Nicosia looks nice. The clinic website shows pictures of boats bobbing on blue-green Cypriot waters. Spain feels more familiar, but the Ukraine is cheaper. Or what about Mexico, where you can choose whether to have a boy or a girl?
The fertility business is global and booming. As the NHS cuts back on free treatment for the childless, lumping IVF with tattoo removal as an act of kindness rather than treatment for a disease, the competitive prices of private clinics overseas compared with their UK rivals will look ever more tempting. This weekend a number of them will be touting for business at the Fertility Show, now in its second year, at London's Olympia.
Their websites are in English, their blandishments are soothing and the success rates they advertise are eye-popping to those unversed in the complexities of such data. You can get an instant email quote (in sterling) – I was offered IVF using donor eggs (difficult to obtain in the UK) in Kiev for £5,277, in Nicosia for £3,945 (including six days in a hotel and airport transfer) and in Mexico for £4,316 – or £5,091 if I wanted to choose the sex of my child. The UK has some of the best and safest IVF clinics in the world. It is the home of the pioneers – Bob Edwards, responsible for the world's first IVF baby, Louise Brown, recently won a Nobel prize, putting reproductive medicine firmly in the category of humane treatments that have advanced us as a species. But the government's yearning towards the free market and its dislike of red tape are threatening the quango which keeps standards high and clinics safe. The Human Fertilisation and Embryology Authority (HFEA), this week celebrating the 20th anniversary of the Act that set it up, is down for abolition. Its various roles are to be picked apart and handed to other bodies.
These are rocky times for the unhappy childless. North Yorkshire and York, Bury, South West Essex and West Kent have already cut back or suspended NHS fertility treatment. IVF, in a cash-strapped health service, is one of the first things to go. Funders know that desperate people will do it anyway. Houses will be re-mortgaged.
"Couples know they can't wait for the recession to be over," says Clare Lewis-Jones, chief executive of Infertility Network. "There won't be as much NHS IVF, but patients will find the money at least for one cycle. They have had to in the past and they will do it again."
IVF is expensive in the UK. "There are many places in Europe that are cheaper," says Francoise Shenfield, a reproductive medicine specialist at University College London hospitals and an expert in cross-border care – she hates the phrase "fertility tourism". "Even if you go to Belgium where the standard is very high, it is cheaper. It costs £6,000 to £7,000 in some clinics in London. It is probably £3,000 to £4,000 in Belgium."
Her work has shown huge movement around Europe as people try to escape the barriers to IVF in their home countries. In Italy there are tough legal restrictions on what is available; in France gay women cannot get help. Cost is already a major issue for people in the UK, Shenfield's study showed last year, as is age. More and more women are leaving it later to have families. Government statistics released this week show more than 100 women over the age of 50 had babies last year. Women over 40 travel because the NHS won't help them and there are far more donor eggs available in Spain and the Czech Republic. In Spain, egg donors are paid ¤900. In the UK, they get expenses only, up to £250 – although egg sharing schemes, where women with eggs get cut-price treatment in exchange for donating to somebody else, have eased the logjam.
Shenfield has more issues with egg-sharing (fearing women may donate out of desperation) than with travel. Spain is very good. The Czech Republic, she notes, is compatible with the EU Tissue Directive. Their labs are inspected and their standards are high. But she wouldn't advise the Ukraine, while Greece's regulatory body has not got off the ground because it has no money. Above all, she says, "make sure you do not have more than two embryos in your uterus."
As IVF has become safer, multiple pregnancy has become the biggest risk. One UK consultant recently saw a woman who had been treated abroad who was five months pregnant with five babies. The chances of saving even one were slim. The consensus among experts is that we need to move towards putting back a single embryo each time.
Lis Jardine, chair of the HFEA agrees. "It is accepted worldwide that it is the only way to go." Yet in the unregulated US, she points out, "it is impossible".
Twenty years of regulation in the UK, she says, "has worked like a dream. There is public trust and the co-operation of the research sector means that this country is absolutely the envy of the world for the way it carries out assisted reproduction." China and Kuwait recently asked the HFEA's advice on regulating their own industries. New Zealand and Australia are already copying the model. But new ethical dilemmas arise all the time. "We're barely into the second generation," says Jardine. As the children of IVF want children themselves, who knows what we will find? We already know that boys conceived by ICSI [a single sperm injected directly into an egg] are likely to have the same problem as their father."
She recognises that women who badly want a child will do anything, and that troubles her. "We ought to make it possible for people to have it done here," she says.
Ian Cooke, professor emeritus at Sheffield University and a member of the International Federation of Fertility Societies, believes there may be an answer. IVF, he says, does not have to cost the earth. He is one of a disparate group of fertility experts scattered around the globe who started the Low Cost Foundation. It is trying to prove that low-key, low-cost fertility treatments can be safer, more pleasant and at least nearly as effective as the high-tech versions. Their methods involve fewer drugs, less artificial stimulation of the woman's ovaries, reducing the physical and emotional damage. If they are right, then many more people will be able to have the baby they long for.
But he expects "enormous resistance to this in the developed world". Clinics are wedded to league tables. They are in business to make profits. "The problem [with low cost treatment] is that the success rate falls a bit. But in Scandinavia they have shown that if you improve the quality of the lab work, it comes back to where it was," says Cooke.
The true success rates of fertility treatment are far lower than people think. "The true take-home baby rate is probably 10% to 15%," says Cooke. Anything better probably has much to do with the youth of the patients. Professor Bill Ledger's clinic at Sheffield University is achieving an impressive 60% pregnancy rate through growing embryos to the five-day blastocyst stage, but the patients are under 35.
The work of Cooke and his Low Cost Foundation colleagues should prove very attractive to patients – and the NHS too, in these straitened times. But first they need the evidence. When I spoke to him, he was filling out grant applications to carry out the sort of large trial needed to prove the case. The World Health Organisation supports them, but there is no money. The only money for now is in the cash registers of the burgeoning commercial clinics around the globe – and it's coming from patients who may have sold or mortgaged all they have in the world for the chance of a baby.
Article: by Sarah Boseley 6th November 2010 www.guardian.co.uk
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