Electronic tags to track embryos, eggs and sperm samples should be mandatory for fertility clinics to reduce the risk of IVF mix-ups, according to a fertility expert.

Gedis Grudzinskas, a consultant in infertility and gynaecology, said that the technology existed to tag samples and should be made standard best practice.

The call from Professor Grudzinskas, formerly Emeritus Professor of Obstetrics and Gynaecology at St Bartholomew’s Hospital in London, follows a case in which a couple undergoing fertility treatment had their last embryo accidentally implanted in another woman.

The couple had been trying for a second child when the IVF Wales clinic in Cardiff discovered the error. When the woman in whom the egg had been implanted was told of the error she chose to have a termination.

Professor Grudzinskas said that tagging would reduce the risk of such incidents and called on the Human Fertilisation and Embryology Authority (HFEA) to enforce its introduction in all clinics. He added that recent HFEA measures to avert mix-ups, such as “double witnessing” of sample sources, had been shown to be insufficient.

“The technology for tagging will minimise the risk and increase confidence in fertility treatment, because this case in Wales shows that things are still going wrong,” he said. “There is a strong case for saying tagging should be mandatory.”

The HFEA said that electronic tagging had advantages, but should not replace manual checks at the key stages of IVF procedures.

The IVF couple, from Bridgend, South Wales, identified only as Deborah and Paul, were told of the error in December 2007. A trainee embryologist had taken their embryo from a shelf of the incubator that was being used to store more than one patient’s embryos, contrary to official guidance.

The trainee failed to carry out “fail-safe” witnessing procedures to ensure that the embryo being taken from the incubator and implanted belonged to the correct patient. Cardiff and Vale NHS Trust has apologised after admitting liability for gross failures in care, and has paid the couple an undisclosed sum.

Guy Forster, the couple’s solicitor, said that there had been two near misses at the clinic the year before. “An HFEA inspection in February 2007 had warned the clinic to tighten its witnessing procedures, yet it would seem nothing was done,” he said. “This was an accident waiting to happen.”

Ian Lane, medical director of Cardiff and Vale NHS Trust, said: “We apologise unreservedly for this mistake. This was a rare but extremely upsetting incident for everyone involved, and we take full responsibility for the distress caused to both couples and their families.”

An HFEA spokeswoman said that because the IVF process involves microscopic materials it was impossible to eliminate all human error and clinics were encouraged to report any incidents.

A scheduled inspection of IVF Wales took place in March 2008 and the clinic was found to have put in place everything they should have done, the HFEA said.

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