The death of Sir Robert Edwards, the pioneer of in-vitro fertilisation, has come as a blow to the world of fertility medicine. He died peacefully after a long illness and tributes have poured in from all across the world, led by the first “test tube baby”, Louise Brown, who said she considered Sir Robert like a grandfather to her .
In light of his death, James Mulhall looks at how fertility treatment in Ireland lacks specific regulation.
Fertility treatment has been regulated in most countries for years now, but regulation in the Republic of Ireland has been an issue of contention for quite a while.
A report on Assisted Human Reproduction (AHR) was conducted in Ireland in 2006. The report was conducted by a committee of medical experts in Ireland and looked at the various aspects of fertility treatment. It found that “it is clear that a comprehensive range of high quality AHR services is currently available in Ireland”.
The committee looked at statistics from the International Federation of Fertility Societies. Countries were looked at under “legislation, guidelines and neither”. It found Ireland merely has “guidelines” governing fertility. The report went on to state that “The Commission recommends that: A regulatory body should be established by an Act of the Oireachtas to regulate AHR services in Ireland”. This never came into fruition.
The Doctor’s Perspective
Declan Keane is a senior clinical embryologist and director of ReproMed. The organisation is an Irish based group that aims to assist couples in fertility treatment. Declan believes that the regulations need to change.
He said: “There’s very little regulation of fertility practices in Ireland – firstly the Irish Medical Council has an ethical code and standards of practice and secondly the Irish Medicines Board is the regulatory authority that implements the statutory instruments created under the EU Tissue and Cells Directive of 2004-2005”.
The European Union Tissue and Cells Directive aimed to establish a set of rules to govern the various aspects that are to be considered in fertility treatment. The import and export of cells and tissue, the handling of such, the processing and storage are just some of the considerations that have to be looked at.
“I think certainly there is an obvious demand and need to offer patients and fertility practitioners guidance and a set of rules for the existing fertility practices and services landscape”, Declan says. “At the moment there is nothing to say whether or not I can carry out a surrogacy pregnancy for somebody – it’s just a total void for us at the moment, we need legislation”.
The success rate is still low, at about 30% in Ireland. However, this is a substantial improvement since Sir Robert Edwards pioneered the treatment in the 1970s. The real issue with fertility treatment in Ireland is the lack of regulation. Current fertility laws in Ireland are governed by the country’s membership of the European Union. The problem here is that these regulations are generic and have been laid out as a guideline for the member states. Ireland is one such state which does not have a set of rules to be followed internally.
Martina Devlin is an Irish author and is one of thousands who tried to conceive a child through the IVF route in Ireland. She calls her two years of trying her “baby hunger” years. Martina struggled with the process but was aware of the lack of regulation. To Martina and her then-partner, and thousands of other potential parents, this did not matter. The heart-wrenching decision is not one taken lightly and, in hindsight, Martina does not feel she was adequately informed.
“I didn’t feel adequately briefed on the psychological impact of the treatment, it was overwhelming” she says. “I didn’t understand that my body would go into a fake menopause and that I was being turbo-charged with hormones. My emotions were see-sawing and if it had been explained to me in advance that this was to do with the drugs I might have coped better”.
Despite Martina’s view at the time that the regulation was secondary to her prospective children, she believes legislation would benefit people in her situation in the future. Aoife O’Brien works for the Department of Health. According to Aoife, the Minister is “considering policy proposals to further regulate Assisted Human Reproduction”. The most recent report remains to be the 2006 report on Assisted Human Reproduction. At the time, then-Tánaiste Mary Harney said: “It is not satisfactory that there is no statutory regulation in the area of assisted reproduction”, yet the government has failed to implement any regulation in the seven years since then.
What regulation is needed?
This poses the question; what regulation is needed? Declan Keane believes Ireland needs a unique framework. While other countries have systems that work for them, Ireland needs one that suits its own needs.
“Looking at some of the Scandinavian countries, Germany and Italy, you see that they are quite conservative for such liberal countries and the UK guidelines under the Human Fertilisation and Embryology Authority can actually be quite restrictive”, he says. “What Ireland needs to do is not mimic or copy systems that have flaws but in fact take the best from each of these systems”.
It is not only for the benefit of parents but also of practitioners like Declan that these changes should be brought in. It is clear that this is a section of the health sector that the Health Minister James O’Reilly, TD, needs to look at sooner rather than later.