Dr. John Kennedy:

There is a great deal to get through. With regard to age, which is a subject close to my heart, of course there should be age limitations and nobody disputes that. The average age of the menopause is 50.8 and that is a natural barrier. The chance of conceiving spontaneously as a woman approaches her late 40s is low and the risk of miscarriage is high. Advances in medical technology, specifically with regard to donor eggs, have overcome these limitations and, therefore, it is possible for women to conceive as they get older, but medical risks are associated with that. Our clinic has an age cut-off of 50. It is self-imposed and we adhere closely to it. If somebody is in or around that age or if they have embryos created and they are looking to use them but they have passed the age of 50, we involve a multidisciplinary team. We get the input of obstetricians in a pre-pregnancy phase to assess the risk and deem whether the patient is suitable. One of the issues is we do not have much data on women pregnant in their 50s. The numbers are low and we do not know what the risks of high blood pressure or pre-eclampsia are but we certainly think they increase. There should, therefore, be age restrictions. The UK, for example, has an age restriction of 50 but it is 55 for oncology patients. We would be comfortable with that in our organisation but 47 is arbitrary. At the other end of the age profile, the number of patients seeking treatment aged between 18 and 21 is low but it is not zero. One would not want to tell a woman who is 19 or 20 years old, who wants to conceive and has gone through appropriate testing and counselling but who is unable to conceive spontaneously, that she should wait for no reason when she could conceive spontaneously if she did not have an underlying medical condition.

Counselling is available and encouraged. There are certain instances where it is mandatory. For example, when somebody is using donor egg or donor sperm, we require them to attend at least one session. That is called implications counselling. It is about information gathering as well as exploring some of the issues that we want patients to consider.

Therapeutic counselling, which is counselling after a negative outcome with fertility treatment or beforehand if we feel the patient is struggling, is something we encourage and that is available for our patients. In one of the clinics in the past, counselling was a mandatory requirement for a number of years and the feedback we got from a significant number of patients was that they did not believe it was either necessary or helpful. Many patients did find it helpful, but we found that the patients who self directed counselling got more from it than the patients who were forced into doing it. It is something we encourage and make available, but is not something I believe should be a requirement.

With regards to surrogacy, nothing is being done in Ireland. If someone wants to avail of surrogacy, they have to go abroad. They have to go to the United States or Canada, where they will be looking at paying upwards of €100,000 for treatment, to eastern Europe, where they may pay approximately €40,000 for treatment, or to India, where there is a great deal of exploitation, and nobody is in favour of that. The problem with this legislation is that it does not govern those patients except to say they cannot do it. However, patients are still going to do it because it will be virtually impossible for couples in Ireland to avail of surrogacy. As it is not advertised and is non-commercial, they need to have a close family member who is willing to give up nine months of their life for nothing in return. It is not feasible. It is also not feasible for certain other subsets like homosexual couples. They will require surrogacy to have a family. Unless a close family member or somebody else volunteers, that will not be a viable option for them.

The notion that we cannot facilitate, test, treat or advise those patients is ridiculous. It will not work in practice. These are patients who are coming to us. The women who require surrogacy generally have been through an incredibly tough time. Invariably, they have had a number of failed cycles and there are major issues which can only be overcome with surrogacy. We would ask that something be put in place to help facilitate care for these women. We are not allowed pay surrogates. If that is the decision of the legislative body, that is fine, but we cannot advertise so we cannot even try to recruit surrogates. I have absolutely no doubt that there is a shortfall of available surrogacy in this country.