strategy on minimising multiple pregnancy following fertility treatment´ and will be implemented through the combined efforts of a ´Multiple Births´ stakeholder group and the commitment of all clinicians involved in the provision of fertility services.

National Strategy Stakeholder Group members

  • Olga Van Den Akker (BICA)
  • Carolyn Basak (RCN)
  • Peter Braude (RCOG)
  • Clare Brown (INUK)
  • Rachel Cutting (ACE)
  • Jane Denton (MBF)
  • Alun Elias-Jones (consultant paediatrician)
  • Mark Hamilton (BFS)
  • Lisa Jardine (HFEA)
  • Claire O´Donnell (Cheshire and Merseyside Specialised Services Commissioning Team)
  • Tony Rutherford (BFS)