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Last Updated: Thursday, 24 July, 2003, 16:04 GMT 17:04 UK
Can we police a test tube future?
A two-day embryo (Science Photo Library)
Few could have predicted, even after the birth of Louise Brown, the scale of the lucrative industry that would follow.

But it is the speed of scientific progress from that date which has been the greatest surprise.

There are now a vast number of treatments - some controversial - already available to patients, with plenty more in the pipeline.

Just 25 years later, many scientists believe that attempts to clone humans are probably already in progress somewhere in the world.

Even mainstream fertility scientists believe that a revolution in genetics will quickly hand parents the ability to prevent many congenital diseases - and perhaps choose a baby's sex, hair or eye colour.

Even if it doesn't happen here, they say, someone, somewhere will be prepared to do it.

In the middle of the debate is a body which, since 1990, has been trying make sure that the ethics of the IVF business keep pace with technical advances.

The Human Fertilisation and Embryology Authority, which regulates clinics, faces accusations that its methods are both too lenient and too strict.

Internal affair

Medical ethics are an "in-house" affair in most specialties, involving the occasional submission to the hospital ethics committee - but fertility treatments have always been a special case.

We inspect once a year, but unless you sit in that laboratory 365 days a year there is a limit to what you can do
Dame Ruth Deech, former chairman, HFEA
Dame Ruth Deech, who chaired the authority for seven years from 1995, told the BBC that, aside from the moral and religious implications of IVF, the fact that the bulk of treatment is offered to private patients means that a strong regulator is needed.

She said: "These patients are very emotional, vulnerable and desperate, and often not very well-informed.

"This creates a situation in which it's possible that exploitation can happen."

Recent publicity surrounding IVF blunders - the use of the wrong sperm to create IVF embryos for a Yorkshire couple - has led to calls for procedures to be tightened further.

It is only the past year that the first prosecution of an individual under the HFEA Act was brought.

How do doctors make a "test tube baby"?

However, Dame Ruth says that there is little more that can be done.

"We inspect once a year, but unless you sit in that laboratory 365 days a year there is a limit to what you can do.

"You can't simply close down clinics either, because all of them will have women who are part-way through a cycle of treatment."

Cloning question

Dr Peter Brinsden, the medical director of the Bourn Hall Clinic in Cambridgeshire, believes it is time for the Human Embryology Act of 1990 to undergo some "tinkering" to bring it up to date.

He says that the HFEA is doing a good job under very trying circumstances.

"Whatever they do, they are going to get the brickbats - it's an impossible task."

But he says that, at the end of the day, the "individual conscience" of the doctor will be the main driving force.

If you hold onto a few crucial principles all these issues can be resolved
Dame Ruth Deech, former HFEA chairman
And this creates a problem when the doctor is confronted with a medical problem that may require an unethical solution.

"We tend to get very involved - become very sympathetic to the situation which this couple find themselves in."

A personal example is the use of cloning to create babies.

This is currently outlawed on both safety and moral grounds, but Dr Brinsden says that he can foresee very rare medical situations in which it might be acceptable.

"I can't rule it out at some point in the future," he says.

'Good law'

So should the laws governing IVF be changed to take account of the fast pace of research?

Dame Ruth thinks not: "It's a good law.

"It's flexible enough to deal with what is going on today, and certainly doesn't need any wholesale tinkering.

"If you hold onto a few crucial principles all these issues can be resolved."

Even though the UK has so far outlawed cloning for reproductive purposes, she can see many challenges ahead, not least because of the arrival of European Human Rights legislation.

This, she says, has given some couples the belief that they have the right to try for a baby - no matter how controversial the techniques they require.

Dr Brinsden believes that the problem could worsen as a higher proportion of couples opt for IVF.

"I can foresee, in 50 years, that assisted conception will have almost become the norm.

"This is because screening techniques will have improved to such an extent that parents can make their children free of even minor defects."

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