HFEA policy on multiple births

Following a public consultation in 2007, the Human Fertilisation and Embryology Authority (HFEA) launched their policy on minimising the risk of multiple births from IVF treatment in January 2009.
Read more about the public consultation

Key elements of the policy

• Overall aim to reduce the UK IVF multiple birth rate to 10% in stages over a period of years
• The HFEA will set a maximum multiple birth rate that clinics should not exceed, which will be lowered each year
• All centres will devise their own ‘multiple births minimisation strategy’ setting out how they will not exceed the maximum multiple birth rate
• The HFEA policy will form part of a wider national strategy to reduce the risk of multiple births from fertility treatment involving professional bodies, patient groups and NHS-funding bodies

What are centres required to do?

All IVF centres must have a multiple births minimisation strategy, that sets out how the centre:

• intends to reduce their multiple birth rate so it does not exceed the HFEA maximum multiple birth rate for that year
• identifies suitable cases for single embryo transfer at their clinic, using patient selection and embryo assessment criteria

Centres are required to regularly audit and evaluate the progress and effectiveness of their strategy. They must also log cases in which multiple embryos were transferred in patients who met the criteria in their strategy.

Read the HFEA General Directions: 0003 Multiple Births (133 KB)

Read the Code of Practice Guidance Note: Multiple Births

What is the maximum multiple birth rate?

2012 Year 4: Maximum 10%

At the end of 2011 the HFEA evaluated the full Year 2 of the multiple births policy and the first seven months of Year 3.

On the basis of this, in January 2012, the Authority set the final (Year 4) maximum multiple birth rate at 10%, to come into effect on 1 October 2012.  This is the rate we have been aiming for from the outset of the policy. Ordinarily, the Authority introduces a new target rate each year in April. However, the Year 3 target has been challenging; so when making the decision about the Year 4 target the Authority acknowledged that centres need time to refine their strategies and implement changes.

…read the HFEA Authority Committee Paper on the Year 4 multiple births target

2011 Year 3: Maximum 15%
At the end of 2010 the HFEA evaluated the full Year 1 of the multiple births policy and the first six months of Year 2. They examined the progress of individual centres and the sector as a whole in reducing multiple pregnancies, and the impact on overall pregnancy rates.

On the basis of this in December 2010, the Authority set 15% as the Year 3 maximum multiple birth rate. The Multiple Births Stakeholder Group recommended 15% as a stretching but feasible target for centres to achieve that will help maintain the good progress centres have made so far.

The Year 3 maximum multiple birth rate of 15% came into effect in April 2011 and applies to all IVF births from treatments started between April 2011 and March 2012. 

In October 2011 HFEA guidance around double blastocyst transfer and a licence condition, which requires centres not to exceed the maximum multiple birth rate, were introduced.

…read the Authority Committee Paper on the Year 3 multiple births target

2010 Year 2: Maximum 20%
In December 2009 the HFEA evaluated the first year of the multiple births policy, by analysing the available 2009 pregnancy data along with feedback from patients and clinics.

On the basis of this, in January 2010 the Authority set 20% as the Year 2 maximum multiple birth rate. The Authority decided that 20% would maintain the momentum that centres built up in 2009, whilst allowing centres time to review and improve their strategies to lower their multiple rate further.

The Year 2 maximum multiple birth rate came into force on 6 April 2010, and means that no more than 20% of a centre’s annual live birth rate from treatment started from this date should be multiples.

2009 Year 1: Maximum 24%
The policy was introduced in January 2009. The HFEA set the Year 1 maximum multiple birth rate at 24%, the national average at the time.

This means that no more than 24% of a centre’s annual live birth rate should be multiple births. It includes all births from IVF, ICSI, and GIFT treatments, using fresh or frozen embryos from either the patient’s own eggs or donor eggs.

Monitoring and enforcing the policy

The HFEA is committed to supporting centres implement the policy and to help share best practice across the sector. HFEA inspectors continually monitor clinics’ performance and the impact of the policy on multiple and overall pregnancy and birth rates.

The HFEA will support centres as they evaluate and improve the effectiveness of their multiple birth minimisation strategies. Centres that are statistically above the target will, as a first step, be asked to attend a management review meeting with HFEA staff to discuss recommended actions. This is in line with the HFEA’s overarching Compliance and Enforcement Policy.

Multiple births is a focus of every centre’s inspection.

…read more about how the HFEA has assessed centres’ performance with the multiple births policy

Supporting documents

December 2010 Authority paper: Mulitple Births

Analysis of centres year 1 performance

Summary of evaluation of Year 1 of multiple births policy (153 KB)

December 2009 Authority Paper: Evaluation of Year 1 of multiple births policy (184 KB)

October 2007 Authority Paper: Policy options (669 KB)

• Multiple births – Background and statistics
• Multiple Births consultation document
• One Child at a Time report by Expert Group

Further information

If you have further questions about the HFEA multiple births policy, please contact: Hannah Darby, Senior Policy Manager hannah.darby@hfea.gov.uk