Jane McCredie: Let's talk about IVF baby

AUTHORS of scientific breakthroughs are often referred to as “the father of” whatever new field they usher in, but the term is particularly appropriate for Robert Edwards.

Edwards was awarded the Nobel Prize in Medicine last week for his pioneering work on in vitro fertilisation (IVF), which is estimated to have led to the birth of as many as 4 million babies worldwide in the past 30 years, 100 000 of them in Australia.

The clinicians and scientists involved in what is now a major industry can be justifiably proud of what they have done for couples who might otherwise never have had the experience of being parents.

But the story of IVF isn’t all adoring parents and happy babies. The costs of assisted reproduction — physical, emotional and financial — can be enormous.

Like most people my age, I’ve watched friends ride the IVF rollercoaster. And it isn’t always pretty.

For every treatment cycle that results in the birth of a live baby, there are another four that do not, according to the latest report from the Australian Institute of Health and Welfare. The report presented data from 36 fertility centres in Australia and New Zealand for 2008.

Unsurprisingly, the odds worsen as women age, with the report showing only 6.6% of autologous fresh cycles in women aged 40–44 years resulting in a live birth. For women aged 45 years and older, only 0.3% of such cycles result in a baby.

Despite such odds, women in their 40s have been accessing the technology in steadily increasing numbers over recent years and now represent just over a quarter of all treatment cycles.

Australia has been generous in its public funding of assisted reproduction technology, with often joyous results, and it would be unkind to suggest it should be otherwise.

Opposition Leader Tony Abbott certainly discovered how emotive the issue was when, back in his days as Health Minister, he suggested Medicare funding should be capped based on the number of cycles already undergone, or on maternal age.

Now I wouldn’t want Mr Abbott making decisions about my, or any other woman’s, reproductive options but I have to wonder if there’s a flip side to our generosity in this area.

Although I am sure most women receive an exemplary standard of care, there have always been rumours that some are encouraged to persist with treatment after repeated failures and in the face of apparently insurmountable odds.

In theory at least, the absence of a funding cap could make such outcomes more likely.

And it certainly imposes a burden on the health budget: an Australian study, published in 2008, estimated the cost of autologous assisted reproduction in women aged 45 or older at $1.3 million per live birth.

I have nothing but compassion for couples trying desperately to conceive a child, but maybe, just maybe, we do need to talk about this …

Jane McCredie is a Sydney-based science and medicine writer. She has worked for Melbourne’s The Age and contributed to publications including the BMJ, The Australian and the Sydney Morning Herald. She is also a former news and features editor with Australian Doctor. Her book, Making girls and boys, on the science of sex and gender, will be published by UNSW Press early next year.

Posted 11 October 2010