Dr. John Kennedy:

With regard to the posthumous use of gametes, there is a provision in the proposed legislation that people would have to wait a year after their partner had died before they could use those embryos. That, in conjunction with an age restriction of 47, seems ridiculous. I have had women come through whose partners have passed away. Most would have waited over a year because that is what happened organically. I have had one who has not. She went through counselling. The counsellor, myself and the team deemed she was fit for treatment and she went on to have treatment. I thought it was a good thing. One year seems arbitrary to me.

A couple of the questions referred to how we curb the worst excesses. It is simple: provide the care here in Ireland in an affordable way. Publicly fund IVF. Make donor eggs available, in a cheaper sense, in Ireland, both anonymous and open. Then we will stop people travelling. People are travelling because of costs and availability. It is not purely about cost. People are travelling because they want to avail of anonymous egg donation or they want to do it in a cheaper fashion. Many of the eastern European clinics are going to be persistently cheaper. There may be some diminution in terms of quality and care. There is certainly not anything at all like the follow up that Irish clinics have. The European clinic does the treatment. Then the patient goes back to her own country and never the twain shall meet again.

If we want to curb the worst excesses of travel and people shopping around, provide it here. We know most European countries have some degree of publicly-funded IVF and AHR programmes. Israel is the example that springs to mind. There is free IVF for everybody up to the age of 45 or until a woman has two children, after which seven free cycles are provided. That is very idealistic. However, it shows the differing priorities. We need some form of publicly-funded IVF.

Another question was on costs and add-ons. Publicly funding IVF would go a long way to curbing that as well. I think publication of success rates for all of the clinics is a great idea and that is something the AHRRA will be able to do. It will designate the parameters by which success rates are published. It will not be possible to pick a good patient cohort or a good six months. That is going to be fantastic.

In respect of add-ons, one of the problems is IVF and AHR have become very commercialised. Most IVF and AHR success rates, in my experience, come down to having a good lab collecting eggs, creating embryos and storing them. If we have a patient in front of us, 90% to 95% of the success that is possible will be within that framework. There is a place for a number of add-ons. Some have a degree of evidence, others less so. We are looking for the small margins, the small percentage points to try to improve a couple's chance.

In our practice, and I cannot speak for other clinics, I do not believe there is exploitation of couples. I refer to appropriate counselling, care, attention and explaining the pros and cons, and specifically the limitations and lack of evidence associated with the tests. Natural killer cells were mentioned. There is a good theoretical basis they may make an impact. There is no evidence to suggest they will increase the chances of having a baby. Patients need to be clearly informed of that. However, these patients are self funding and the cycles are expensive. Costs are between €5,000 to €6,000 or €7,000 for a cycle of IVF. If there is an extra test which costs €200, that amount is a demand even if it is only on a theoretical basis that it is going to improve the outcome.

If we publicly fund IVF we will get to take control of that situation. We get to say we are paying for the treatment and a couple will not get a test. We can do a side-by-side comparison of the success rates and see if there is any value in the add-ons.