Dr Brian Lieberman, a member of the Human Fertilisation and Embryology Authority (HFEA), has broken ranks with colleagues to criticise many clinics with high birth rates which are routinely transferring three embryos into the womb after fertilisation. No clinic is allowed to transfer more than three embryos but he said the chances of success were just as high with two, and there was less risk of disability.
The chance of a baby conceived through in vitro fertilisation (IVF) dying within a month of birth rises dramatically with multiple births, from 1.4 per cent with one baby, to 5.9 per cent in twins, and 9 per cent in triplets. There is also a higher risk of disability; studies show cerebral palsy occurs in 17.4 per 1,000 triplets, compared with 2 per 1,000 single babies.
Dr Lieberman, who is director of the fertility unit at St Mary's Hospital in Manchester, pointed out that the national live birth rate from a woman who has two embryos replaced after IVF was 20.6 per cent, compared to 20.9 per cent for a woman who has three embryos. "Some [clinics] put back three just to maintain their high pregnancy rate," he said. "They are not taking the welfare of the children into account."
Dr Lieberman has also attacked the HFEA's Patient's Guide to DI [Donor Insemination] and IVF Clinics, which details the success rates of more than 100 clinics licensed by the HFEA.
The main figure cited is the adjusted live-birth rate - the number of births (rather than the number of babies) for every 100 treatment cycles undertaken. But the figure was misleading because it gave no indication of the number of multiple births, Dr Lieberman said, while the emphasis on "live births" regardless of the child's health was alarming.
He added: "One is concerned not just with adjusted live-birth rates but with live, healthy non-handicapped babies ... I'm concerned about triple pregnancies. The higher the rate of triple births, the higher your chances of having handicapped children."
The guide is being used as a "league table" of the top fertility clinics in the country but that was misleading because it did not compare like with like, Dr Lieberman said.
Nurture (Nottingham University Research and Treatment Unit in Reproduction) has the highest rate of live births of any clinic (23.7 per cent) and has used the figure in mail shots to health authorities promoting its services. However, the unit has a high multiple-birth rate which is not referred to; of 157 births surveyed in the last year, 43 were twins and six were triplets, accounting for nearly a third of all the IVF pregnancies achieved.
But Dr Simon Thornton, the medical director of Nurture, dismissed Dr Lieberman's criticisms, and insisted that many triplets were born healthy. "We go to extraordinary lengths to consider the welfare of the children," he said. "If you put back three you certainly do run the risk of a triplet pregnancy. You increase your overall success rate by 6 to 7 per cent, but the down side is a 1 per cent risk of triplets. It is a risk [women] are counselled about. They are also told that selective reduction - aborting one foetus - is available."
A spokeswoman for the HFEA declined to comment on Dr Lieberman's criticisms but said there was a growing trend to transfer two rather than three embryos into the womb, particularly if the woman is young. "It is a clinical decision for the doctor to make after taking into account the prognosis of the patient," she said. "We are not here to dictate on clinical judgement."Reuse content