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There are major loopholes in the plans drafted by a new watchdog to
oversee embryo research, according to the Interim Licensing Authority. In
the ILA’s sixth and final report, its chair, Mary Donaldson, and her colleagues
pinpoint ‘gaps’ in the proposals drafted by the Human Fertilisation and
Embryology Authority.

They also fear the HFEA may lack real power, becoming a ‘large bureaucratic
machine’ because of its close relationship with government. Donaldson likens
her own authority to a ‘bit of grit in the oyster-like machinery of government’.

The HFEA, which is due to take over on 1 August, may be unable to police
the small centres which currently offer in vitro fertilisation. These centres
have a low success rate. Such centres are ‘being established without the
necessary facilities, adequately trained staff or proper supervision’, the
report warns. Formal training for embryologists, counsellors and IVF coordinators
is urgently needed, says the ILA. ‘There is a case for not having small
units,’ comments Donaldson. ‘We need regional centres, centres of excellence.’

A second ‘area of concern’ is the rising number of multiple births.
The number of triplets and quadruplets is increasing because some clinicians
persist in transferring four or more embryos, in the hope that this will
increase the chance of establishing a pregnancy. Yet the practice carries
a substantial risk of producing multiple births, with disastrous consequences
for the infants, the parents and NHS special baby units.

This practice has continued despite the ILA’s 1987 guideline that no
more than three eggs or embryos should ever be transferred, except in ‘exceptional
circumstances’. In 1989, clinicians performing IVF transferred four or more
embryos 1027 times, representing 10 per cent of all transfers. Clinicians
performing the fertility treatment known as GIFT (gamete intrafallopian
transfer) transferred four or more eggs in 59 per cent of cases.

‘We do not consider 10 per cent or 60 per cent of cases to have been
exceptional circumstances,’ says William Thompson, professor of obstetrics
and gynaecology at Queen’s University, Belfast. ‘It shows that if you open
the door even slightly people rush through.’

Several leading clinics are now transferring only two embryos with no
fall in success rates, Donaldson says. ‘We hope the HFEA will follow their
lead and set two as the statutory limit.’ But the new body has declined
to regulate GIFT centres, and so will have no authority to limit the number
of eggs transferred in those, she says.

‘GIFT is totally out of control,’ warns Donaldson. ‘Many centres will
be encouraged to use GIFT because there will be no controls.’ She regretted
that the ILA, run on a shoestring, had lacked the resources to bring GIFT
officially into its licensing system.

The ILA also condemns the HFEA’s plan to disband the independent ethics
committees that now oversee both clinical and research aspects of IVF. The
HFEA says that only research on embryos presents ethical dilemmas. ‘We are
very concerned about the threatened loss of these specialist ethics committees,’
says Julia Neuberger, a rabbi and visiting fellow of the King’s Fund health
charity in London. ‘We need more, not less, monitoring of treatment by lay
people,’ she says.

Clinicians also support ethics committees. ‘Treatment is still developing,’
says Robert Shaw of the Royal Free Hospital School of Medicine in London.
‘These committees are very helpful to clinicians faced with difficult ethical
decisions about who they should treat or whether a new treatment is developed
enough to be used on patients.’