In Vitro Fertilisation: 40th Anniversary

Baroness Jolly Excerpts

Thursday 13th September 2018 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I know it is customary when we begin to wind up to say, “This has been an excellent debate”, but this debate really has been. It has been excellent simply because we have all the expertise here among us—I certainly do not include myself in that at all. The tone was set by the contribution of the noble Baroness, Lady Deech, raising the outstanding issues of genetics regulation and new science. All this of course comes from her role as chair of the HFEA. She raised many more issues and it might be worth trying to tease some of them out, and perhaps have more detailed debates. We have all been painting with quite a broad brush today and some of the issues need a slightly more detailed camel-hair brush.

The noble and learned Lord, Lord Mackay of Clashfern, was there to ensure that the law was fit for purpose, and 300,000 children are really grateful that that happened. He spoke about the ground-breaking legislation but also the importance of his neutrality; I thought that was a really interesting history lesson. My noble friend Lady Barker spoke of surrogacy and reminded us all that families just do not look the same any more. The noble Baroness, Lady Boycott, painted—as a feminist—a lovely technicolour picture of offshore bank accounts, conception and contraception. I can remember being newly married as a young woman when all this was happening. It was quite amazing compared with what our mothers had had to go through; it seemed we could have choice every which way we looked.

I remember as well the sense of excitement and wonder at the arrival of Louise Brown, the world’s first test-tube baby. There were photographs of a beaming Steptoe and Edwards on the front pages, and clunky graphics by way of explanation. My noble friend Lady Barker and the noble Baroness, Lady Boycott, both mentioned Jean Purdy and I am going to talk about her too. The helpful Library briefing tells us that she was part of it at the first. A nurse by profession, Jean Purdy was the one who actually made what Steptoe and Edwards needed and wanted to do: she actually made it happen. She was not an add-on but absolutely part of the team, and seen by both of them as part of it. She was the one who saw the fertilised egg which was to become Louise Brown dividing to make cells. I cannot imagine how exciting that must have seemed at that time.

However, I do not recollect seeing Jean Purdy in any press coverage at the time. It appears, again, that she was wiped out of history by Oldham when a plaque was put up in 1982, and again by Bourn Hall—the centre which she, Steptoe and Edwards founded to deal with the huge call for IVF after Louise. To give credit where it was due, Edwards tried to remedy this and wrote letters to all the people concerned but he was not listened to. I sometimes get the feeling that some things never change.

There is absolutely no doubt that on the ethics of this birth, opinion was not restrained. Many, including religious leaders, wondered out loud whether we should be playing God. In response, the Government very sensibly appointed the eminently qualified academic Mary Warnock, later to become a Member of this House, to head up the Committee of Inquiry into Human Fertilisation and Embryology. Her report gave rise to the 1990 Act and its successors, which today still govern human fertility treatment and experimentation using human embryos. Its effect has been to require licensing for procedures such as in vitro fertilisation and to ban research using human embryos more than 14 days old. It has been really interesting to listen to the noble and learned Lord, Lord Mackay, explain where the 14 days came from, the need to balance faith and credibility and all the issues that were going on at the time.

Dame Suzi Leather—a name that I had forgotten about for a long time—former chair of the HFEA, noted that,

“perhaps the greatest achievement of the Warnock committee is that it managed to get an ethical consensus that people understood as well as shared”.

That is quite interesting. The report is worth a read—it is not hugely long—and if you look at who was sitting on her committee, you can see exactly what she meant. They included the usual: academics, medics and scientists, lawyers, the vice-president of the UK Immigrants Advisory Service, social workers, a theologian, the chair of a health authority, an expert in adoption and fostering and a former student counsellor of Cambridge University students. Evidence-givers were just as diverse. Again, they were the usual sort of suspects: churches and faith bodies, scientists, lawyers, health bodies, health practitioners, organisations dealing with fertility, gay rights organisations and, the one that really made me chuckle, Garter—the College of Arms gave evidence. I thought that was really interesting. Those of us who have been to talk to Garter will probably have a quiet smile at that thought.

Baroness Warnock said in her report, and in the letter that she wrote to the noble Lord, Lord Fowler, now the Lord Speaker:

“Despite the way in which members have worked together, there remain nonetheless certain differences between us; indeed, it would have been surprising if, on such sensitive issues, we had been united. These differences, presented in three formal expressions of dissent have, significantly, focused on the very subjects, surrogacy and research on human embryos, which, to judge from the evidence, arouse the greatest public anxiety. Thus even in our disagreement we have reflected the range of views within society. It is not possible that a report like this should be equally well received in all quarters, given some of the controversial issues we have had to consider. There is bound to be criticism that we have gone too far, or not far enough. However, we have sought to provide on the one hand a reasoned discussion of the issues which we hope will contribute to a high standard of public debate on matters which are of deep concern to the public, and on the other a coherent set of proposals for how public policy, rather than the individual conscience, should respond to a range of developments which many people will not wish to participate in, but which others find entirely acceptable. We have tried in short, to give due consideration both to public and to private morality”.


She writes well.

In 1985 the immediate response was to set up a licensing authority as an interim measure prior to the legislation, which was the Human Fertilisation and Embryology Act 1990. This happened when many of us were young and could readily identify with the importance and significance of these measures. Some 33 years later we have gene editing in research; mitochondrial donation; same-sex and unmarried couples treated just as married couples—as legal parents; the outlawing of sex selection; the removal of anonymity; and still more research continuing in hospitals, research establishments and universities. British scientists are nearly always at the cutting edge of this research. Here I agree with the points that were made by my noble friend Lady Barker and the noble Baroness, Lady Deech, about the critical importance of a strong regulatory framework and parliamentary scrutiny. However, the moral issues have not gone away. We dispute the difference between storing sperm for 55 years yet eggs for only 10. Is this an issue of equality or science? Then, there is the question of overdue legislation. Could the Minister tell us when and where this might be considered, and by whom?

Previous research has mainly focused on the economic issues that can affect assisted reproductive technology usage, such as a country’s wealth and health insurance costs. However, in 2017 scientists from the Oxford University department of sociology and Nuffield College assessed for the first time the relative importance of the role that economic, demographic and cultural normative factors play in the process. The study compares the prevalence of ART usage across 35 European countries since 2010—the number of ART cycles per million women of reproductive age, defined as 15 to 44 years. The findings reveal that although economic factors and national wealth are important, it is not merely affordability that determines ART use. ART treatments were more widely used in countries where it was considered culturally and morally acceptable to do so. For example, the Czech Republic, which ranks 51st in a poll of the world’s wealthiest countries, reported nearly 10,500 cycles per million women, a usage level almost identical to the comparatively wealthier Denmark. By contrast, high-income nations such as Italy and the UK reported only around 5,000 cycles per million, half the rate of the Czech Republic. I am not sure what that tells us, but it is interesting that it is not just about the ability to pay.

We cannot have this debate without discussing the availability of IVF on the NHS, an issue already raised by the noble Baroness, Lady Boycott, and the noble and right reverend Lord, Lord Harries of Pentregarth. The 211 CCGs in England should be offering three cycles to women who meet the criteria based on evidence. In 2013, 24% of CCGs met that recommendation; now, it is nearer 12%—halving in five years. That is one in eight CCGs. I know that choices are difficult for a commissioner, but the consequences can be heartbreaking for a couple wanting a family. CCGs in Bury, Heywood, Middleton and Rochdale, Oldham and Tameside and Glossop all offer three cycles, as per guidance. I like to think that Oldham is aware of its history in making that decision. CCGs in Cambridge, Croydon and Basildon do not offer IVF at all.

Are the local health and well-being boards involved? Could the Minister clarify what public engagement and consultation goes on when making those difficult commissioning decisions? What support or counselling is given to couples, many of whom may be grief stricken or distraught? Is IVF only possible for affluent couples? Is a baby something that all families should consider as a right and therefore available on the NHS? These are questions that, hitherto, we have been sufficiently wealthy as a nation not to need to answer, but we do now.

Perhaps, then, the 40th anniversary of Louise Brown, the first test-tube baby, should be an opportunity to consider these questions again.