Fertility treatment code 'unworkable'

A clinical embryologist has told the High Court he disagrees with the Medical Council guidelines on the practice of fertility treatment here.

The guidelines are impractical, unworkable, don't reflect the reality of IVF treatment and are not adhered to by most IVF clinics here, Dr Aonghus Nolan said.

He said the guidelines state that any fertilised egg must be used for normal implantation in the uterus or frozen but the reality is that most fertilised eggs will not implant because of a high wastage rate.

Many patients also chose not to have unused fertilised eggs frozen and invariably those embryos not frozen would perish naturally.

Dr Nolan, a member of the Commission on Assisted Human Reproduction, also said only one of the 24 members of that commission had dissented from its view that legal protection should be accorded to an embryo only from the time of implantation in the uterus rather than the moment of fertilisation.

He was not sure when individual human life began but did not believe it was before implantation. He believed that view was shared by most embryologists.

He was giving evidence in the continuing action by a 41-year-old mother of two aimed at having returned to her three embryos, created following IVF treatment undertaken by the woman and her husband in 2002, and now stored in the Sims fertility clinic in Rathgar, Dublin.

The couple separated in late 2002 and the 44-year-old husband is opposed to the embryos being released to his wife.

Mr Justice Brian McGovern has ruled that documents signed at the clinic by the husband did not amount to a consent for the implantation of the embryos in the woman's uterus.

The case is now proceeding to determine public law issues, including whether constitutional protection attaches to the embryos.

Yesterday, Dr Nolan told Donal O'Donnell SC, for the Attorney General, that he is attached to an independent fertility unit at University College Hospital, Galway, and had worked in the field of embryology for some 17 years.

Dr Nolan outlined various stages in the development of an embryo from fertilisation to implantation in the uterus.

He said there was a very high wastage or attrition rate of embryos from the fertilisation stage to implantation, about 90-95 per cent worldwide, and this was a "bugbear" for IVF specialists.

It was the policy of the Galway clinic to implant at most two embryos into a woman's uterus and that would yield a maximum success rate of 40 per cent.

Dr Nolan told John Rogers SC, for the husband, that he had no ethical problem with his work because he knew it had a value and saw the outcome when people brought in their babies. He also saw what happened when lesser-quality embryos had to be transferred to the uterus and had not resulted in a child.

He did not see his work as tampering with the beginning of life but rather observing the beginning of life.

Most of his job was to wait and let nature decide what embryos would be best for implantation; it involved observing natural selection.

Cross-examined by Gerard Hogan SC, for the woman, Dr Nolan agreed the wastage rate of embryos was irrelevant to the issue of whether a pre-implantation embryo constitutes individual human life.

He accepted it was not possible to empirically measure the wastage rate after normal fertilisation occurs but believed an educated extrapolation could be made from wastage rates in IVF and other studies.

He was aware that in this case the husband did not want a child and believed a person could not be forced to become a parent. As long as the three embryos in the case were kept frozen, they will never make a baby, he said.

Mr Hogan said it was his case that the husband, in consenting to the mixing of his sperm with his wife's eggs, has already become a father of three embryos.

Dr Nolan said it was his view that, until implantation in the uterus, an individual human life does not exist. He agreed that if it were not for fertilisation, he would not be here.