Comment 718 www.thelancet.com Vol 369 March 3, 2007 transfer has equal chance of a livebirth compared with double embryo transfer, with greatly reduced risk of twin pregnancy. Heijnen and co-workers report cumulative livebirth rates after 1 year of treatment and support the contention that one fresh embryo plus one frozen embryo transfer equals a double fresh transfer, without most of the resultant twin births. Equivalent numbers of births were achieved in the single embryo transfer group with reduced cost and distress for couples. An elective policy of single embryo transfer remains controversial in the UK, as shown by media coverage of the MBSET working-group report. Some patients want to complete the procedure as quickly as possible, and see twins as the most desirable outcome. 8 While 75% of IVF treatment in the UK continues to be paid for by patients themselves, and the guidance by the UK National Institute for Clinical Excellence in 2004 that all eligible couples are offered three full cycles of IVF 9 remains a pipe dream, many couples will opt for double embryo transfer because it is much less costly. Governments should recognise the long-term benefits to patients, to neonatal and postnatal care, and to the public purse of implementing a policy of single embryo transfer and encouraging adoption of the policy with increased funding for such treatments. William L Ledger Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Sheffield S10 2SF, UK w.ledger@sheffield.ac.uk I declare that I have no conflict of interest. 1 Human Fertilisation Embryology Authority. Facts and figures. http://www. hfea.gov.uk/cps/rde/xchg/SID-3F57D79B-6350C24C/hfea/hs.xsl/406.html (accessed Jan 3, 2007). 2 Fauser BC, Devroey P, Yen SS, et al. Minimal ovarian stimulation for IVF: appraisal of potential benefits and drawbacks. Hum Reprod 1999; 14: 2681–86. 3 International Society of Natural Cycle Assisted Reproduction. First World Congress on natural cycle/minimal stimulation IVF. London, Dec 15–16, 2006. 4 Heijnen EMEW, Eijkemans MJC, De Klerk C, et al. A mild treatment strategy for in-vitro fertilisation: a randomised non-inferiority trial. Lancet 2007; 369: 743–49. 5 Human Fertilisation Embryology Authority. Multiple births and single embryo transfer review. http://www.hfea.gov.uk/cps/rde/xchg/SID- 3F57D79B-09487768/hfea/hs.xsl/483.html (accessed Jan 3, 2007). 6 Gerris JM. Single embryo transfer and IVF/ICSI outcome: a balanced appraisal. Hum Reprod Update 2005; 11: 105–21. 7 Hamberger L, Hardarson T, Nygren KG. Avoidance of multiple pregnancy by use of single embryo transfer. Minerva Ginecol 2005; 57: 15–19. 8 Newton CR, McBride J, Feyles V, Tekpetey F, Power S. Factors affecting patients’ attitudes toward single- and multiple-embryo transfer. Fertil Steril 2006; 87: 269–78. 9 National Institute for Clinical Excellence. Fertility: assessment and treatment for people with fertility problems. Clinical Guideline 11, February 2004. Available at www.nice.org.uk (accessed Feb 26, 2007). Health statistics are no longer boring! Health statistics hit the headlines almost daily, but controversies about statistics are not uncommon. Some have their origins in technical complexities; in other cases, disagreements are a cover for vested interests and political manoeuvring. Big diseases mean big money, and disease programmes cleverly use data to advocate their case. But a conflict of interest can arise when these same programmes are responsible for monitoring progress. Thus the highest possible standards and transparency are required. Nowhere is the potential for controversies more striking than in the area of disasters and conflicts. A report in the Lancet on postinvasion mortality in Iraq prompted a same-day disclaimer from the US President. 1 Health statistics underlie greater commitment to transparency and accountability in the health-care system. Examples include: the Commonwealth Fund’s Commission on a High Performance Health System about the USA; 2 Healthy Canadians, a federal report on health indicators; 3 Mexico’s monitoring and evaluation of Seguro Popular (Popular Health Insurance); 4 and South Africa’s “district health barometer”. 5 Ranking and international comparisons are increasingly used to assess performance and make informed decisions about resource allocation. Targets are used both in national health systems, such as England’s star-rating system, 6 and international initiatives, such as the WHO/UNAIDS 3 by 5 initiative to scale-up antiretroviral treatment in developing countries. The strong focus on monitoring in the Millen- nium Declaration and major international health initiatives, such as the Global Fund to fight AIDS, Tuberculosis and Malaria and the GAVI Alliance, is designed to enhance transparency and accountability, and allow a better understanding of what works: how many lives have been saved by interventions and at what cost. But the demand for sound statistics rapidly outstrips supply of data, especially in developing See Perspectives page 735 See Series page 779