Friday 25 July, 2003 was a very special birthday for a young lady whose birth had changed the world. In 1978 Louise Brown, the world's first "test-tube" baby was born in England, and the prospects for the approximately 15 per cent of couples that face significant fertility problems had been transformed overnight. Over one million "test-tube" babies have been born world wide as a result of techniques pioneered in the UK, and IVF (in vitro fertilisation) and ICSI (intra cytoplasmic sperm injection) have come to be regarded as acceptable and successful solutions to the problem of intractable infertility.
A conference held at the Royal College of Obstetricians and Gynaecologists in London on Louise's 25th birthday brought together the pioneers of IVF who described the difficulties, disappointments and ultimate success of the early days of IVF. Listening to Professor Robert Edwards describing the resistance that he and his fellow pioneer, the gynaecologist Patrick Steptoe, had encountered when they first tried to permit women with irreparably damaged Fallopian tubes to experience the joy of motherhood was a deeply humbling experience for my generation of IVF doctors who grew up believing that IVF was an ethically sound and scientifically successful solution to the real medical problem of childlessness. The conference included lectures from IVF specialists from the USA, Australia and Belgium who had followed in Steptoe and Edwards' footsteps and helped to establish IVF and ICSI on the world stage. IVF may have been invented in the UK, but provision of specialised fertility treatment in the UK lags far behind all other European countries; leaving couples who need help to conceive at the mercy of the "post-code lottery", and facing long waiting lists or no prospect of NHS funded treatment at all. At a time when extending life-spans due to improved medical care mean that an increasing number of pensioners are needing to be supported by the tax revenues of a declining number of young workers, basic economic theory tells us that we must reverse the current trend. The current anxiety about a future "pensions crisis" is partly explained by the fact that the economically active population is not reproducing at "replacement level".
Modern fertility treatment is very successful"a far cry from the early days when fertility clinics were unkindly described as "futility" clinics. Success rates with IVF and ICSI (approximately 20 per cent live birth rate per cycle started and 30 per cent per embryo transfer, for women aged under 40) have improved significantly over the last decade, and treatment protocols and procedures have become simpler, more cost effective and more "patient friendly". These include the introduction of new techniques such as ICSI and the development of purer hormonal preparations. There can be few medical procedures that have the same potential for transforming lives and creating happy families as effective fertility treatment. It is not for nothing that the right to family life is enshrined in the European Convention on Human Rights. Assisted reproductive techniques (ART) in the UK have been referred to NICE (National Institute of Clinical Excellence) and the clinical guideline on the assessment and treatment of people with fertility problems is due to be launched this autumn. The All Party Group for Infertility is working to raise awareness of infertility and the need to provide access, now more than ever, to NHS funded fertility treatment, which is safe, effective and of the high quality that patients deserve.
Human beings, as a species, are not very fertile and even young couples, with normal fertility, have only a 25- 30 per cent chance of establishing a pregnancy each month they try. After a woman reaches her mid-thirties, this monthly chance drops to 10-15 per cent and by her early forties it is less than five per cent a month and she is facing a 40 per cent chance of miscarriage. Delay in referral for diagnosis and treatment therefore reduces the chance of a successful outcome, and adds to the stress and distress of the couples. Recent research has highlighted the intense pain and depression associated with the inability to conceive, and the medical profession and society at large must recognise that infertility is not a "life-style" issue but a serious, genuine and solvable medical problem.
Current demographic trends to-wards delayed child-bearing due to career or financial pressures, together with a high rate of divorce which results in many women seeking to conceive in a new partnership and at an older age, combine to produce an apparent "epidemic" of infertility in women aged 35+ years. In the United Kingdom 12 per cent of live births are to women aged 35 years or older and first live births to women 35 or older account for seven per cent of all births. Good nutrition, healthy lifestyles and modern medical care mean that many women in their late thirties and early forties look and feel much younger than they actually are, but their chances of successful spontaneous pregnancy are unfortunately quite low at a time when they are ready and able to be excellent parents. As school curricula expand to include topics that are considered of real relevance to current students, perhaps we could speculate that knowledge of human reproductive biology and an awareness of the dangers of deferring motherhood should be up there with how to fill in a tax return or surf the internet as essential information for young women today!
For many years, patient support groups and campaigning organisations have highlighted the inequity of access to fertility treatment in the UK. The launch of the APG and the referral to NICE have brought the needs and hopes of the one in seven couples who must have help to conceive into the public arena at last.
Dr Gillian Lockwood is theMedical Director of MidlandFertility Services and Memberof the Specialist Advisory Groupto the newly-launched All Party Group on Infertility
