Page last updated at 05:01 GMT, Wednesday, 21 April 2010 06:01 UK

The perils of cheap fertility drugs

Professor Bill Ledger
VIEWPOINT
Professor Bill Ledger
Professor of Obstetrics & Gynaecology, Sheffield University

Multiple births pose a health risk to both the mother and her babies, and put financial strain on health services.

Baby feet
Doctors have a duty to consider the long-term consequences of fertility treatment

During the 90s multiple births rose as doctors implanted a number of embryos into women having IVF - this has since been reduced.

But the multiple birth rate is still on the increase.

In this week's Scrubbing Up, leading fertility expert Professor Bill Ledger says part of the problem is the liberal use of cheap fertility drugs, and warns there will be dire consequences if this does not end.

There can be no doubt that having one child at a time is best for both mother and baby.


Multiple births often happen too early, with risk of neonatal illness needing intensive care, and sometimes permanent disability as a result.

Rates of twin and triplet birth were too high in the UK the 1990s because well-meaning fertility specialists were transferring too many embryos after IVF.

These drugs need tighter control because whilst the high tech end of fertility medicine is highly regulated in UK, any doctor can prescribe these drugs

The Human Fertilisation and Embryology Authority (HFEA) has worked to all but abolish three embryo transfer for the under 40s, with a corresponding fall in triplet births, and is now trying to reduce the number of two embryo transfers.

But as the number of IVF multiples has fallen, a new problem has emerged.

Many women conceive after simple and effective treatment with drugs designed to induce ovulation. This might be with tablets such as clomifene (Clomid) or injections of FSH(follicle stimulating hormone).

These drugs need tighter control.

Whilst the high tech end of fertility medicine is highly regulated in the UK, any doctor can prescribe these drugs, although the recommendation is that they are used only in a hospital practice by experienced staff.

Monitor not ban

If you make regulations any tighter then you will certainly force people to go abroad to get pregnant

Sarah Saynor, Leeds


Lets not have a "clamp down". If we do so then even more couples will travel overseas for unregulated treatment.

We must accept the deeply felt need that many men and women feel when faced with infertility. If we do not respect this then they will resort to purchasing Clomid through the Internet or having heroic doses of FSH in other countries, and return to UK carrying triplets or quads.

Instead we need to better inform couples of the sense in having "one at a time" and at least maintain the current parlous level of NHS funding for infertile couples so they can make the best decision on medical rather than financial grounds.

These drugs are much cheaper than IVF and allow a much more normal conception, involving happy sex rather than medical practice. They should remain a part of the treatment pathway for those who have a reasonable chance of conceiving.

And with care and experience the number of twin pregnancies can be kept below 10% with both tablet and injectable preparations, figures which are yet to be reached in UK IVF practice.

But this will require close monitoring of patients.

A simple ultrasound scan can identify those women at risk of a multiple conception, by showing if the ovary has been over-stimulated and are releasing too many eggs.

These couples could refrain from having unprotected sex for a few days.

So long as treatment is cheap and not too stressful, most will accept a month's postponement and a second attempt with a lower dose. This is not bicycle science let alone rocket science.




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