IVF is big business in the UK but are profits being put before the health and safety of children and their parents? The Money Programme investigates.
In Vitro Fertilisation (IVF) is big business in the UK and it's currently under scrutiny after controversial cases where embryos were implanted into the wrong woman.
But even leaving aside headline cases such as these, critics argue that clinics' efforts to increase success rates are coming at the expense of both families - who face a higher chance of being left with children who have disabilities - and the taxpayer, who has to pick up the bill when more twins and triplets are born with medical problems that require intensive care treatment.
Twenty four years after the birth of Louise Brown, the world's first test-tube baby, the fertility industry has become a multi-million pound business - but where are the safeguards?
Suzi Leather is head of the UK Human Fertilisation and Embryology Authority, which regulates the industry. She insists that any clinics which break the regulations and implant more embryos into women than the rules allow will be dealt with severely:
"If we find clinics who are deliberately and flagrantly breaking the rules we will not hesitate to close them down."
Some action has already been taken to clamp down on the practice some clinics have pursued of implanting large numbers of embryos into women's wombs to maximise the chances of success. With some IVF treatments costing many thousands of pounds, there's a clear financial incentive to do this.
But multiple births involve greater risks - for the babies and also the mother. Leather says that the inherent problems of multiple births did lead to a change in the HFEA's guidelines in 2001:
"The reason why the UK and indeed many other countries are trying to bring down the number of embryos transferred into a woman in infertility treatment is to try and avoid the problem of multiple pregnancies, multiple births. There is very well documented evidence that if a woman has twins or triplets, there is a much higher risk not only to her babies but also to her own health."
One mother, who doesn't want to be identified, ended up with triplets after treatment ten years ago. But one of the children has cerebral palsy and has since told his mother he would rather not have been born. She adds: "Well, he's told me that he wished that he'd never been born, he hates being disabled. I think it's more difficult being a triplet, a disabled triplet, because he's constantly seeing his brother and his sister who are able bodied and can do things. I mean, it's in his face all the time."
Clinics' responsibility for mothers and their unborn children ends with successful implantation. In most cases, problems with births become the responsibility of the NHS and that's what happened in this mother's case - after six week's expensive treatment, all paid for by the taxpayer, she was allowed home - but now she has to live with the consequences of bringing up a disabled child.
The HFEA has introduced guidelines that say doctors should not implant more than two embryos, three in exceptional circumstances, into women. But not all doctors agree with the guidelines - and the HFEA says it is they, the doctors, who must decide what 'exceptional circumstances' are.
Dr Mohammed Taranissi from the Assisted Reproduction and Gynaecology Unit in London disagrees with the guidelines. Figures for 2000-2001, the most recent year for which statistics are available, show that he replaced three embryos in 92% of cases where the patient had more than three embryos available. Dr Taranissi says:
"Seventy per cent of patients that we see here, if not probably more by now, are people who have repeatedly failed elsewhere. Do you want to tell me that I'm seeing somebody on the sixth or seventh attempt having had three embryos put back every time and then coming to me and all of a sudden I'm just going to say we're going to put two embryos [back] because the HFEA think that this is the right thing for you?"
Last year Dr Taranissi took the HFEA to court to fight for the right to implant five embryos in a 46 year old woman, but he lost. He argues that even within the guidelines he's still right to put back three as often as he thinks fit because the HFEA doesn't define exceptional circumstances:
"If you're asking the question 'what are exceptional circumstances in their opinion', they're not going to give you any guidelines. That's what it is. I mean [it's] OK if they can give us some guidelines and tell us exactly what exceptional circumstances mean [but] if they want to leave this up to me then it's up to me to make a decision."
And there's another concern - league tables. Sam Abdalla, from the Assisted Conception Unit at the Lister Hospital, fears that commercial pressure to be high on the league tables could be affecting clinical judgment in some fertility units:
"The league table, in my view, is one of the major reasons why a higher number of embryos are transferred."
The HFEA says it is introducing tougher inspections and will be looking closely at those with high numbers of multiple births.
Suzi Leather says the regulator can close clinics down. But she rejects suggestions that IVF clinics should be liable for some of the costs of caring for babies born through multiple births. Leather adds:
"I've been quite clear that I do not favour taxing clinics that are putting back higher numbers of embryos. I think what we have to do is agree between all the professional groups and patient groups what is the best way to reduce the risks associated with IVF. Ultimately we may want to follow the example of other countries in coming down to single embryo transfer, because that would mean that artificial reproductive technology was really mirroring what happens mostly naturally."
This programme was first transmitted on
Wednesday 27 November 2002.