Nine months ago, a world-famous infertility clinic, Bourn Hall in Cambridge, England, opened a satellite clinic at Clane General Hospital in Kildare. The first baby conceived through this new partnership is expected to be born within days of this article appearing. The expectant parents, who had experienced the pain of infertility, chose to try Intrauterine Insemination (IUI) by donor, a historic development in the history of assisted conception in the Republic. IUI is less stressful than In Vitro Fertilisation (IVF) but until now few Irish couples have had a chance to try it. With IVF, the female's eggs are removed and fertilised outside the body, then replaced. With IUI, ovulation is gently stimulated and monitored and the eggs make their way down the fallopian tubes naturally. The sperm is prepared as for IVF, then placed in the uterus when time is ripe for conception.
IUI is not available at the Rotunda Hospital in Dublin, although it is practised at the country's other major fertility unit, at University College Hospital, Galway. Galway's unit, however, was told by the health board not to use donor sperm in the procedure.
"To allow the use of donor sperm, but not to allow it in IVF and IUI is illogical. Donor sperm is donor sperm, whatever you do with it," says Dr Peter Brinsden, medical director of Bourn Hall for the past nine years and the leader of the team at Clane. IVF by donor sperm is not yet being offered to infertile couples at Clane. For nearly a decade, Irish couples have been making their own ethical choices about the various forms of assisted conception - not just IVF and IUI by donor but also egg donation, embryo freezing, embryo donation and surrogacy - by travelling to clinics in the UK. For the past eight years, about 30 infertile couples per year have chosen to travel to Bourn Hall, Cambridge, which was founded in 1980 by Dr Patrick Steptoe and Dr Robert Edwards, who created the world's first "test tube baby", Louise Brown. All treatment offered at Bourn Hall is approved and monitored by the Human Embryology and Fertilisation Authority which sets guidelines for fertility treatment in the UK. "There were a number of people coming to us in Cambridge who wanted a second or a third opinion, having had treatment in the Republic. I believe people are entitled to a second opinion. Before, they came to Bourn Hall; now we're coming to them," says Dr Brinsden.
"I've been a doctor for 32 years and I'm very much a patients' person. I'm passionately concerned to do my best for individual patients. Before setting up at Clane, our group sought the views of obstetrician/gynaecologists in the Republic and it was felt by several senior people in gynaecology that there was room for a third clinic to give patients a choice," he adds.
The unit at Clane is run by an Irish medical team, including two senior consultants, Dr Julian Dockeray and Dr Pat Tunney, an embryologist, Geraldine EmersonLyons and a co-ordinator, nursing sister, Marea Fitzsimons. It's early days yet, but already the clinic's success rates are on a par with those at Bourn Hall, Cambridge. The chance of going home with a baby is 39 per cent per couple for IVF (25 per cent per treatment cycle), 21 per cent per couple for IUI (10 per cent per treatment cycle) and 50 per cent per couple for IUI by donor (18 per cent per treatment cycle). Clane, under a different fertility team, actually assisted the conception and birth of the Republic's first IVF baby 10 years go.
A fundamental policy of Bourn Hall at Clane is that younger couples who are medically suitable for IUI should try it before going on to the more costly and traumatic process of IVF.
Bourn Hall's Irish clinic provides, first and foremost, full investigation of male and female infertility and counselling. But it also enables couples to consider forms of assisted conception which are not available in the Republic, such as egg donation and surrogacy. By having their counselling and medical preparation and monitoring here, then travelling to the UK at the crucial moment for conception, Irish couples can sidestep the moral indecision which has limited fertility treatment in the Republic.
The arrival of Bourn Hall in this country should revitalise arguments on fertility issues. Dr Brinsden himself is an internationally respected thinker on issues of fertility and ethics, who is frequently consulted.
"We are not trying to do horrendous things that are anti-God or anti-ethics or anti-life," says Dr Brinsden. "We are trying to do things that are fully accepted in the UK by the government, by ethics committees and by our own consciences.
For example, Dr Brinsden is convinced - and the Human Fertilisation and Embryology Authority agrees - that it is ethically correct for a woman with a healthy womb to carry the genetic baby of another woman. If, for example, woman has ovaries but no womb and her husband has viable sperm: they can produce an embryo, but need a "host" or "surrogate" to incubate the child.
He also supports egg donation, in which women with healthy ovaries donate eggs to women who do not have eggs of their own. The waiting list at Bourn Hall for donated eggs is nearly two years long, but Irish women - and others - can jump the queue by having a friend or family member willing to donate eggs on their behalf.
"I believe that the day will come when young Irish women will carry egg donor cards, just as many carry organ donor cards today." He believes that Ireland is not yet ready for embryo donation - in which infertile couples who have been through IVF donate their left-over embryos to other infertile couples who "adopt" them literally in the womb. But he is convinced of its value and practises embryo donation at Bourn Hall. "I believe passionately in doing everything to help a patient have the child she so desperately wants," says Dr Brinsden. "I will do whatever I can to help couples have a child, but I will stop short at what the general body of people feels to be inethical."
Where do you draw the line? In the Republic, where debate has been muted, we have no legislation, few guidelines and no monitoring body. Outside the IVF clinics at the Rotunda and University College Hospital, Galway, the whole issue of infertility treatment has become a kind of underground movement where people seek solutions through word of mouth. The lack of regulation also means that anyone can set up an infertility clinic and anxious couples are extremely vulnerable to self-appointed "experts" offering miracle babies. The recent decision by the Rotunda to offer embryo freezing, in advance of the medical council's expected decision on the subject sometime this year, is an example of the moral fudge which exists. For years the Rotunda has been directed to implant two or three embryos only, then to place the others outside the cervix where they inevitably die. Some Irish couples have felt strongly that this is wrong and have travelled to Bourn Hall for embryo freezing. "We have had 700 babies born from frozen embryo treatment in Bourn Hall and if we had the same policies as Ireland, those babies would not be here," says Dr Brinsden.
Clane has the equipment to implement embryo freezing, but will wait for the Medical Council's go-ahead before introducing the procedure, says Dr Brinsden. We in the Republic can dither over issues such as embryo freezing and perhaps for those who have never experienced infertility either first-hand or in a loved friend or family member, such possibilities may seem alien or even outrageous. But for infertile couples and those dedicated to helping, it is the Government's inaction on these ethical issues that is outrageous.
Bourn Hall Clinic at Clane General Hospital (045) 868004. IUI costs £450 per cycle, with an additional charge of £150 per cycle if donor sperm is used. IVF costs £1,950 per cycle.