'Staff shortage led to embryo mix-up'

Understaffing at a fertility clinic led to two women patients having the wrong embryos transferred to their wombs, requiring them to have a further procedure to remove the fertilised eggs.

The blunder happened in April this year at an IVF clinic at St George's Hospital in Tooting, south London. The unit was shut down earlier this month after health service managers decided it was unfunded and no longer sustainable.

Three women were involved in the mix-up. The first had produced a number of embryos from which the best-quality pair were selected for implantation. But a mistake by doctors meant that her poorer quality embryos were reserved for her, while her "good" embryos went to a different woman.

The first woman failed to become pregnant. The second woman's embryos were transferred to a third woman, compounding the error.

The second and third women went home believing they were pregnant but within hours were told they were carrying the wrong embryos. Both patients received drugs to prevent pregnancy.

Professor Paul Jones, medical director of the St George's Healthcare Trust, said last night: "It was a number of errors which occurred because people were overstretched and asked to do too many things at once." The Human Fertilisation and Embryology Authority (HFEA), which was notified of the error when it happened six months ago, said correct procedures had been in place, but that "the procedures were not complied with".

The doctor and an embryologist involved in the mix-up were not disciplined but the head of the unit, Dr Geeta Nargund, has been suspended by hospital managers for "unrelated, non-clinical matters".

Both women were given further fertility treatment at the unit, which was known as the Diana, Princess of Wales, Centre for Reproductive Medicine. Both are now pregnant.

The controversy will fuel concerns about mistakes by embryologists after a case earlier this year in which a white woman gave birth to black twins after undergoing IVF treatment.

The hospital trust said an inquiry had been launched into the "three-way mix up" and the incident was reported to the HFEA. Professor Jones said that the unit had been reliant on patients paying for private care. "We realised we had a unit that was not run as well as we would like, that has had a major incident and that did need investment to make it safe," he said. The hospital added that its inquiry had uncovered a "serious lack of leadership" within the unit.