Dr. John Kennedy:

I apologise to the joint committee for my attire. I was called into the clinic this morning and it was not until the eleventh hour that I realised I would be able to make it here. I certainly do not mean any disrespect.

I thank the committee for giving me the opportunity to talk to it about something that I think is critically important to us and our patients. I am the medical director of the Rotunda Hospital IVF unit, the National Fertility Centre. I am also the medical director of Sims IVF in Clonskeagh and Cork. Between the three clinics, we probably account for over 2,000 IVF cycles per annum in Ireland, which is not quite half but as close to it as to make no odds. The statement I will make is not just my own work but that of the medical teams at the three clinics, the embryologists, compliance specialists and nurses, all of whom had a great input in determining what we thought of the proposed legislation. I echo the sentiments of my colleagues who have already spoken to the committee that we very much welcome the introduction of the legislation, but there are a number of points which cause us to pause and cause us concern. We would like to have an input in perhaps changing them as time passes.

I have submitted a document on this issue, but there are specific concerns that I would like to address, many of which arise under head 6 of the draft Bill and which mainly concern the age at which we can treat patients. There seems to be a minimum age of 21 years and a maximum age of 47. They appear to us to be very arbitrary figures. The legal age of consent and at which one has voting rights in Ireland is 18 years, the time at which he or she becomes an adult. I struggle to think of any other circumstance or event in which one cannot partake between the ages of 18 and 21 years. Fertility treatment is uncommon between the ages of 18 and 21 years, but it is not unheard of. There are associated medical conditions which preclude somebody of that age from conceiving spontaneously and which necessitate the use of assisted human reproduction if she wants to have a child. The upper limit of 47 years is also heavily prescriptive. We have audited our practice in the past five years. Not many patients over the age of 47 years come in for treatment, but there are a few. We counted approximately 160, of whom over half had a successful treatment. Over 80 children have been born in the past few years who would not have been born had this legislation been passed.

We have concerns about the restrictions on male patients. While there is no age range, in particular, it is stated in the proposed legislation that to proceed with assisted human reproductive technology the man must reasonably be expected to survive until the child reaches adulthood. This would have a major impact on many people, especially our oncology patients whom we look after in the Rotunda Hospital, who come with a cancer diagnosis and where the timelines for their survival are very much in doubt.

I echo the concerns of Dr. Wingfield about counselling being non-mandatory and of Dr. Waterstone about the requirements in respect of single embryo transfer. It is something to which the field is moving and that we most commonly do and that we believe should be down to practice guidelines, not the focus of legislation. There does not appear to be any provision in the legislation on double donation - the use of donor eggs and donor sperm. There is provision for the use of surplus embryos, created in other cycles, but it is prescriptive. We have same-sex couples where a donor egg is required and in respect of whom there may also be a need for donor sperm. Iit looks like these patients will have to travel abroad for treatment as they have done in the past. We would, therefore, like to see proposals introduced to allow for double donation.

We welcome the limitations on the storage of embryos but wonder if they will be applied retrospectively to embryos already created. Will there be a five-year storage limit? How will it apply to oncology or younger patients where five years may not be a relevant timeline?

I share and echo Dr. Wingfield's concerns about the surrogacy portion of the Bill. It appears to us that patients will travel to avail of surrogacy and that we may be liable for fines or face criminal action if we advise or help patients in that regard. Furthermore, if we treat patients and there are surplus embryos frozen, will we be permitted to release them to the care of patients to do with them as they will, even if it involves travelling to avail of surrogacy?

There are other provisions which I hope to address during the question and answer session. We welcome the formation of the assisted human reproduction regulatory authority, but I share Dr. Waterstone's concerns about how it will be made up, who will be on it and how they will be chosen. My other concern is the cost that may be incurred by the patient. In the United Kingdom the maintenance of the Human Fertilisation and Embryology Authority, the equivalent UK authority, is funded by an additional charge on every single cycle. Is this the proposed mechanism to fund the new organisation, as it would put further financial strain on an already difficult process for patients?

I thank the committee for its time.