Telling the truth about IVF

ARE IVF patients being experimented on? Any couples who spent yesterday getting used to the idea that - as Professor Robert Winston has apparently alleged - they are hapless guinea pigs of the large, hairless variety that will try anything for the sake of a child, might like to pause and consider for a moment some other memorable moments in the professional life of this prodigiously well-known fertility personality.

My own favourite remains the modest announcement with which the great scientist introduced the television audience of The Human Body to a slideful of genetic wrigglers: "These are my sperm.

Amazingly, about 500,000 of them from a single ejaculation."

But who can forget his later remark, in an interview, to the effect that Mrs Blair would be having a caesarean? Then his subsequent denial, followed by the replaying of the tape in which he had, as it turned out, said precisely that? Having thrown in, for good measure, his view - as a New Labour peer - that our national health system is worse than Poland's. Another view subsequently amended.

Still, bravo Lord Winston!

Britain would be a duller - and certainly less populous - place without him.

And this time he is right.

Most patients know by now that if they want to try for a baby by IVF they must become gamblers, staking thousands on a one in five chance of success.

Fewer, I think, are aware of their other role, now highlighted by Winston, as laboratory animals.

THE conventional, Louise Brown IVF method has, in the past 25 years, produced enough healthy children to be considered, provisionally, pretty low-risk. But the longterm consequences of more recent variations of IVF, including the practice of replacing frozen embryos, are not known.

As Lord Winston has suggested, this has not stopped such procedures being tested upon thousands of grateful, paying patients.

A few years ago, interviewing IVF grandees for a BBC documentary, I was struck by the readiness with which they conceded this point. The director of the Centre for Assisted Reproduction clinics, Dr Simon Fishel, for instance, was entirely open about the unknowns involved in ICSI (Intra Cytoplasmic Sperm Injection), the method whereby, in defiance of natural selection, a sperm which could never otherwise have fertilised an egg is given a helping hand.

"If you want to put it in biblical terms," Dr Fishel said, "ICSI may beget ICSI in the following generation." Was it ethical to take such risks? It was fine, he thought, so long as you warned the patients.

Which I am sure he did.

Since, in less scrupulous clinics, many people are not even informed about the numerous risks of mundane forms of IVF treatment - that of ectopic pregnancy, for instance, or of ovarian hyperstimulation, or the likelihood of multiple birth - one cannot feel very confident that the majority of ICSI patients realise they are volunteering any future child for a fertility experiment.

It's true though, that even if they did, many would probably decide to take the risk anyway. Before she died of ovarian cancer, Liz Tilberis, then the editor of Harper's Bazaar, told me that even though she believed in a potential link between her nine IVF cycles and the emergence of this dreadful disease, she thought patients in her position would probably go ahead with treatment anyway.

She just thought they should be alerted to the hypothetical connection. Lord Winston, I remember, disagreed.

Forcefully.

"I think it would be very unwise," he said, "for doctors or the media to raise that spectre unnecessarily because you make patients, or we make patients ... more sensitive or anxious than they need to be."

In practice, as the IVF industry has discovered to its immense pleasure and profit, you don't need to worry about the sensitivities and anxieties of IVF patients. If anything, as their sensitivities and anxieties are worth millions, you probably ought to cultivate them. It is precisely because IVF patients are so particularly sensitive and anxious that private clinics have been able to argue that conventional controlled tests are in their special instance not merely irrelevant, but a cruel postponement; a bureaucratic denial of baby joy to the desperate.

Just about any criticism of private IVF medicine, from its fearful cost to its bizarre indulgence of practices such as egg "giving" and foetal reduction, can be dismissed by a clinician's reproachful allusion to the bliss of the existing IVF multitudes.

Would you rather, the doubter is effectively asked, that these sweet babies had never been born?

Had IVF been mainly publicly funded or properly policed, such emotive rebuttals of the scientific conventions could not have been sustained.

At some point, there would have been a demand for objective evidence. But the discoveries of IVF pioneers Patrick Steptoe and Robert Edwards have resulted, for now, in an overwhelmingly private, scarily under-supervised, furiously competitive market whose regulatory body, the industry-funded Human Fertilisation Embryology Authority, spends most of its time organising crude "live birth rate" tables, using evidence supplied by the clinics, whose effect is only to make the baby business yet more furiously competitive and unquestioning.

Small wonder that its participants appear to be about as eager to conduct randomised controlled trials on the use of their product as the average chocolate factory. Why bother?

IN support of their recent, controversial decision to recommend state funding of IVF, the Government's medicine-evaluaters at the National Institute for Clinical Excellence summarised the state of IVF research.

Basically, there's hardly any.

There hasn't even been a study to establish whether, in cases of unexplained infertility, IVF treatment is any better than no treatment. That, as our dashing elite of IVF specialists know, is because it hasn't been in the industry's interest to find out.

But if they are to get their hands on public funds, they must do more to protect their patients, as well as provide them with babies. Hard as it is to believe, Lord Winston's latest ejaculation may turn out to be yet more significant than that unforgettable effort for the Human Body.

. Catherine Bennett is a columnist for The Guardian

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