The globalisation of fertility treatment
A huge variation in the availability and practice of fertility treatment is revealed in a new survey of 105 countries. The UK, which pioneered IVF, has 66 clinics, whereas Germany has 120, Spain 200 and Italy 360. Japan has more than 600 clinics. There has also been a huge increase in the number of clinics in developing countries; India now has around 500 clinics.
The survey shows that many Catholic countries have strict controls on the use of embryos. Costa Rica, in Central America declared IVF unconstitutional in 2000 because it regards the embryo as a person from the moment of conception.
Presenting the results of the survey Professor Ian Cooke, Education Director of the International Federation of Fertility Societies said:
"What is considered acceptable varies from country to country. These great differences in clinical practice don't show up in other fields of medicine, indicating that social or religious attitudes, rather than the best-practice of medicine, often drive what is allowed."
Professor Cooke gave as an example a 2004 ruling in Italy which stated that all fertilised embryos should be put back in the womb. This raised the potential of multiple pregnancies and damaged embryos being put back. This ruling was overturned earlier this year. He also highlighted the difficulties which cause people to travel abroad for fertility treatment:
"In some countries, such as the UK, the removal of donor anonymity has led to problems in finding sperm donors. Gamete donation is generally forbidden in Islamic countries, and Turkey has recently banned anyone from going abroad to receive donated sperm or eggs."
It's estimated that two thirds of all IVF births in the UK are the result of private treatment. That is despite a recommendation six years ago that the NHS should fund three cycles of IVF. Dr Francoise Shenfield a lecturer in infertility at UCL Medical School in London said France had around 70% more cycles per head of population than the UK because it was free. This raises another issue when in comes to IVF: whether society considers infertility on a par with other forms of ill-health. In this era of budget constraint it is hard to see access to fertility treatment becoming more generous across the NHS.
The survey suggests that the Czech Republic and Spain are two of the most popular destinations for British couples seeking treatment abroad. Dr Shenfield said it would be wrong to use the term "fertility tourism" as the couples are not going on holiday but seeking treatment for a medical need. She said those affected were often women over 40 who could not get funding for treatment in the UK and who may have found it cheaper to go to Barcelona or Prague than to a private clinic in Britain.
Professor Johannes Evers from the Netherlands has suggested that women up to the age of 44 should be given free IVF because it is "cost-effective". Presenting his findings at the World Congress of Fertility and sterility in Munich, Professor Evers said he based his calculations on the cost of treatment compared to the economic contribution a person makes to society over their lifetime:
"This work shows that society actually receives substantial benefits from each baby produced via IVF, and simply looking at the costs of IVF without looking at the benefits is false economy."
Professor Evers said each new life contributes around 238,000 euros (£200,000) to the economy once healthcare, education, social welfare and retirement costs were taken into account. He based his calculations on the Netherlands but said similar calculations could be done elsewhere.
Four years ago researchers in Sheffield also suggested that the economic contribution of those born through IVF greatly outweighed the costs of treatment.