The whole area of fertility treatment is fraught with complexity and emotion. Variation in NHS provision across the country, despite an intention to end the so-called post-code lottery, causes immense resentment. Then there is the entirely practical matter of the shortage of donated sperm and eggs. And underlying much of the debate is a difference of opinion about whether having a child should be regarded as a human right or a privilege.
The Human Fertilisation and Embryology Authority has now announced that it is to review several of its policies over the coming year, the general intention being to reduce risk and increase the number of people who are helped. Which is only to be welcomed. Not only does medicine advance, but social attitudes change – one instance being an earlier decision not to require any reference to a father.
Some of the questions for review have more to do with good housekeeping than principle. Would it be harmful, for instance, to raise the limit on the number of families that a sperm donor may create, which currently stands at ten? And how can the health safeguards that apply to UK donations be extended, with greater certainty, to donations obtained from abroad?
But there are other issues that are quite as contentious as removing the need for a prospective father to be on the scene for a woman to qualify for NHS treatment. One is the question of whether someone may restrict his or her donation to certain recipients – members of specific ethnic or religious groups, for instance, or heterosexual couples. Not to allow this risks reducing the number of donations overall. To allow it, though, is clearly discriminatory.
The most vexed question of all, though, is that of payment. At present, donors may be reimbursed for expenses, but the voluntary principle has been retained. It is also enshrined in EU guidelines, although the actual interpretation of the not-for-profit principle varies. In Britain, a woman may receive free treatment in return for sharing her eggs, in effect a benefit in kind.
The HFEA detects that opposition to payment may have softened, a development which – if true – may not be unrelated to the sharp fall in sperm donations in recent years. Payment, though, would create problems of its own, not just ethical, but practical: how much to pay, how to collect the money, and the inevitable rise in treatment charges to recoup the cost.
Unfortunately, the one change that might do more than anything else to increase donation – restoring anonymity for donors – is not within its power, as the original decision was made by Parliament. One predictable – but underestimated – effect of the law that gave donor-children the right to know their genetic descent was to reduce the number of donors. That is a balance that MPs had to draw. We wonder whether they would make the same judgement again.