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Last Updated: Thursday, 21 February 2008, 08:45 GMT
The trouble with twins
By Clare Murphy
Health reporter, BBC News

Triplets in the womb
The more the merrier? Not so, doctors warn
There was a point last year when, for the first time ever, every neo-natal care bed in the country was taken.

Doctors have put this down in part to the growing number of babies born as a result of IVF. This can produce many multiple births - infants who are often premature and sickly, and therefore in need of intensive and expensive specialist care.

The foremost fertility minds are currently at work to try to find ways to reduce the number of twins and triplets born as a result of these procedures, which often involve the implantation of as many as three embryos.

For many women, this may well maximise the chance of a successful pregnancy, but at a price.

"One of the real obstacles is persuading parents that twins are not 'two for the price of one'", says Dr Gillian Lockwood, medical director of Midland Fertility Services.

"I see these babies all the time - tiny things who often have real problems - but parents don't always understand the risks - or if they do, are prepared to take them if it means they end up with a baby."

Last chance saloon

A quarter of IVF babies are twins or triplets: multiple births are nearly 20 times higher as a result of assisted conception that when it happens spontaneously.

30,000 treated every year
25% of births multiple
Less than 5% of PCTs offer three cycles
Private treatment costs up to 6,000

However they are conceived, those who share a womb with siblings are far more likely to be born prematurely - and this brings with it a series of risks.

Twins are seven times more likely to die in the first few weeks of life than their singleton counterparts, and are six times more likely to develop cerebral palsy.

But for many infertile couples these are chances worth taking.

"It's true that for some couples twins are seen as highly desirable, double the joy, and many simply haven't had the risks properly explained," says Susan Seenan of Infertility Network UK.

"But it's a very complicated picture. Many couples are afraid they are only going to get one shot at this - because of the costs, because NHS treatment can be very limited - and they want to maximise their chances of having a baby at all. They can't afford to keep doing it."

See it as disease, please

Privately, one cycle of IVF can cost as much as 6,000.

What other NHS treatment for 3,000 gives you a much loved, much wanted baby, who before long will be paying their taxes? It's very good value
Dr Gillian Lockwood
Midland Fertility Services

Guidelines drawn up in 2004 recommended that infertile couples received three cycles of IVF on the NHS, but in the most recent survey less than five percent of primary care trusts (PCTs) said they provided as many as this.

The majority would only fund one, and many attached their own conditions, from how much alcohol was drunk to how stable a couple's relationship was and how long they had been trying to conceive naturally.

Those who want to see the government make PCTs offer three full cycles argue that restrictions are ultimately a false economy for the NHS.

The average cost of a pregnancy involving triplets for instance, is 32,350 - about 10 times more than one involving a single infant.

Care for children with long-term disabilities as a result of premature birth can also prove a serious financial burden.

If couples felt they had the chance to try again when a first effort fails, the logic goes, they would be less likely to opt for multiple embryo transfers.

At the same time, techniques are being developed which appear to improve the chances of pregnancy in certain women when only one embryo is used.

There is much to learn for instance from countries like Belgium and Sweden, which only allow single embryo transfer but have high pregnancy rates.

But as well as action from government on the three cycles, fertility doctors want society as a whole to stop thinking of IVF as a luxury - even for an NHS which refuses to pay for some life-lengthening cancer drugs.

"Some people never get over the inability to have a child - it has a huge impact on their health and wellbeing, it can end up in the break up of their marriage," says Dr Yakoub Khalaf, a consultant at the Assisted Conception Unit at Guy's and Saint Thomas's Hospital in London.

"It has to be seen as a disease, and one for which we have a cure."

A mother's experience of having IVF twins

One embryo call for routine IVF
18 Oct 06 |  Health

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