Laboratory Manager. Centre for Reproductive Medicine, St Bart's Hospital. London
In some ways very little has changed in IVF laboratories since I started working as a clinical embryologist in London back in 1991. But in the UK what can at times seem like an ever increasing regulation of clinics by the HFEA has ensured that we have not stood still in terms of compliance with the changes in the European legislation of ART.
But for me the greatest change, and so impact on the way we work in the UK, came about following changes in the use of donor gametes after the implementation of requirements set out in the SEED report. The use of iD release (non-anonymous) gamete donors here in the UK is now the norm. Our fears that there would be fewer sperm donors available was seen initially and led many of our patients to apply to import samples from overseas. This process was halted for a few months when the HFEA stopped all applications to import from outside of the UK due to an issue over how gamete donors were being ‘reimbursed’, or ‘paid’.
The limitations placed upon the movement of patients’ own gametes and embryos between the European states being dependent upon the readiness of each member state to have ensured that clinics had introduced the regulation as per the EUTD by the named governing bodies responsible or their compliance, has made it a more complicated process despite the perceived increased openness within the EU.
For patients seeking treatment with donated oocytes, the access to clinics in Eastern Europe led to an alleviation in the length of time waiting for access to the chance to become pregnant. But at what cost? And what really concerned me? The overseas clinics I have had the pleasure to work with have been both professional and successful in producing the end product. A take-home baby. But in the UK where we are currently all working towards reducing the rate of multigestations, particularly where donor oocytes are involved. I was concerned that where in the UK a maximum of two embryos could be replaced that our patients could have three replaced. This means an increased chance of a twin or triplet pregnancy and the costs and risk of such a pregnancy would need to be met here in the UK by the system we were trying to reduce them in. With the added complication of the mother being of advanced maternal age in many cases where a singleton pregnancy would be classed as a ‘high risk’. Patient fixation on getting pregnant at any cost, financial or clinical, could endanger their chance of actually taking home a baby or increasing the risk of a pre-term delivery in addition to the risk of disability.
But what of the cost to the patients? The stress of traveling to another country, where the first spoken language may not be their own. That ART provision delivered differently due to that country’s enforcement of the law and regulation, make the treatment a more difficult experience?
I have often wondered whether the changes to the laws within the UK with regards to the anonymity status of donors was meant to reduce the number of children born following such treatment? Or that our obsession in the UK to consider the welfare of the unborn child has led us to increase the pressure on altruistic donors and those who receive limited reimbursement for donating to ensure that any resulting child is able to trace his genetic parent once they are 18 years of age. The limit on reimbursement here in the UK whilst being seen as morally correct in many peoples eyes appears less than honest when compared to the straight ‘cash for gametes’ in place overseas. Can this reproductive tourism be taken as in the words of Professor Guido Pennings as merely a ‘safety valve’, so allowing those seeking these treatments the personal freedom and cheaper and more immediate access to the services they require in order to become parents that they may not be eligible for in their own country.
What role should UK clinics play in the search for treatment overseas, if any? As once involved they are duty bound to try and extend our tight regulations overseas. But with all things considered should it not be a personal decision as to where and how a patient achieves their dream of becoming a parent?