Dr. John Waterstone:

Most of the matters have been addressed by colleagues, but there are a couple to which I would like to speak. We have not really delved into the financial exploitation of patients everywhere, including in Ireland, who undergo assisted reproduction treatment. It might be worthwhile pointing out to members of the committee what we are talking about. The problem is we do not currently have controls in Ireland for the successful outcome of treatments available to couples; therefore, it is very hard for couples to know which clinics do better and which do worse. Most clinics in Ireland have reasonably acceptable success rates, but some do not. However, the general public does not know that. In other jurisdictions - I single out the United Kingdom and the USA, in particular - there are mandatory and transparent reporting systems. There is pressure on the clinics involved to keep up their success rates. That is important as otherwise it is hard for patients to know how to avoid clinics that, to be frank, are not doing well enough. If there are no controls in place, it means that clinics can advertise exaggerated success rates to attract patients under false pretences. Once patients are in them, it opens the possibility that couples may spend thousands of euro more than they had originally budgeted for because of expensive add-on investigations and treatments which cost a lot of money and make more money for the clinics involved but which do not necessarily improve the chances that the couple will go away with a baby. These are the matters the joint committee must address. It is a difficult area to police and recently in the United Kingdom the Human Fertilisation and Embryology Authority seemed somewhat powerless to speak out against add-on investigations and treatments. It is, therefore, a matter that must be addressed. It is not easy, but one of the major problems legislation in Ireland needs to address is financial exploitation.

Deputy Kelleher wondered about unwitting consanguinity in surrogacy, or the possibility that a half-brother and half-sister could unwittingly have babies together if they are the product of the same gamete donor. It is a theoretical possibility but I point out the elephant in the room, which in this case would be misattributed paternity. There are many people out there who conceive quite naturally without assisted reproduction at all and whose daddies are not the men they think they are. Even conservative estimates indicate that between 2% and 5% of children are in this position because of extra-marital affairs and such. Already in society, there is the possibility of unwitting consanguinity and it is not just assisted reproduction that can bring about that possibility; there is a far more common situation of unwitting consanguinity for children naturally conceived. It is a point for the committee to consider.

I echo the sentiments of my colleagues on age limits. The age limit of 47 years is ridiculously low as in the natural course of affairs very occasionally women will conceive naturally up to the age of 48, 49 or 50. I will not dwell on the issue further.

The legislation proposes a lower age limit of 21 years for donors. Some of my colleagues have said it should be 18 years. In my clinic we have a known donor programme or, in other words, the sister or a friend of a woman in a couple can donate. It is an identifiable form of donation that we promote in our clinic and successful. It usually is a sister, but we once had a donor who was the 21 year old niece of the patient who wanted to have a baby. We went ahead and a baby was produced. There was counselling which is mandatory in this position. We felt afterwards that it was ethically slightly questionable in that she was too young. Perhaps 21 years would be a sensible lower age limit to volunteer as an altruistic donor of eggs and not 18.

With regard to the upper age limit, the programme to which I refer in my clinic has a fairly generous upper age limit of 37. We allow the donors, usually sisters, to be as old as 37 years. We assess them to ensure they would have good prospects to be a donor - they might have good egg numbers and perhaps they might have had children - and if they are, we allow them up to 37 years of age. The draft legislation indicates that donors can be no older than 35 years. It would certainly restrict the programme we have in operation and is unreasonable. It should be at least 37 years, not 35. That is enough about age limits.

Senator Colm Burke asked about international examples of the ideal regulatory system. In Ireland we should aim to have something between the overly restrictive regulations that are the norm in some European countries and America where it is very open and there is little statutory legislation in place and having more guidelines. We should aim to end up somewhere in the middle. As I said in my opening statement, we should not slavishly copy some of the European examples as they are too restrictive. That hundreds of thousands of Europeans must travel to other countries to avail of reproductive services illustrates the fact that European citizens have been let down by these practices.

We can speak of ethics and bioethics in the area, particularly about donor anonymity and paying donors. It needs to be evidence based and much of the argument in the past has not been evidence based but more dogma. I think we need to proceed more with an evidence based model for the ethical standards we propose.

I agree with Professor Mary Wingfield, that the joint committee should understand that we should not feel that the impetus for this assisted reproduction legislation is because we are ashamed that we are the last people in Europe to regulate. The only point of introducing legislation is that it does good rather than harm. This is a valuable opportunity as we have the luxury of being able to look at the other countries that have legislated in the past and pick and choose. There is no reason that we should not punch above our weight as we do in rugby and end up with the best regulatory system in the world.