British legislation regulating assisted reproduction is in urgent need of updating to include the "welfare of women" undergoing IVF, along with the welfare of children born from the procedure, according to London-based fertility specialist, Professor Dr Geeta Nargund.

Speaking at the opening of the 7th World Congress on Mild Approaches in Assisted Reproduction in Sydney she has appealed to the British Parliament to update the Human Fertilisation and Embryology Act and widen the scope of the Human Fertilisation and Embryology Authority (HFEA), the independent regulator overseeing the use of gametes and embryos in fertility treatment and research.

Currently, the Act and the HFEA focus only on the "welfare of children" born through assisted reproduction. Professor Dr Nargund said the system in the United Kingdom was not collecting information on drugs and dosages used during IVF treatment that could impact on the health and welfare of women undergoing treatment and their offspring. Professor Dr Nargund said:

"traditional IVF, which relies on higher doses of stimulating hormones and complex tests, has become old fashioned, unfriendly to patients and unnecessary for many people seeking fertility treatment."

She added that with this treatment, a woman is given higher doses of drugs to stimulate her ovaries to produce more eggs, which are harvested and fertilised in the laboratory before a selected embryo, or embryos, are transferred to the patient's uterus. Milder stimulation produces fewer eggs, but researchers have demonstrated that eggs yielded from this gentler treatment produce better embryos and comparable pregnancy rates to those from standard stimulation cycles.

Nargund said many women undergoing traditional IVF treatment in the United Kingdom were receiving higher doses of hormone stimulating drugs that increased their risk of complicated side effects, such as ovarian hyper stimulation syndrome (OHSS).

Artificial IVF 'success' rates

"The HFEA in the United Kingdom publishes data on IVF pregnancy rates and births from each clinic, which some clinics use to create league tables of success rates to attract patients. "But neither the HFEA nor the clinics publish clinic by clinic adverse events for the women - such as OHSS, which results when the ovaries over-react to drugs used in IVF - and babies born from assisted conception. "Vital data on drugs and dosages is slipping through the net and we just don't know enough about what is happening in each clinic in the UK."

New scientific data that conventional IVF can have major health impacts on mothers and babies

"A study of data on 256,381 IVF cycles held in the national registry of the Society for Assisted Reproductive Technology in the United States has revealed evidence of the physiological burden that traditional IVF can impose on patients. The results of the study, released earlier this year, showed that the retrieval of more than 15 oocytes, or eggs, in IVF cycles significantly increases the risk of ovarian hyper stimulation syndrome without improving live-birth rates. Another study of 66,539 singleton live births from IVF, sourced from the HFEA database, also showed this year that the retrieval of more than 15 oocytes was associated with a significantly increased risk of premature birth and low birth weight babies. "The outcomes of these studies suggested that elevated oestrogen levels generated by higher doses of hormones could have a detrimental effect both on mothers and offspring. So there is a link between the welfare of the mother and child in IVF, and we must also take into account the impact of higher dose stimulation in women undergoing treatment who ultimately do not have a baby."

"We are getting comparable results from the milder form of IVF among younger women and this more natural approach also offers greater promise of success for older women with less ovarian reserve. "It does not compromise on quality of care, and it can be delivered safely and at a significantly lower cost making it more accessible for people striving to achieve their dream of parenthood, irrespective of their economic status.

"Yet, women undergoing traditional IVF continue to be given higher doses of drugs and we have no idea of the extent of adverse outcomes. We need a foundation of quality data on drugs and dosages so that we can address problems and improve the future well-being of women and babies.

Greater transparency needed

"It is also important that patients have access to this data clinic by clinic so that they can make informed and balanced decisions about their treatment."

Professor Dr Nargund praised the Australian system of collection of quality data on assisted reproduction and the self-regulation system that promotes single embryo transfer as a standard in that country.

EX HFEA Member calls for HFEA league tables to change

Professor William Ledger, a leading fertility specialist and Head of Obstetrics and Gynaecology at the University of New South Wales, is co-convenor of the ISMAAR meeting. He said:

"I agree with Professor Dr Nargund's statements of concern about the situation in the United Kingdom. The purpose of the HFEA should be to optimise the health of both the mother and the child. There are significant risks to the physical and emotional health of the woman if excessive stimulation and multiple embryo transfer are used.

In addition, the use of HFEA data to construct league tables has had a significant negative effect on safe IVF practices in the United Kingdom. Data on individual clinics should not be provided in a format that allows league tables to be constructed, and it should be non-identifying.

"The current system of specifying the 'success rate per cycle' mitigates against safety of IVF by discouraging OHSS prevention strategies that aim to improve neonatal health and well-being of the mother."