Seventy-three per cent of all couples were offered, or obliged, to receive counselling compared to 91% of those patients treated in the UK. Of the patients who took part in the survey, only 30% received counselling; over half of those patients found it either 'very helpful' or 'helpful'. No differences were observed in the perceived usefulness of counselling, comparing those patients who were offered, and chose to receive, counselling versus those who received mandatory counselling. In patients who did not receive counselling, the main reasons cited were: 'felt I can cope on my own' (37%), 'counselling was not offered' (21%), and 'did not think it would be beneficial' (15%).

The case for routine human immunodeficiency virus (HIV) screening of all couples seeking assisted reproductive treatment is so strong that it should be made obligatory for all couples entering IVF programmes to be given information about HIV transmission, and offered testing. In August 1999, questionnaires regarding routine HIV screening of couples seeking IVF treatment were sent to the medical directors of the 74 licensed assisted conception units in the UK. Of the 45 (60.8%) centres who responded, 19 (42.2%) routinely screen both partners for HIV antibodies, 25 (55.5%) do not screen and one centre selectively screens high-risk patients. There was no significant difference in the proportion of centres that routinely carried out screening with regards to the unit size: six out of 13 (46.2%) small units compared with 13/32 (40.6%) large units. In all, 17 centres (37.8%) rated HIV screening as essential, nine (20%) as desirable, 11 (24.4%) as not required, while eight (17. 8%) centres did not comment. Of the 19 centres that have a routine screening policy, 18 have management protocols in the event that the test is positive. Of these 18 centres, 12 adhere rigidly to the protocol, while five centres adhere to the protocol with few exceptions and the remaining one uses its protocol for guidance only. The main reasons for not employing routine HIV screening were: the lack of cost effectiveness, low prevalence of HIV infection in their population, necessity for and cost of counselling, uncertainty about the need for screening and potential delay to start of treatment.

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A 36 year old patient underwent in-vitro fertilization (IVF) and embryo transfer. Three embryos were transferred to her uterus and eight spare embryos were cryopreserved. The patient conceived a quadruplet pregnancy and delivered two boys and two identical twin girls by Caesarean section at 30 weeks gestation. The couple subsequently donated their cryopreserved embryos to the embryo donation programme for the use of other couples. Two agonadal patients received these cryopreserved-thawed embryos, each in a hormone replacement cycle. Both conceived, one has safely delivered twins and the other conceived a twin pregnancy, one of the fetuses has vanished and the other is progressing normally. The overall embryo implantation rate was seven out of nine (78%).