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Alison O’Connor: Joy of birth is tainted by doctors' dash for cash

If a Leaving Certificate student asked my opinion on a recession-proof career, my advice would be to train as a doctor and open a fertility clinic.

I've lost count of the people I know who have either recently had, are planning to have, or are in the middle of, fertility treatment. It's not something that clinics necessarily want to shout about but business is booming, and its getting boomier. Up to 3,000 children are born each year in Ireland as a result of IVF or other related techniques.

The technology is fantastic. I know from personal experience and from that of many friends and acquaintances that when the process works and results in a pregnancy, it is truly amazing.

But IVF is one of those things that when you are in the middle of it, there is no perspective at all. The goal of getting pregnant is the only thing that occupies the mind. That's how some couples end up paying tens of thousands and doing multiple cycles, and can still end up childless.

But for all the growth in the industry and the finances involved, there is remarkably little hard scrutiny of the sector.

This is due to a combination of factors, not least the absolute desperation of the couples, who, if told by a clinic that their sperm needed to be washed in champagne and eggs simmered in caviar in order to achieve a pregnancy, would readily agree.

That's the human factor; the legislative one is that we have a succession of governments who would boil in oil rather than draw up laws in this area.

Ireland is the only European country that has failed to provide any legislative or proper regulation for IVF.

Just after Christmas Lord Robert Winston, a fertility pioneer in the UK, attacked fertility clinics there saying the exorbitant fees they were charging were a scandal and there was a huge amount of exploitation going on. He said a combination of avarice on the part of the clinics and desperation on the part of women was driving the market.

For the majority of patients there, who must pay privately, the average basic cost of treatment is just over €3,000 a cycle in NHS clinics and €4,235 in private clinics.

In an Irish clinic, costs for a standard IVF range from €3,700 to €5,000. In his calculations, Prof Winston took account of salaries and overheads for a large unit, treating 2,000 patients a year, where there were economies of scale. In fairness to the Irish clinics, they are obviously smaller, but even so this is clearly a great business to be in.

Prof Winston reckoned that even with a generous costing of salaries, treatment could be delivered for just under €850 per cycle, and adding in overheads of equipment, materials and rent could push it up to €1,570. He rather aptly summed up the situation by saying that even the NHS clinics were basing their figures, not on costs, but on what the market would bear.

Now, one medic I know who is involved with infertility treatment here claims that prices are set fairly and that it's not a business with a licence to print money.

If you want to be involved in something like that, he suggested rather tartly, you become an obstetrician with a private practice and earn a fortune each year. He also pointed out that when Prof Winston was in private practice himself his prices for treatment were amongst the highest.

It's not my intention to give any comfort to those who have problems with bringing science into reproduction. It's just that with so many Irish citizens now using the services of these clinics, we really need matters to become more transparent and openly accountable.

We need them all to publish exact data on their success levels in a way that is easily understandable for people who are considering using their services. For instance, a clinic could have a great success rate with women in their mid-30s, but far less so as they approach 40. This is nature and no surprise, but it should just be detailed in a way that is easy to understand.

From what I know of them, Irish clinics do appear to operate to a high standard, but that is not enough. After all, apart from the money involved, these are procedures that can possibly involve life-threatening health complications for women; have a huge effect on your mental health; and, as the science becomes even more sophisticated, can be fraught with moral issues.

Clinics must abide by Medical Council guidelines, which they obviously take seriously, but if you look at the council's conduct and ethics guide you'll see that this complex area takes up less than a page of that document. It strikes me that a factory making, for instance, infant formula, would be subject to more official scrutiny than a clinic where babies are actually made.

Conversely, then, this lack of scrutiny and regulation (and the particularly Irish moral backdrop) can also mean that couples are being done a further disservice because clinics here can understandably be slow to take on new developments. This is even though there is no law forbidding them.

One example is the screening of embryos for chromosomal abnormality, which is the largest cause of miscarriage. The clinics prefer to operate below the radar and not attract controversy.

Our Government's unwillingness to make law in this area also means that other developments, such as surrogacy and donor sperm and eggs, are resulting in children being born who are stateless, with legal uncertainty around who their parents are, as well as children who will never know their genetic parents.

If you are one of the thousands of couples who have experienced the heartache of trying and failing to have a baby in the way God intended, and IVF is a welcome option, you could really do with the whole thing being easier.

Irish Independent