In Vitro Fertilisation: 40th Anniversary
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)
My Lords, I join other noble Lords in congratulating the noble Baroness, Lady Deech, on securing this important debate. I join my Front-Bench colleagues in commending the quality of it; we are incredibly lucky both in this House and in this country to have such experts who are able to give such informed opinions on these topics. It seems to me entirely right that we should have the opportunity to acknowledge the ground-breaking work of Sir Robert Edwards, Dr Patrick Steptoe and, as the noble Baroness, Lady Barker, reminded us, Jean Purdy—who, it must be said, Bob Edwards always credited as the third IVF pioneer. It is right to acknowledge the development of the technique which has of course brought about the birth of around 8 million babies worldwide who would not have otherwise been born, as well as the signal role that the UK played as a world leader in providing not just the scientific technology but the right regulatory framework.
The noble Baroness, Lady Jolly, reminded us quite rightly that, even though IVF is so commonplace now, it is easy to forget the opposition that Edwards, Steptoe and Purdy faced when they were first doing their work. It is a credit to their determination and compassion that they were not deterred. It is true to say that they have transformed our understanding of human reproduction and what that means for how to have a family for ever. In doing so, they have brought happiness to millions—those who would not have been born and who are, presumably, happy to have been born, and their parents.
The noble Baronesses, Lady Barker and Lady Boycott, talked about the benefits for women of being able to make a choice about conception. I am grateful to the noble Baroness, Lady Boycott, for also talking about men and fathers. When my wife and I tried to start a family and were finding it difficult, it was something that we began to contemplate. We did not have to go down that route but at least we knew that it was there if it had been needed.
As the noble Baroness, Lady Barker, reminded us, it all started with the birthday girl, Louise Brown, born in Oldham in 1978. In a sense, it brought something that was out of science fiction into reality. A baby, conceived in a laboratory—in a test tube, to use the phrase—was then placed in the womb, leading to the birth of a healthy child. It had been unimaginable just a few years before. Not only did it open up the possibility of those kinds of births, but it also raised all the difficult questions with which we have been grappling since, to make sure that such a powerful scientific tool should not be open to misuse. That is why the Government of the day established the Committee of Inquiry into Human Fertilisation and Embryology—to make recommendations on the policies and safeguards that could be put in place to ensure that treatment services were provided in a safe and ethical manner and, as we have been reminded, to guide research using embryos. I shall return to this.
As has been discussed, the recommendations of the 1984 report formed the basis of the Human Fertilisation and Embryology Act 1990, the first legislation of its type in the world. I pay tribute to my noble and learned friend Lord Mackay of Clashfern, as other noble Lords have done, for the role he played in developing this excellent piece of legislation. I also pay tribute to the roles played by the Lord Speaker and by my noble friend Lady Bottomley. They remind us, as does the noble and right reverend Lord, Lord Harries, that it was a highly complex argument. It was happily debated in this House in the best of spirits and with the best of intentions. Difficult, challenging and, indeed, theological reasons were given for some of the policy decisions that ended up forming the 1990 Act. It is right that we recognise the role played by noble Lords and, of course, the work of Lady Warnock and the members of her committee. It is a testament to their sound judgment that so many of the principles they established still hold good. I also join the noble Baroness, Lady Thornton, in paying tribute to the HFEA for the rigour and leadership it has shown over the years and to acknowledge the leadership of the noble Baroness, Lady Deech, as well as the role of the noble and right reverend Lord, Lord Harries, in that institution.
Fertility treatment and IVF go to the heart of the deep desire—and, in some cases, psychological need—of people to have children of their own. As has been highlighted by noble Lords in this debate, we are faced today with questions different from those encountered by Edwards, Steptoe and Purdy, or even by the Warnock committee. I turn to these now.
The noble Baronesses, Lady Deech and Lady Thornton, talked about the 10-year statutory storage limit for non-medical egg freezing and their belief that it should be increased. They will be aware of the recent publication by the HFEA about egg freezing. It is important that we bring the latest available information to the public attention, so that we can have a better-informed debate as we go forward. The report suggests that women should be cautious in approaching egg freezing and keep in mind that current evidence shows that, overall, there is only a one in five chance of getting pregnant using frozen eggs. It is not an effective insurance policy for future family building, although sometimes it is absolutely necessary in order to build a family.
The noble Baronesses, Lady Deech and Lady Thornton, want to see that extension. I understand the reasons for it. There are exemptions for those who have lost their ability to be fertile for medical reasons. The question is whether and how there should be an extension to the 10-year limit for social use. My colleague the Minister for Mental Health and Inequalities has written to the noble Baroness, Lady Deech, in some detail as to why it would take primary legislation to make a change in the law. This is not least because, at the point at which they were passed, Parliament did not expect the regulations to be used to extend storage for social reasons. This is not a judgment on the benefits, merits or otherwise of the argument, but it is important to reflect that any extension to time limits for egg storage would be a significant social policy change, with far-reaching impacts on decisions that women make in starting families. It would require a broader public debate before any change could be contemplated. In some ways, this has been accelerated and amplified by our discussions today.
Several noble Lords mentioned the current postcode lottery in the provision of NHS-funded IVF treatment services, and I will deal with that head-on. We have been clear with CCGs that they need to take account of the NICE fertility guideline and to implement its recommendations in full, and I want to be clear that it is completely unacceptable where CCGs have stopped commissioning IVF altogether. My honourable friend the Minister for Mental Health and Inequalities will meet the HFEA and NHS England shortly to discuss how best to promote this guideline to NHS commissioners and support better-informed commissioning of fertility services, in particular to eradicate the non-provision of services such as these. I reassure the noble Baroness, Lady Jolly, that consultations are required by CCGs before any reduction of services such as this significant one.
Allied to this issue is one raised by the noble Baronesses, Lady Deech and Lady Thornton, about private treatment costs. It is quite right that the HFEA does not regulate cost, and IVF is indeed expensive. However, it is clear in the HFEA’s code of practice that before treatment, storage or both are offered, the clinic gives the patient a personalised and costed treatment plan detailing the main evidence of the proposed treatment, the cost of that treatment and any possible changes to the plan, together with those costs. In that way they have the opportunity to understand at the outset the costs that they are likely to incur and—to address a point mentioned by the noble Baroness, Lady Deech—that they have accurate information about the effectiveness of any treatments, particularly add-ons, that they are offered.
The noble Baronesses, Lady Barker and Lady Boycott, raised the important issue of surrogacy, and the impact on its availability by the 1990 Act; the noble Baroness, Lady Barker, reminded us of the particular impact it has had on single parents. I am pleased to say that we have been making progress in this area, and I am grateful to them for recognising that. A revised remedial order enabling a sole applicant to apply for a parental order was laid in Parliament before the Summer Recess. It addressed potential inequalities that were identified by the Joint Committee on Human Rights, which reviewed an earlier draft of the order, as the noble Baroness, Lady Barker, pointed out. The revised order also ensures that a single applicant who is biologically related to the child will always be able to apply for a parental order regardless of their own relationship status.
The Government are preparing the regulations needed to ensure that the changes made by the remedial order can work effectively. We hope to lay the regulations this autumn to enable debates in both Houses this year, and our aim is to ensure that new laws are in place by the end of 2018. Furthermore, we look forward to the results of the Law Commission’s review of the law surrounding surrogacy in general, and are working with all partners and stakeholders to improve the ability of people to pursue this route to parenthood if it is necessary and desired. However, in doing so it is necessary to recognise and address head-on some of the fraught ethical issues that we need to negotiate in doing so, as the noble Baroness, Lady Boycott, pointed out.
Many noble Lords brought the issue of research to our attention. It is right that the 1990 Act, which we are discussing, also covers embryo research. It is also right that we have fantastic new research opportunities offered by gene editing. Reference has been made to CRISPR/Cas9 and other gene-editing possibilities, which give us the opportunity to prevent serious inheritable diseases. What then does that mean at this stage for the 14-day rule on the use of embryos?
I am sure that noble Lords will be aware that the HFEA licensed the Francis Crick Institute to use this technique of gene editing in a research project in 2016. Therefore in that sense, although the 14-day limit is very much intact, the progress in research on gene editing of embryos below that time limit has started. We have also looked at the Nuffield Council on Bioethics report, which was referenced by the noble Earl, Lord Selborne, and other noble Lords, and we are giving these important issues careful consideration as we decide how to move ahead. There is great potential in these techniques, but these are early days, and the limits of the regulatory framework have not yet been reached. For that reason, there are no current plans to review the 14-day limit for embryo research. Indeed, I think I am right in saying that the noble Baroness, Lady Deech, did not herself feel there was support for such a change at this stage. I reference the important point made by the noble and right reverend Lord, Lord Harries, and the noble Earl, Lord Selborne: if we move ahead in considering these issues, we need both a broad and deep conversation about the right way forward.
Progress has been made on the issue of mitochondrial donation, as many noble Lords have pointed out. Parliament gave clear support for the introduction of regulations for mitochondrial donation to prevent the inheritability of serious mitochondrial disease. The HFEA is currently assessing these cases on a case-by-case basis, giving careful consideration as it does so. We believe this is the right way forward and it perhaps sets the template for how we ought to move ahead in future.
In the 40 years since Louise Brown’s birth, much has changed. Our knowledge of this unique area of science and medicine has developed and the success rates of IVF have improved. In that time it has become possible, as the noble and right reverend Lord, Lord Harries, said, to use the IVF technique to prevent children from being born with serious and sometimes life-ending medical conditions and to prevent the transmission of serious mitochondrial disorders from mother to child. It will be fascinating to see where the use of IVF goes in the next 40 years.
I think we all agree that the UK can take pride in the achievements of Edwards, Steptoe, Purdy and all those who have worked in both clinical and research settings. We continue to be world leaders in the field of assisted reproduction and embryology and owe huge credit to the staff of so many clinics, who have enhanced the lives of so many families. We can take equal pride in the fact that this country has enabled such ground-breaking techniques to be used in clinical practice, within a regulatory framework, administered by the internationally respected HFEA, to ensure safe, effective and ethical treatment for patients. This framework has been a blueprint for the world and will continue to be so. This House has an invaluable role to play in challenging and providing leadership and ideas for how we ought to move ahead.
Baroness Deech
I am very glad to hear that intervention from the noble Baroness. I have often thought about Mrs Brown and it is very sobering to realise how many other people contributed to the eventual success.
I look forward to this House debating changes to surrogacy reform, which I hope will come soon. I hope also that we will debate genome editing and how to regulate it in the future with the expertise that we have.
There is just one issue that I remain unhappy with. I think that there must be a missing letter. The noble Lord, Lord O’Shaughnessy, referred to a letter to me from, I think, Maria Miller. I wrote to the noble Lord in mid-July but I have no recollection at all of receiving a response.
Lord O'Shaughnessy
I am sorry to interrupt the noble Baroness. It was from my colleague Jackie Doyle-Price, the Minister. If it has not arrived, I absolutely apologise, and I will make sure that it gets to the noble Baroness as soon as humanly possible.
Baroness Deech
I contacted the noble Lord this morning to say that I had not received a response. I can see that something went wrong somewhere and I do not quite know what the response will say. I listened to the noble Lord but I think that relying on medical exemptions to the 10-year limit is insufficient. Many—indeed, an increasing number—of the women who want egg freezing do so not for medical reasons but for pressing social reasons, with which we should have sympathy.
Regardless of the science, there is no reason why, if you can keep your eggs for 10 years, you should not be able to keep them for 20 if that is suitable—and it can be achieved simply by a change in regulation. The pressures on women with the biological clock ticking and the cost of freezing are such that it is a pity to say to them, “Don’t wait for Mr Right. Time is ticking. Mr Average will have to do, or Mr He-Will-Do will have to do”. As has been said, it would not involve many women—but the fact that there are not many is no excuse for not changing the law. So I hope that the letter, which I have not yet seen, is sympathetic. I will continue to raise in this Chamber the issue of egg freezing until we get a change, because it means a great deal to many women and it will have a profound psychological effect on the way they lead their lives.
I conclude by thanking all noble Lords who have participated in this very meaningful anniversary debate, and I am even more grateful to those who have played such an important part in achieving this great British success over the last 40 years.