Zulehkha Waheed
Progress Educational Trust
06 March 2007
 [BioNews, London]
Women trying to have a baby using standard in-vitro fertilisation (IVF) techniques are spending money on unnecessary drugs that have harmful side-effects and which could be compromising their health, according to the authors of a new report published in the Lancet medical journal.
In standard IVF, two embryos are usually implanted, after stimulating the woman's ovaries with large doses of hormones, which can cause side-effects such as hot flushes, night sweats, insomnia, reduced libido and depression. This treatment can sometimes trigger ovarian hyper-stimulation syndrome, and also increases the risk of multiple births, which carry a higher risk of complications for mother and baby and can induce premature birth.
A report published in 1999 described an approach that uses reduced drug doses, has a shortened treatment period, and involves implanting just one embryo at a time (so-called 'single embryo transfer', or SET). This method is known as 'soft IVF' and uses hormone antagonists which bypass the side-effects that are triggered by conventional IVF drugs. In the latest study, Bert Fauser's team at the University Medical Centre in Utrecht compared 'soft' and 'standard' IVF treatment in 404 patients.
Their results show that replacing one embryo in the womb at a time, and freezing another for use in a second, has the same live birth rate (44 per cent) over one year as standard IVF. They also noted that this approach reduces the risk of ovarian hyper-stimulation, and that the chances of having twins is dramatically cut to 1 in 200 births from 1 in 8 births in standard IVF. They also claim that the soft version was cheaper overall by 2400 Euros per pregnancy.
The authors believe that soft IVF will revolutionise conventional IVF as it will benefit patients and clinics by encouraging repeat attempts at IVF, 'Our findings should encourage more widespread use of mild ovarian stimulation and single embryo transfer in clinical practice', the researchers said. They continued: 'However adoption of our mild IVF treatment strategy would need to be supported by counselling both patients and healthcare providers to redefine IVF success and explain the risks associated with multiple pregnancies'.
It is thought that getting SET accepted as routine practice will be challenging in the UK. Professor Bill Ledger, an IVF specialist at the University of Sheffield, acknowledged the ever increasing gap between demand and supply on NHS resources and reflects that it just is not feasible for the NHS to follow recommendations by the National Institute for Health and Clinical Excellence (NICE) set out in its 2004 report, which recommended providing all couples with three free cycles of IVF treatment. He continued by saying, 'Some patients want to complete the procedure as quickly as possible and see twins as the most desirable outcome. While 75 per cent of IVF treatment in the UK continues to be paid for by the patients themselves, many couples will opt for double embryo transfer because it is much less costly'.
Professor Ledger also explained that it would be difficult to get private IVF clinics to adopt new guidelines because the Human Fertilisation and Embryology Authority (HFEA) rates their position in the 'league table' according to their success per cycle, and as mild IVF may take more cycles, this could reflect badly upon them. A spokesperson from the HFEA said: 'We are about to launch a consultation about trying to minimise multiple births because they are the single biggest risk involved in IVF'. The authority is due to announce its new policy in the autumn.
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© Copyright 2008 Progress Educational Trust
Reproduced from BioNews with permission, a web- and email-based source of news, information and comment on assisted reproduction and human genetics, published by Progress Educational Trust.
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