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Human Fertilisation and Embryology Bill [HL]

I rise in strong support of this amendment, and am sorry that my noble friend Lady Jay is unfortunately unable to be here this afternoon. Forgive me if I appear to repeat some of the points already made so ably by the noble Baroness, Lady Finlay, but I want to describe in some detail what the experience of infertility implies to the Committee, and to put it on the record. People who are infertile initially face a degree of anxiety which causes quite a lot of personal stress. Eventually, when they start to realise that they are seriously infertile, even before treatment, they have a feeling of disbelief. The anxiety rapidly becomes a serious form of sadness in a large number of cases. Depression is common in infertile couples, both in females and males. It is common, if not usual, for a happily married couple to have sexual problems once they realise that they are infertile. It is also quite common for males to be impotent and women to be anorgasmic and not enjoy intercourse. I have heard it repeatedly said by many patients in my own clinic when I was a practising doctor in this field, ““I feel like an empty vessel””. Males also feel that there is no point in having sex—one of the greatest gifts that God has given us—any more. There is naturally a huge incidence of marriage breakdown in infertile couples, and something akin to real physical pain. I do not want the House to underestimate that. The pain of infertility is as corrosive and serious as the pain of an osteoarthritic hip, for which treatment is easily available under the health service. A relationship breaking down is not good for anybody. The depression is sometimes so serious that even suicide has been contemplated and undergone by these people. There is a biblical moment when Jacob is faced by his aggrieved and beautiful wife Rachel, and she says to him: "““Give me children, or else I die””." That cry rings down the ages. It is true in this country and, incidentally, in the third world, where infertile women are often abandoned. When people suggest that there are already too many babies in the world, and that these technologies are therefore not necessary, they only need to look at the suffering of, for example, African women in this situation, or women in Asia where there is a serious population problem. One should not equate the notion of overpopulation with the lack of need to treat these patients effectively and with genuine compassion. It is interesting that Jacob replied to his wife, ““Am I in God’s stead, that I can give you children?””, an angry response that rings true today. Most noble Lords are in this House because of singular, great, personal achievements—they have contributed hugely to society in one way or another and feel very proud of those achievements. I feel quite proud of some of my achievements, but I must tell noble Lords that nothing in my life is remotely as important as the fact that I have produced three healthy children who contribute to our society. For nearly all of us in our society, promoting the next generation is the single most important thing we do. We do it as parents, we can do it as children or in many other ways, but it is something that is denied to these couples. Indeed, it is denied in a very subtle way. Women who are infertile sometimes cannot even bear to go into a room where there are pregnant women or children. They cannot attend a dinner party where the commonest conversation will be how people’s children are getting on at school or how the rest of the family is. Very often, they cannot tell their parents that they are infertile because they are ashamed, embarrassed or in pain about such a private grief. I promise noble Lords that I am not exaggerating. One issue is that the National Institute for Clinical Excellence has in its wisdom, and I believe it was a wise decision, recommended that three treatments should be available to infertile couples under the health service. What has happened in practice has been well described already. Hardly any commissioning authorities will pay for more than one cycle, and many will not pay for any cycle at all. There is a postcode lottery in this form of treatment. Noble Lords should consider what that means. The implantation rate of the human embryo under ideal circumstances is about 18 per cent. That means that the rate for one treatment cycle under ideal circumstances, which is doing rather better than nature, is about 18 per cent. I do not suppose there are many people in this Chamber of child-bearing age but if you were, and you went home and had regular intercourse during your menstrual cycle, your chances of getting a pregnancy would be less than 18 per cent, much less in most cases. There is a cumulative need to repeat the cycles. What happens is that one cycle is given and then the treatment is refused. That is like treating a cancer and then withdrawing the drugs half way through the therapy. It makes no sense. It results in a huge waste of public money where it is undertaken in the health service; it results in these patients being put through the pain and the investigations and the results being ignored, even though they have been paid for. There is another problem, which is the issue I referred to at Second Reading. As was so eloquently said by the noble Baroness, Lady Finlay, these patients are ripe for exploitation. The biggest single problem is that 90 per cent of patients go to a free-standing in vitro fertilisation clinic outside the health service. In the commercial sector, that means that they get in vitro fertilisation whether it is the most suitable treatment or not. There are hundreds of treatments for infertility. Infertility is not a disease; it is a symptom. If I have a pain my chest, I do not immediately ask for a bypass operation. I might have indigestion, high blood pressure, some cardiac impairment or bronchitis or I might have broken a rib, but once the infertile patient goes to a private clinic she gets a treatment that is not based on any solid medical evidence but is the treatment it can offer. That is why it is essential that these treatments are seen inside a comprehensive health service, the kind of health service that we are justifiably proud of in this country. Inevitably many patients who are given vitro fertilisation do not justify the treatment because if they were given much cheaper treatments they would become pregnant; indeed, some may get pregnant without any treatment whatever. Exploitation is a real issue. The combination of desperation and high costs is corrosive not only to the patient but to medical practice. That is why the yardstick of having a really effective health service treatment is extremely important; indeed, in my view, if there had been proper health service provision in the beginning I doubt whether the 1990 Act would have been necessary because the health service could have very adequately regulated most of these clinical treatments, excluding the research. There are other problems. The noble Baroness referred to a number of treatments which are totally non-evidence based that are offered to patients in the private sector. One is immune treatment for people who might undergo an early miscarriage or failure of implantation. People are being given treatment which most immunologists regard as being slightly dangerous, if not very dangerous; for example, gamma globulin treatment by injection or suppression of their immune system in a hopeless attempt to get these people pregnant. Of course some of them get pregnant, but no properly controlled studies have been done to justify that treatment, and certainly not to justify it in the private sector. I have no problem with a private clinic offering treatment on a research basis, but if it is on a research basis then it is not reasonable for the patient to pay for that research. That should be done independently, and it concerns me that the Human Fertilisation and Embryology Authority has not been more rigorous in pursuing that line of thought in its code of conduct. That is not the only treatment; the treatment of chromosome screening, which is widely offered at around £2,000 a time, has no scientific evidence, except in very rare circumstances, that it actually works. Indeed, the Cochrane review, which is the official review of these treatments, says that this should be seen merely as a research procedure. Why should patients pay £2,000 in the unwitting belief that this treatment will help them in some way when there is no evidence that it will? I will not go on with other unproven treatments because I do not want to bore the Committee at great length. I must refer to two other issues. One of the real concerns that has already been raised is the issue of fertility tourism. That is not a good situation. It is very concerning that some clinics in the private sector clearly have arrangements with overseas consultants or clinics where they send patients when the treatment is not allowed under the HFEA. That is something that should be written into the code of conduct. If we have this kind of approach from the commissioner of infertility treatment that would be a start to better regulation in this area. Finally, the noble Baroness, Lady Finlay, raised the issue of multiple embryos and the ideal solution of transferring single embryos. That is a very unlikely possibility unless this treatment becomes available in the health service. Unless that happens, it will not take place. At the moment there are large numbers of multiple births, which clearly have a massive drain on the public services. To keep a premature baby in an incubator on a daily basis costs roughly £1,000 a day, and a triplet pregnancy invariably means that you have three babies in incubators perhaps for a month or more. It does not take much mathematical expertise to work out the cost to the health service. Therefore, it is very important that the public sector is stimulated, and I hope that the Government will consider this amendment, which could be improved—on Report we can add bits to it—in all seriousness.