Oireachtas Joint and Select Committees

Wednesday, 28 February 2018

Joint Oireachtas Committee on Health

General Scheme of Assisted Human Reproduction Bill 2017: Discussion (Resumed)

9:00 am

Photo of Keith SwanickKeith Swanick (Fianna Fail) | Oireachtas source

I welcome all the witnesses to the meeting. I welcome the recent media coverage on infertility. I refer to the advertisements on television and I think that raises public awareness of the whole issue.

I agree this is a complex issue because medicine is moving fast in this very sensitive area. I concur with my colleague Deputy Murphy O'Mahony. I am a GP. I listened to the contributions on the concept of counselling. I understand that it is not mandatory with the exception of implication counselling for sperm donors. Most couples who embark on infertility treatment have had a rough road prior to that and invariably they have attended their GP on multiple occasions. All of the blood samples would have been sent off initially and the results would be back and the usual investigations would have been carried out. Personally I think much of that counselling would have already taken place in the primary care setting. This is an important point to highlight. Many GPs may not be familiar with or comfortable in this area because one cannot have an expertise in everything, and the primary care setting is the place for this counselling to occur, prior even to a referral for or to a recommendation on infertility. I would like to hear the views on that.

The issues on the ground are the cost of such treatment for couples. Couples compare fertility clinic services on cost. They will google for information and then come to the GP and discuss it.

Most clinics cost around the same for a service. However, we all know the different levels of treatments can be complex be it ovulation induction or intracytoplasmic sperm injection, ICSI. There is a wide range. I am often told that when people have embarked on a treatment they feel they are hooked and have to complete that treatment. There are many hidden costs which concerns me. I had a patient recently who was informed of a cost but was not informed it was necessary to go to the UK for a test for natural killer cells in the womb. The travel was a greater cost as was paying the separate clinic for the test.

There many discrepancies from clinic to clinic. I would like to hear the views of the witnesses. Can we regulate this more stringently? The other thing Dr. Waterstone alluded to, and I agree, was reporting systems and rates of success. It is a moveable feast. We can all have great success rates if we limit the couples we take on to simple cases. We need to have some kind of regulation.

I refer also to the reproductive tourism sector and couples going to eastern European countries, especially for donor eggs and the implanting of multiple embryos. I know it is outside our jurisdiction and impossible for us to regulate. However, inevitably our obstetrical system is going to deal with any outcome, fallout or complications from that. That is not proper. The medical staff here might be dealing with a multiple pregnancy and the mother's life could be at risk or that of the babies. We need to have some kind of control on that issue.

There is also a great deal of discrepancy in the cost of storing embryos. While the costs generally for the treatments may equate from clinic to clinic, I heard recently there is a big discrepancy in the cost of the storage of embryos. I am not sure if that is correct and I would like the opinion of the witnesses.

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