Bridgend couple shell-shocked after IVF error

17 Jun 2009

A couple from Bridgend have been left heartbroken after a mix-up at their IVF clinic led to their embryo going to another patient.

Deborah and Paul had been attending the Cardiff-based University Hospital of Wales’ IVF clinic. In 2007 the couple attended the clinic for the implantation of their last viable embryo, but when they arrived they were told there had been ‘an accident in the laboratory’.

Their embryo had been given to another patient who, on discovery of the error, terminated the pregnancy.

Deborah explained: “I will never forget the moment the hospital broke the devastating news to us. I just could not believe what I was hearing. Initially the hospital staff told me there had been an accident in the lab and that the embryo had been damaged, I thought that someone had perhaps dropped the embryo dish.

“I remember thinking, ‘That’s our last hope gone – we will never have another child.’ I left the hospital feeling totally shell-shocked.

“When we went back to the hospital two days later and we were told the truth about my embryo being given to someone else; I was so angry.

”I had been given a handbook before every course of IVF explaining all the elaborate precautions the clinic undertook to ensure this sort of mix-up was impossible – and yet despite everything, it had still happened. ”

Cardiff and Vale NHS Trust, which runs the clinic, admitted gross failures in care and have agreed to pay the couple an undisclosed settlement.

Deborah and Paul’s solicitor, Guy Forster, said the error was “an accident waiting to happen” after it was revealed there had been two near misses at the same clinic the year earlier.

The error with Deborah and Paul’s embryo came about after a trainee embryologist mixed up their embryo after taking it from the wrong shelf of the incubator. Guidance that recommends only storing one patient’s embryos in the incubator was ignored.

“Fail-safe” witnessing procedures are in place to prevent embryos being transplanted in the wrong patient. In this case the trainee embryologist failed to carry out these procedures.

The clinic only noticed the blunder when another member of staff realised that Deborah’s embryo was missing.

Guy Forster, who represented Deborah and Paul, said: "A report by HFEA investigators shows that the error occurred primarily due to failures by laboratory and theatre staff to carry out basic procedures. However, it is clear that there were a number of system failings, in that the Clinic had failed to implement the procedures set out in the HFEA's Code of Conduct, workloads were above safe levels and there were staff shortages.

"IVF Wales reported two 'near miss' incidents to the HFEA in 2006 and an HFEA inspection in February 2007 had warned the Clinic to tighten its witnessing procedures, yet it would seem nothing was done. This was an accident waiting to happen."

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