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.
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Here's an idea that perhaps one day (soon) will come to fruition.
There are already too many children in the world who will grow up and produce more children. The earth's population is approaching non-sustainability.
When will people overcome that barrier that an aopted child is not their blood; it's not the same.
I believe every adult who wants a child and cannot seem to conceive one has a first obligation to the children already born - the children that are hungry, deprived, uneducated, without a future. Think what these neglected (often unloved) children could benefit from the money it costs to artifically produce a child (making fertile does not come cheap).
As for the child not being of your blood, you take a chance with any child - whether your blood or not. S/he can become a valued productive citizen, or a pauper, a thief or worse.
Lastly may I just add that whereas the biological clock runs on conception, it need not run on adoption.
To me, it seems a terrible waste of resources to create a child when so many children are wanting.
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The 'economic argument' for IVF is completely ludicrous, since babies created in vitro are obviously not more economically useful than those conceived in vivo. If we really wanted to increase our population for economic reasons, a much simpler solution would surely be to offer fertile couples money to have extra children. Assuming that three cycles of IVF costs about £15,000, we could award, say, £10,000 per extra child, thereby achieving the same economic gain at only two-thirds the cost!
While I am not necessarily opposed to IVF, this cannot be a reasonable justification for spending taxpayers' money on it.
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#2. James wrote:
"If we really wanted to increase our population for economic reasons..."
OVER-POPULATION - neither you, nor the Pope, seem to be aware that the planet's resources are already under strain - there are already sufficient people. If we want more here, for what ever reason, we are in the most fortunate position that there are plenty of willing immigrants so why go through the expensive and bothersome breeding and educating business when you can just allow a few more in who are already adults and educated? Economically it is far more expedient and cheaper to let in more immigrants than to breed your own citizens - the immigrant has the added advantage that when they are no longer required you can, if you are of a right wing xenophobic political persuasion chuck them out!.
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The 'economic argument' for IVF is absolutely ludicrous, back babies created in vitro are acutely not added economically advantageous than those conceived in vivo. If we absolutely capital to access our citizenry for bread-and-butter reasons, a abundant simpler band-aid would absolutely be to action abundant couples money to accept added children. Assuming that three cycles of IVF costs about £15,000, we could award, say, £10,000 per added child, thereby accomplishing the aforementioned bread-and-butter accretion at alone two-thirds the cost!
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Fertility or the lack thereof is more a social 'problem' than a medical one, hence the inclusion of social attitudes in the provision of services related to it is unsurprising.
In times when the economic situation means that governments are unable to meet their obligations in respect of life-saving health care it is also unsurprising that serious questions are being raised about the provision of IVF funded by taxpayers' money.
And indeed - as an adopted child myself - there is always the option to adopt if, as my parents found, the natural processes fail to work. (As it happens, my daughter was conceived in the conventional manner, but after 12 years of happily-married life - I was unconcerned, it either happened or it did not.)
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Babies are not a commodity.
Babies grow up to be sentient beings (people).
These people go through various stages of dependancy over a long period of time and are a massive drain on emotional and financial resources for years and years.
Unlike pets, humans cannot be dumped at the RSPCA when the novelty wears off.
Is there a risk that IVF treatment could encourage the idea of commodity and 'rights' above the needs of the potential human involved?
I am sure that most people involved in receiving or administering IVF are doing it for all the right reasons and I would not want to offend them. It is the others that I worry about.
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Fergus,
Quite correct, with one exception: Fertility and morality go hand in hand.
And I suspect it is this which is contentious, rather than the economics of IVF treatment itself.
Despite what may appear in our soaps et al, one perhaps should not go forth and decide to have a baby as if it were a commodity, or a lifestyle choice.
So if the real issue in our nation is not the economics of IVF (which of course should be an option which couples have access to), but social / traditional attitudes behind having children, then have we not missed a bigger point in the whole debate?
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Hm. The opening paragraph of that article was a bit misleading, wasn't it?
Sure, we know that religious types can have some very strange views on assisted conception, but how much do we know about whether variations from country to country are due to religion and how much are they due (as you acknowledge is also relevant further down your article) to different attitudes to the extent to which infertility is an illness that deserves public funding?
The latter is an important question. Some would say that infertility is a disease just as worthy of public funding as any other, others would say it isn't. It wouldn't surprise me if different societies come to different conclusions on that one. Is there any data that allows us to judge the relative contributions of religion and more prosaic economic attitudes to the variation between countries?
As for the economic argument that a life contributes to the economy, I have some difficulty in believing those figures. Surely the appropriate measure of the economic wellbeing of a society is GDP (or whatever other economic measure you want to use) per head of population. If we assume that the life created contributes, we would presumably have to assume that it contributes by an average amount, and so the effect on GDP (or whatever) per head would be unchanged. In that sense, the costs of IVF would simply be costs, and any benefit would have to be judged purely on the basis that the people undergoing IVF have a desire to have a child.
However, if you also consider that the planet is seriously overpopulated and factor in the environmental costs of each extra human life, then I suspect that the economics of IVF (or indeed natural conception) would come out very strongly against creating new lives.
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I don't believe that having children is a right, nor do I believe that IVF and NHS resources should be wasted for lifestyle reasons etc. But it is very easy for people to judge those who resort to IVF to start a family, especially as most of these people have children of their own, conceived naturally. It's easy to say that IVF shouldn't be available/ people should adopt when you have what you want. I have benefitted from IVF as I am currently pregnant with my first child following a successful cycle. I was lucky enough to receive the treatment for free, but if I want to have subsequent children we will have to pay for these cycles. If IVF was not successful for me I would have considered adoption, but I felt, as the opportunity was available to me and my husband, that I would like to try and have our own child. I don't think that there is anything wrong with that. I have felt so positive because the IVF has been successful that I would consider egg donation in the future as I would like to help other women who are perhaps not as fortunate as I have been.
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"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."
Hi, Fergus,
an interesting statistic.
"For the Netherlands, with a Gross National Product of €24,320 per year and an average life expectancy of 76 years, the contribution of every individual to the GNP is €1,848,320. The costs to society through childcare and education (€640,000), social welfare and healthcare (€550,000), and retirement benefits (€420,000) total €1,610,000.
In other words, taking the benefit to GNP from the costs to GNP, each baby contributes €238,000 towards the society’s GNP." (I Torjesen, Onmedica, 14 Sept 2010)
It would be even more interesting if a lifespan cost / benefit curve comparison could be created so we could see where the lines crossed or whatever. Once an agreed point of optimum economic value is reached then the society in question would have the appropriate criterion for triggering the standard voluntary euthanasia letter.
Geoff.
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It always amuses me, as an infertile man who has seen his wife go through three rounds of IVF without success, when people who have had children moralise to the infertile about over-population.
My question to them is why they did not adopt instead of selfishly having their own children, if this is so important to them. I have yet to hear a response to this, other than an apology, that is not crass hypocrisy of the worst kind. You might as well moralise to someone with a mobility scooter about the effects of global warming.
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I cannot believe that poeple in this country are still so single minded in this day and age!! I cannot concieve naturally through no fault of my or my partners own, we dont have any children between us and have gone through evasive, emotional times to try and get pregnant through IVF 2 (once free, the over cost over £3000.00) with no success even though we are both early thirties and have no other medical problems. We have tried the aoption route everyone keeps going on about but due to a minor incident my partner had over 10 years ago which involved being arrested (he was 19 years old!!) we have been refused. Why should we be denied the chance to have a family when we both work, have a nice house, loving family and friends, yet people that can concieve naturally are not judged even when they cant afford their chilren and in the worst cases abuse and/or murder them. I dont think people realise the effect it has on you when you cant concieve naturally unless they are close to someone who can't, I think people should put themselves into others shoes before judging on other peoples future.
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Bluesberry
As you have pointed out the world is already overpopulated why don't we just ban everyone from having children until all the unadopted children have been adopted?
This would fit in with your beliefs that our first obligation is to the children already born. I'm assuming of course you practise what you preach and either have no children or your children are adopted.
I also assume that those of you who have so casually joined in the argument against IVF on whatever grounds also have adopted your children or have none.
If you do have children I'm sure that you would be happy to turn down costly medical treatment for them on the same grounds - the world is over populated so one less child is a good thing and you will have the space to adopt one to replace the one you lost.
Does this sound ludicrous to you all?
Re-read your own posts and you will see who is being ludicrous.
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Those of you condemning IVF - and probably ART in general - have never dealt with infertility, have you? Until you have or intimately know someone who has, you have no room to talk. It's painful, emotionally and financially taxing, and lonely.
Just adopt? How simple a solution. The only problem is that adoption is not for everyone, for whatever reason. And it's not so simple. Have you ever tried to adopt. Do you have any idea how invasive the adoption process is as it delves into every aspect of your life - past, present, future, health, home, work, and so on? Couples open themselves up to strangers to judge their fitness as parents. Could you do that?
I know of several couples who would be excellent parents who have pursued adoption and who have been denied. Do you understand that pain? They can't have their own children, the can't adopt, people denounce them for trying ART or tell them to just accept it as God's will, say that it was just meant to be, or utter some other trite, thoughtless remark.
Don't you dare moralize until you've been in the infertile couple's shoes.
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IVF is not the easy option, i would have adopted but because of the breaucrats and the over complicated system we were not allowed to adopt.
this planet may be over populated but dont make infertile people pay for this.
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The point many of those arguing against NHS-funded IVF seem to be missing is that there is empirical evidence in support of the fact children born of this procedure are much likely to be wanted, cherished, loved and doted upon by parents who will overwhelmingly have their best interests at heart, and as a result of never being taken for granted like so many kids in welfare Britain are probably more likely to become productive contributors to society who will help offset the burden placed upon it by the offspring of those who fall pregnant seemingly at will.
That said I think adoption could offer much more of a solution than at present were it not for the over-involvement of social services and their refusal to accept that not everyone shares their / the government's values and approach to the nuances of parenting. There is a cruel irony to the apparent ease with which many of the contributors to the adoption backlog can become pregnant, and the intrusive and increasingly arbitrary hurdles regarding everything from body size to choice of daily newspaper which those wishing to give these frequently damaged and challenging children a shot at a stable family life outside institutional care must now clear.
As regards IVF, the UK medical establishment have no right judging the prejudices and dogma which restrict access in other countries when they would rather fund dangerous weight-loss surgery with all its ongoing costs and dangers (including gestational complications as or more serious than any of those associated with being fat) than allow larger people, many of whom suffer from PCOS which along with creating fertility difficulties makes individuals resistant to weight-loss attempts, the same access to no-questions-asked family life as everyone else. If we are going to maintain this rather frightening ambivalence toward the medical profession's desire for a society based on eugenics and human perfection I would suggest there are those far less deserving of the gift of children than 'the obese'.
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#12, cursuswalker:
Perhaps you could say who you think is moralising about overpopulation while having children of their own?
While there are some posts above pointing out the dangers of overpopulation, I don't see any from anyone who has also stated they have children of their own. Were you making assumptions before accusing people of hypocrisy?
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As if infertility were the only part of medical practice that is affected by social and religious attitudes!
Need a kidney transplant, but your perfectly matched sibling won't donate? You are absolutely not allowed to take that life-saving kidney by force -- because of "social and religious attitudes" about self-determination.
Does your spouse or sexual partner have a sexually transmissible infection? In most of the world, you have zero right to be told that you're risking your health, fertility, or even life over the partner's objections -- because of "social and religious attitudes" about privacy.
Want to have a physician kill you? In most of the world, if you want to commit suicide, you have to do it yourself -- because of "social and religious attitudes" about killing people.
Desperately want to talk your aging and anxious mum into a life-saving surgery? The surgeon must disclose the real risks involved, even if that may scare her off -- because of "social and religious attitudes" about the patient's right to know and right to choose.
Want to know why your child can't get an aspirin from a nurse without your consent, but the same child can get birth control pills, condoms, and abortions without you ever finding out? That's another "social and religious attitude" issue.
It is idiotic to pretend that infertility is the medical condition that is affected by our values.
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"In some countries, such as the UK, the removal of donor anonymity has led to problems in finding sperm donors."
According to HFEA figures, the numbers of sperm donors have gone *up* four years in a row since the ending of anonymity, thus reversing a three year decline. The 384 donors in 2008 was the highest figure since 1996, and 160 more than in 2004 just before anonymity ended.
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I think there has been a few very important arguments raised here. AN economic argument, which for me doesn't come out strongly for either side. Another is the argument that adopting is a superior option. I think that it may be, however not in the eyes of most infertile couples. In my view we should be raising the profile of adoption to encourage people to choose it rather than restricting their choices in regards to assisted conception.
Overcrowding is another, and one that is compelling. Currently in our society the vast majority choose to have offspring (observation no evidence) however some do not out of choice and are perfectly content. I just feel that is is such a shame that more subfertile couples do not feel this way, with my motivation for saying this being the wish for them to not suffer, what ever their decision.
I do fear that this is rooted in our rather sexist society and that it stems from some back dated idea that women are only valued for their fertility. And thus affects the couples decisions if they unfortunately end up in the position.
The population prediction for the UK are a little scary and wether the increase is due to immigration or reproduction I'm ignorant I'm afraid however I do think less would be better for obvious reasons.
I would like to say to HWS sorry if she feels victimised and that she's had such a rough time of it, good luck!
Ultimately I feel that a shift in societies attitudes to infertility would help, an onus on acceptance might be better. Lets not forget that IVF is not 100% for some is painfully low and overall to the subfertile population does this hope, wether false or true do more psychological harm (in the failures) than the joy of the success. Ultimately I think that the balance of those two should decide wether we choose IVF as a society or not.
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Oh dear I missed one thing. Someone decided to bring up PCOS, possibly better termed polyfollicular ovarian syndrome. Not sure I would be advocating IVF and using PCOS as an example. There is an increased risk of hyper stimulation syndrome (HSS) when performing IVF in those women due to the pathology of the disease giving them a predisposition to developing more than one follicle... and so often different techniques are used using clomifene instead. The result of which usually means less eggs (develop from follicles) are ovulated and hence less chance of success due to risks of poor quality etc. per cycle than normal.
So here we have an argument for IVF based on the fact that some women have PCOS, and that it is not their fault because its a medical reason.
A) most women or couples fall into the unexplained subfertility category and I wouldn't like to suggest that because they don't have a well defined medical reason that they are to blame for it.
B) using examples like PCOS that either have higher risk of complications, eg. HSS and lower chance of success, seems somewhat less than wise.
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Overpopulation in Europe? Where?? Have the statistics changed that much recently? Last time I checked, most European countries were barely at replacement level birth rates.Some countries were well below that.
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