Better NHS funding of fertility treatment will be crucial to the prevention of hazardous twin and triplet births, the IVF watchdog said yesterday as it announced a national strategy to reduce rates of multiple pregnancies.

The Human Fertilisation and Embryology Authority (HFEA) expects clinics to cut the proportion of twin and triplet pregnancies from one in four to one in ten over three years. Multiple births are the biggest health risk in IVF.

Instead of backing the target with the threat of restrictions on the transfer of multiple embryos, the regulator has chosen a voluntary approach by which professional groups will draw up guidelines on how it should be achieved. It called on the Government to pay for more free cycles of treatment to make the plan work.

Walter Merricks, the interim chairman of the HFEA, has written to Dawn Primarolo, the Health Minister, to press the case for better access. The National Institute for Health and Clinical Excellence recommends that three cycles of IVF should be offered to women under 40, yet the Government asks primary care trusts to offer just one and many have imposed restrictions on which patients qualify.

Mr Merricks said: “We always have in mind that still the greatest risk in the eyes of patients is the risk of not having a baby.” Increased NHS funding for IVF was the key, he said: “Women with access to only one funded cycle of treatment are only acting rationally if they beg for a double embryo transfer in their single chance of becoming pregnant. The risk of a twin pregnancy seems nothing to the risk of no pregnancy.”

His comments were backed by Professor Peter Braude, of King’s College London, who led an expert panel that advised the HFEA on reducing multiple births. “It is important that there should be some comeback from the Department of Health to include frozen cycles or pay for at least two cycles for all patients,” he said.

To achieve the 10 per cent target, about 50 per cent of women having IVF, most of them first-time patients under 35, would have just one embryo transferred at a time. Currently only about 10 per cent have a single embryo transfer.

Twins and triplets are much more likely to be stillborn, to die in the first week of life, to be disabled or to be born prematurely than a single baby. Mothers also have a greater risk of life-threatening conditions such as pre-eclampsia and heart attacks. The HFEA estimates that 126 IVF babies who died in 2003 would have survived had they been single births.

Modern techniques mean that success rates with one embryo can be just as good as with two for young women with a good prognosis, but only if a back-up cycle of treatment with a frozen embryo is offered. Very few NHS trusts provide this and about 75 per cent of IVF patients pay for their own treatment.

IVF treatment accounts for only 1.2 per cent of all births, but for nearly 20 per cent of multiple births. Although the HFEA has already restricted embryo transfers to a maximum of two for most patients, the latest data show a slight increase in multiple births from 2004 to 2005.

Mark Hamilton, the chairman of the British Fertility Society, agreed that better NHS provision would be critical to reversing this trend and backed the HFEA’s voluntary approach.

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