Limits to IVF treatment tipped

By REBECCA WALSH health reporter

Young women having in vitro fertilisation treatment may be restricted to having only one embryo implanted in an attempt to reduce the number of multiple births.

A committee overseeing IVF guidelines in New Zealand and Australia is certain to recommend new limits when it meets next week of one embryo for women under 36, and two for older women.

The guidelines are supported by fertility specialists but they say couples affected by infertility are likely to struggle with the decision, especially as the New Zealand Government funds only one cycle of IVF treatment.

About one in five IVF pregnancies result in a multiple birth but they are at higher risk of premature birth and complications.

Caring for premature babies is expensive and they may suffer ongoing chronic medical conditions.

Dr Guy Gudex, clinical director of Fertility Plus at National Women's, said it was common practice to put two embryos back, but that had resulted in an "unacceptably high" rate of twins.

It could also result in triplets, which were seen as "quite unacceptable" from an obstetric and social point of view.

American research had shown 50 per cent of relationships broke up within two years or triplets being born.

Putting only one embryo back would lower a woman's chance of getting pregnant but if the first attempt was not successful it was possible to use frozen embryos, which had a 70 per cent survival rate.

Dr Gudex supported the guidelines, likely to be recommended by the Australian Reproductive Technology Accreditation Committee, but said he would feel "more comfortable" if there was state funding for a second IVF cycle. New Zealand couples received funding for one cycle of treatment, which cost from $7000 to $8000.

In Australia the funding was unlimited, but most patients contributed about $1000 towards the cost per cycle.

Funding a second cycle would add about another $2.5 million to the $5 million spent by the New Zealand Government on assisted reproduction technology, he said.

"For a couple who know they can't afford private treatment and know they aren't going to get a second go at it, they are going to be concerned.

"For them, having twins is not a big deal, it's the instant solution to their problem of infertility."

Dr Richard Fisher, director of Fertility Associates, said the goal for several years had been to move towards single embryo transfer. But he anticipated "significant resistance" from people wanting to get pregnant who would understandably view twins as a "bonus".

For Auckland couple Cathy and Paul Bebelman, a second IVF cycle was their last chance at having their own children. They begged to have three embryos implanted after three earlier "lots of two" hadn't worked but doctors would only agree to two.

The couple now have healthy two-year-old twins, Nicola and Sophia.

Mrs Bebelman, 35, said while she could understand the reasons for limiting the number of embryos, she questioned whether it was understood from a consumer point of view.

"It gives us a family we would have had no other way of having. We appreciate having these two children more than anything in the world because they were so hard to get."

Robyn Scott, co-president of Fertility NZ, a group for people affected by infertility, said the group would continue to push for additional funding for IVF treatments.

A spokesman for Health Minister Annette King said a decision about Government funding a second cycle of IVF treatment would be made before July.

GROWING TREND

More babies than ever are being born as the result of assisted conception.

472 babies were born in New Zealand and 4801 in Australia during 2000 from assisted conception, such as IVF.

The babies accounted for almost 2 per cent of all births in both countries, about double the 1992 percentage.