Embryo transfers in IVF: more need not always be better

Health minister Leoš Heger has announced that within a broad reform of the health system he wants to change the rules for fertility treatment. The minister has proposed curtailing the practice of multiple-embryo transfers in assisted pregnancies – in favour of single-embryo transfers on the grounds that it is the most inexpensive IVF method and least likely to result in high-risk multiple births.

Photo: Tomasz Kobosz, Stock.xchng

Every year thousands of women in the Czech Republic undergo infertility treatment and conceive with the help of IVF - in vitro fertilization. If they get a multiple-embryo transfer there is a 15 percent chance that they will conceive twins or triplets. While mums desperate to conceive often feel that “more is better”, doctors point to the dangers of multiple births and the chances of later developmental problems for the babies, who are often born prematurely. Milan Mrázek, one of the country’s leading experts on IVF says the final decision is always a compromise between three parties.

“If we plan an embryo-transfer it is a three-party agreement – based on the couple’s request, the advice of the gynecologist and that of the embryologist. So it depends on the quality of the embryos – that is one of the most important factors and then the willingness of the couple to try for a single baby rather than twins. Some couples aim for twins and we try to discourage them from that plan. “

Milan Mrázek

So you are saying that some couples push you to undertake multi-embryo transfers?

“Yes, some couples specifically wish to have twins, so we have to explain what the drawbacks are.”

Does a multiple-embryo transfer not also increase the chance of conceiving?

“Of course, that is why it is a three-party decision where we must try to weigh all the factors and find the best way to achieve pregnancy. But we must point out that having twins or even triplets (triplets are a disaster) involves certain risks and is not very good. So we have a rule about never using three embryos in the first IVF cycles. I think that in about 50 percent of cases we undertake a double embryo-transfer. The rest are single embryo-transfers.”

How would your patients –who are often desperate to conceive -react to a change of the law – would they see it as discriminatory?

“No, I think most women would see the decision as a chance to have longer infertility treatment covered by health insurance. I do not think it would be viewed as discrimination. Single-embryo transfers are becoming a standard practice in many countries of the world and I think that will soon be the case of the Czech Republic.”

Leoš Heger

At present Czech health insurance companies pay for women to undergo three separate embryo transfers and, eager to see results fast, would-be-mums often push for multiple transfers. What the health minister is now suggesting is that health insurance should cover five separate IVF cycles instead of three – but with only one-embryo transfers on each occasion. The move has yet to be debated with insurance companies, but experts say they would welcome the change. Many point to the current practice in Belgium where the first two IVF cycles are always one-embryo transfers and only if they are not successful can the client consider a multiple transfer. Gynecologists generally believe this to be the best course –since even doctors who favour single-embryo transfers as a rule –admit that decisions have to be made on a case by case basis, with much depending on the client’s age and the quality of embryos transferred. A change of law which would restrict multiple-embryo transfers, but not rule them out in later stages of infertility treatment would give would-be mums greater protection while not robbing them of what could be their last hope of conceiving.