Reproduction becomes a (baby) booming industry

ASSISTED reproduction is a booming industry in this country, with nine clinics opening in the past 15 years.

Up to 4,000 couples have assisted reproduction treatments each year with most of those paying out thousands of euro to private clinics.

Average payments include €120 for an initial consultation, about €100 for each of the blood tests and then up to €8,000 for the most expensive treatments such as ICSI (intracytoplasmic sperm injection) with egg donation.

Public clinics operate in hospitals in Dublin, Cork and Galway but often these clinics do not offer the full range of week-round services provided by their private counterparts as they are so costly.

In some cases, limited treatment is free to all patients but most clinics charge non-medical card holders a fee. There are often long waiting lists for treatment from three months to over a year.

Private clinics also offer a certain percentage of their cycles to medical card holders but it is difficult to obtain precise numbers from clinics and it is believed that it is often less than 5% of overall numbers again due to cost.

According to the Commission on Assisted Human Reproduction (CAHR), which published its report earlier this year, the private clinics are "open to the danger of commercialisation in a number of ways" as theoretically, and there has never been evidence of such, people could be given indefinite treatment cycles as long as they are willing to pay.

The commission has called for the future development of assisted human reproduction services to "avoid the risk of commercialisation."

"I've heard of people selling a second car. They've cashed in insurance policies. People forfeit summer holidays and weekends away, new clothes, whatever is necessary.

"It's not only the affluent who use private clinics. A few couples have had their families help them out so they can have another go," said a National Infertility Support and Information Group (NISIG) spokesperson.

NISIG has long called for infertility to be defined as a medical condition so that couples would be entitled to claim for fertility treatments under their health insurance. They have written to VHI and BUPA seeking a wider "fertility options scheme" for couples who are of childbearing age.

The medical condition definition could ensure, they believe, paid time off work for fertility treatments. Doctors say women "agonise over whether to tell their bosses about their treatments."

Dr David Walsh of the SIMS Clinic in Dublin argues that couples in Ireland enjoy lots of benefits that their British counterparts, for instance, do not.

The British Government has announced that the National Health Service (NHS) will offer one free IVF treatment to all infertile couples but he believes there are "catches" as you can not have children already and you must be under 40.

"In Ireland, the drugs used for infertility treatments are paid for under the Drug Payment Scheme (DPS) and so anything over €90 is paid for by the State.

"Treatment can also be claimed back as a medical expense and so a treatment that costs about 4,000 will only cost about €2,500 after 42% tax relief. In Britain, drugs could cost stg£1,500 (€2,168) on top of stg£3,000 (€4,336) for treatment and no tax relief," he argues.

The expansion of infertility treatments and the growing numbers who will do anything for a child will ensure that the multi-million-euro fertility industry will continue to boom.

The Commission on Assisted Human Reproduction (CAHR) issued its recommendations last May and Health Minister Mary Harney is due to legislate on them in the coming year just watch out for the fireworks and those ducking for cover in the Dáil.

Of the 40 recommendations, all but seven were unanimously agreed by the commission's 20 members while the remainder were majority views, some with only a single dissenter.

Among the main recommendations are that the embryo formed by IVF should not attract legal protection until placed in the human body. Options for dealing with surplus embryos should include donating to other recipients, voluntary donation for research or allowing them to perish.

It also says that the regulatory body should have the power to intervene where sperm, eggs or embryos are abandoned or where the couple disagree on a course of action, separate, or where one or both of them dies or becomes incapacitated.

One of the areas that will attract most interest is the recommendations on donor programmes. The commission says that medical tests and all other necessary steps must be taken in the selection of donors to ensure that donated sperm and eggs are free from the risk of transmitting disease or passing on genetic disorders.

In order to avoid commercialisation, it says donors should not be paid for their donations, except to cover expenses and that children born through donations should be entitled, when they reach adulthood, to know the identity of their genetic parents, but the donor should not be able to find out the identity of the child.

According to Dr Walsh, egg donation is a "huge issue" which is leading dozens of Irish couples to go abroad for treatment.

"We can get donations from anonymous sources or from a family member. It's great when a family member does it, but unfortunately, we just don't have enough from either source.

"There's a waiting list of two years and people are crying out for donors. So over half of couples travel to Spain or Eastern Europe as there is also a severe shortage in Britain as their anonymity for donors has been lifted," said Dr Walsh.

He admits that "reproductive tourism" is not "ideal" and it makes people feel "prejudiced" against the practice, but he said it is a response to the lack of investment in issues such as donor education programmes.

According to registrar gynaecologist Dr Honora Ryan, growing fertility problems could lead to the very real situation where "single women in their 20s, who don't want to rear a child alone will seek to freeze their eggs for future usage. It could be their 40s when they meet somebody. So, it's a potential ethical time bomb."