Serena Bryans, a 31-year-old recruitment consultant, miscarried repeatedly in the first few years of her marriage, typically losing the baby eight weeks or so into the pregnancy. Serena Bryans is one of the people trying to improve assisted-reproduction services, writes Anne Dempsey.
Then she was diagnosed with polycystic ovarian disease, which in her case seemed to be leading to abnormal eggs that were incapable of becoming viable foetuses.
"I was devastated," she says. "I felt there was no point in carrying on. I was like a sports car with no engine. I had the power steering, the sun roof, the passenger air bags, but the fundamental reason that made me a woman was missing. Having a baby was everything to me."
One option was to receive donated eggs, which could be fertilised with her husband's sperm in a treatment available in the UK. Another was to boost her fertility with hormone treatment and closely monitor any subsequent pregnancy. She also contemplated a hysterectomy. "I couldn't take the hope. I felt I could cope with no hope of a child if it was certain, rather than my life being on hold."
In the event, nature stepped in. Serena became pregnant naturally and carried her baby to term. Her son is now five years old, and she also has a two-year-old daughter. She was subsequently told the original diagnosis was incorrect and that she had been suffering from an unexplained infertility that affects thousands of women.
Her family complete, she wanted to help people in similar circumstances. "The thought of other infertile couples had never left me, and realising that my eggs are healthy, I wanted to donate them."
Early in 2000, she approached the three Dublin maternity hospitals, which offer a range of fertility services, but was told the Republic did not have an egg-donor programme. Her GP referred her to the Royal Hospitals, in Belfast, which accepted her on their scheme. Between May and November 2000, she travelled to the city each month for medical screening and counselling. The donation procedure involved a month of hormone treatment to boost her egg production.
"They told me of the possible side effects, which could include weight gain. I did suffer from headaches and sleeplessness. I donated my eggs under sedation in November 2000. Twelve eggs were retrieved and the procedure was a little uncomfortable.
"I travelled back to Dublin groggy but great. I knew some woman would receive a fertilised egg in some days' time and could become pregnant. She could be having the best Christmas present of her life, and I would have given it to her. I knew I would do it again."
She has since helped an infertile couple she knows, who were on an egg-recipient waiting list at a Manchester hospital, by donating eggs to their programme. Some of the resulting embryos have been frozen so her friends can have as many chances at pregnancy as possible.
She plans to donate eggs again - with luck, to a hospital in the Republic. Her growing awareness of the number of couples needing help to conceive has led her to question why the State does not have an egg-donation scheme. She has set up a website to promote debate and raise awareness.
"I would like to see the service available here through the hospitals, but before that could happen, we need proper protocols and licensing. I accept that egg donation is not for every couple, either as donors or recipients, but we do need information to allow people make their own informed decision."
Ultimately, she would like to see the establishment of a charitable trust similar to Britain's National Gamete Donation Trust - gamete is the collective term for eggs and sperm - to educate and recruit donors. She says money is a crucial issue, and the lack of national public facilities means private clinics have a clear field.
"When a couple is desperate for a baby, they are very vulnerable. You hear of couples remortgaging their house selling their car to fund their clinic costs. I donated my eggs without charge. I do not believe women should be paid for donating their eggs. They should receive expenses for any costs incurred, but we should be very clear where expenses end. I have heard of cases in the US where women are paid as much as $10,000 for their eggs, and I think this is very dubious. If women are paid, they become not egg donors but egg sellers."
About one in six couples suffers from infertility at some time in their lives. In many cases the problem can be cured by advice, drug therapy or surgery. To have a chance of a child, however, some couples need help to conceive; as women are starting families later, there is less time to put any problem right.
Helen Browne, one of the founders of the National Infertility Support and Information Group, estimates that 5,000 couples are undergoing in vitro fertilisation (IVF) treatment in one of the State's six clinics, with a new clinic due to open shortly in Cork (see panel).
She would welcome the wider availability of egg-donor facilities, but she feels we first need guidelines for such services as counselling and follow-up to surround each treatment. "We are the people who have to pick up the pieces if things don't work out," she says.
Charges vary from €2,222 to €3,174 for each treatment cycle. The main factors that determine outcome are the woman's age, the length of time she has been trying to conceive, her success rate and the quality of the sperm. The internationally accepted success rate for IVF is 17 per cent for each cycle. IVF using donor eggs may be offered to older women, to women suffering premature menopause, to those whose eggs will not fertilise and to those whose ovaries have been removed.
Dr David Walsh is a consultant gynaecologist at the Sims Fertility Clinic, in Dublin, which is the only clinic in the State that offers a service for egg donors and recipients. "Egg-donation pregnancy rates are consistently higher, because donors are under 35 years of age, compared with other patients undergoing IVF, who may be in their late 30s," he says.
The clinic introduced the service 18 months ago and has reduced a two-year waiting list to 12-18 months using a method of egg sharing. This means couples coming for treatment can opt to donate their excess eggs without compromising their own treatment. Egg donors are not paid, although couples involved in egg sharing will be offered a discount.
Couples pay €635 to go on the clinic's waiting list; the money is deducted from their bill if they go ahead with the treatment. In the absence of Irish legislation, Sims operates under the guidelines of Britain's Human Fertilisation & Embryology Authority.
The Republic has few legal guidelines on assisted-reproduction procedures. Irish Medical Council guidelines on egg and sperm donation say that "due consideration must be taken of the potential social, medical and legal implications" of donation, but they do not spell them out. Guidelines from the Institute of Obstetrics and Gynaecology advise that treatment should be only for heterosexual couples and those in long-term relationships.
Two years ago, the Minister for Health and Children established the Commission on Assisted Human Reproduction, which has not yet reported on its findings. Dr Deirdre Madden, a law lecturer at University College, Cork, is one of its members. Speaking in a personal capacity, she suggested that any proposed legislation could be guided by Britain's Human Fertilisation & Embryology Authority, which she describes as one of the most comprehensive regulatory bodies for assisted reproduction.
The authority regulates the ethical and legal issues of assisted-conception programmes, from fees, counselling and consent to use, storage and information disclosure. Under British legislation, for example, couples who receive an egg become the legal parents of the child, with the egg donor waiving her parental rights. Also, the authority is legally obliged to disclose, if asked by an adult in the future, whether that person was born as a result of IVF or donorinsemination.
"We need to look at all the issues relevant to donor, parent and child. I would like to see legislation introduced here that would safeguard the future of the child, to make sure the issues which were significant to a child 18 years down the line - particularly that of genetic parentage - would be able to be addressed," says Dr Madden.
Serena Bryans will continue her campaign in the meantime. "As someone who has children, I know how blessed I feel. I didn't believe I was going to hold a child in my arms until I had my son in my arms. I did not realise how much love you can give and receive. I want this same opportunity for other couples. I am a woman with a mission, and I don't give up easily."
Serena Bryan's website is at www.eggdonorireland.com; the National Infertility Support and Information Group is at PO Box 131, Eglinton Street, Cork (1890- 647444)
What are the options?
Among assisted-conception procedures available here are:
Insemination by sperm, including donor sperm.
In vitro fertilisation (IVF) - mixing of eggs and sperm outside the body and implantation of fertilised embryos in the womb.
IVF using donor sperm
IVF using donor eggs. Currently available at only one Dublin clinic.
Intracytoplasmic sperm injection - injecting sperm directly into an egg and transferring it to the womb
Follicle tracking - identifying egg-producing follicles to maximise chances of conception