A place of hope from conception to birth
The Rotunda Hospital’s Hari unit has overseen the birth of 4,000 babies since it opened under the guidance of Robert Harrison, the father of Irish IVF. But the State could do more to help couples who have difficulty conceiving, writes RÓISÍN INGLE
EVERY INCH of one corridor in the infertility clinic behind the Rotunda Hospital in Dublin is covered with photographs of babies and toddlers who were conceived on the premises. Understandably, some patients find the beautiful-baby display at the Human Assisted Reproduction Ireland (Hari) unit difficult to stomach. For an estimated one in six people in this country, conceiving a baby does not come naturally. Couples who attend the unit have often been striving for years to live the dream that decorates these walls.
The architect of that dream was 85-year-old Prof Robert Edwards, who this week won the Nobel Prize in Medicine for his work on IVF with the late Dr Patrick Steptoe. This work led in 1978 to the birth of Louise Brown, the world’s first test-tube baby.
Since then more than four million babies have been born around the world using the assisted-reproduction procedures pioneered by Edwards. The Hari unit in Dublin, a self-funding non-profit facility, is central to the Irish story of IVF. It was the first facility to treat couples, as opposed to just women, and it remains one of the largest and busiest of the 10 such clinics now established in Ireland.
“A few of our patients have said they find it hard to look at the baby photographs,” says Benny Hennelly, nurse manager of the unit, who has worked there since it opened, in 1989. “I can see where they are coming from, but I think it’s important that the photographs are on display, because it shows that there is hope and that it can and does happen for many.”
Talking about the increasing numbers of people being seen at the clinic – about 1,500 each year – she says: “There is no recession here.” She knows of people who are so desperate to have a baby that they have remortgaged their houses to pay for IVF. It is costly and not the quick-fix baby-making procedure often portrayed in celebrity magazines. The chances of conception for under-35s are one in three; at 42 there is only a one-in-10 chance.
The Hari unit has overseen the birth of about 4,000 babies since it opened under the guidance of the now retired Prof Robert Harrison, author of The Smart Guide to Infertilityand the acknowledged father of IVF in Ireland. The first time he worked on an IVF procedure that resulted in a live baby was in 1987, although when asked about “his” first IVF baby, and whether he keeps in touch, he says: “They are not my babies any more than the babies in England were Edwards’s babies or Steptoe’s babies. They are the couples’ babies. We were just the facilitators – it’s an important distinction to make.”
Harrison was born in England but studied in Dublin before founding fertility clinics in Sir Patrick Duns and, later, St James’s Hospital. In St James’s he remembers having to harvest eggs late at night because that was the only time the theatres were free. Harrison’s late wife, Caroline, worked with him, and although it sounds incredible now she would carry the fertilised eggs in her cleavage to incubate them at room temperature. At this fledgling stage the staff were voluntary and some of the nurses sought ethical guidance from priests before agreeing to work there.
When Harrison was appointed professor and head of the department of obstetrics and gynaecology at the Rotunda Hospital he was given permission to set up the dedicated infertility clinic that was to become Hari in the old master’s residence at the back of the main hospital. Back then consultations took place in what used to be the upstairs bedrooms. One of the toilets in the house was set aside for semen collection. An old Aga was got rid of so that the kitchen could be converted into a laboratory. More sophisticated equipment gradually began to arrive, and cleavage-based storage solutions were abandoned.
Over the years, new procedures such as intracytoplasmic sperm injection, whereby sperm is implanted directly into an egg, and frozen embryos were introduced.
One of Hari’s current patients, 41-year-old Dara Russell, is lying drinking a cup of tea just beyond the baby-photograph corridor, having just undergone a routine procedure in the unit. She is trying to have a second baby. Her husband, Alan, is showing Hennelly a holiday video, taken on his phone, of the Russells’ son, Bobby, who will turn three in December.
Infertility is defined as the inability of a couple to conceive after trying for a year, and that was how long the Russells had been married when they first sought the help of a clinic. They weren’t happy with the treatment there and transferred to the Hari unit. After one cycle of IVF failed “I took to my bed”, says Dara. “I just couldn’t talk to anybody.” But she carried on, and after the second attempt Bobby was conceived. “Everyone thinks their babies are miracles; he is ours.”
Dara has now completed four cycles of IVF. Soon she will begin taking hormones to prepare her womb for the implantation of a frozen embryo from a past cycle of IVF. She has less than a 15 per cent chance of having a baby this time. “The way I see it, if the chance is there we are going to take it,” she says. “There was only a 20 per cent chance when I got pregnant with Bobby.”
“It’s better than no chance,” says Alan.
Ireland is one of only three EU countries that has no legal framework regulating the area, despite recommendations from the European Commission on assisted human reproduction published five years ago. Dara wasn’t aware of this before. “That’s terrible,” she says. “People in our situation are desperate”.
The Department of Health says it is developing policy proposals on regulation that should be finalised by early next year. The proposals will examine issues arising from a Supreme Court judgment on frozen embryos that stated they were not entitled to be protected as “unborn” until they were in utero. Clinics in this country adhere to guidelines from the Irish Medical Council.
Asked why he thinks there has been such a delay in regulation, Prof Harrison, who chaired the World Health Organisation task force on infertility in the 1980s, says the issue is “a political hot potato . . . I think people in Ireland are actually very lucky. There are good clinics here; they keep with the guidelines, most of them”. When regulation does come in, he worries about “who will write the rules and which side they will come down on”. He points to the Catholic Church’s criticism this week of Edwards’s Nobel Prize and its “obsession with people having babies through intercourse”.
While Harrison has described infertility as “the last great taboo”, those affected have in recent years become more willing to talk about their experiences of the Irish system. Martina Devlin, for example, wrote about hers in her powerful book Baby Hunger.
Some say the online infertility community is where they garner most support, as opposed to the waiting rooms of infertility clinics, where there can be a reluctance even to make eye contact. Fiona McPhillips is a blogger and the author of Trying to Conceive: The Irish Couple’s Guide, a book written to help people navigate the complex, stressful world of assisted reproduction. She now has three children but has continued to be a voice for those affected by infertility issues. Her latest project is a charity, Pomegranate, that she set up with a friend to raise funds for those who can’t afford fertility treatment and to lobby the Government and insurance companies to introduce public funding.
“Infertility is a medical condition,” she says. “The stress associated with it has been shown to be the same as with patients who have cancer. The lack of funding means people suffer even more, as there is no obligation on anybody to help them.”
There is some limited support for those who can’t afford treatment. In the Merrion Fertility Clinic, in Holles Street hospital, patients with medical cards are offered reduced rates and at Hari they are treated free of charge. The price of one IVF cycle can be around €4,000, plus an additional cost of up to €3,000 for drugs, which is subsidised by the drugs payment scheme. There is tax relief on the medical expenses. In a statement this week the Department of Health said that the Minister, Mary Harney, was “conscious of the financial burden that IVF treatment can place on the couples concerned, and she has asked her officials to consider policy options in this regard”.
For more information on Fiona McPhillips’s charity, see pomegranate.ie