TEST tube babies. In the late 1970s, for a nation raised on a diet of The Six Million Dollar Man and The Tomorrow People, those words conjured up haunting images of futuristic medicine and far-fetched science fiction. How could a human baby grow in a test tube anyway?
Nearly 35 years on, almost all of us know at least one person who has had or is going through IVF (in-vitro fertilisation), while hundreds of celebrities have spoken openly about their struggle to conceive, including Celine Dion, Lisa Stansfield, Courtney Cox and Nicole Kidman.
The technology and knowledge about how it works has also developed considerably. A woman's eggs can now be frozen, giving her more control over her fertility, and embryos kept for longer, increasing the likelihood of a positive outcome. “The ability to freeze eggs means now women can harvest their eggs earlier, so they're not going to put their fertility at risk later on," says IVF expert Dr Caroline Phillips. “It also means embryos can now be frozen more reliably.
“They can also now leave the embryos until later on, when they're much better developed, so they go back into the womb at the right time. The impact of that is that you need to put fewer embryos back into the womb. Instead of implanting three – with the risk that you'll have triplets – you only need to implant one."
Research in September also found that drinking a strong cup of coffee with every cycle could dramatically reduce the risk of ovarian hyperstimulation, a condition that affects around a third of women undergoing IVF. Most cases of OHSS are mild, causing abdominal pain and an uncomfortable bloated feeling, but at its most serious it can be life-threatening, resulting in blood clots and kidney damage.
Ironically, though, while the technology gets increasingly reliable, cutbacks in the NHS and ongoing financial hardship for many families mean it’s getting harder for couples to receive the treatment they so desperately want. Some have resorted to the internet and social networking sites in an effort to raise the necessary cash. In 2006, Brandi and Shelton Koski from Kansas started the trend for setting up fundraising websites with BabyOrBust.com, where they asked each visitor for a $1 donation. Within two years they had raised $20,000, and four years on welcomed daughter Paisley into the world.
More recently, San Francisco couple Brian and Molly Walsh threw an IVF wine-tasting evening, with an invitation that read: “You can't help us in the bedroom, but you can help us make a baby." In one night they raised $8,000 towards treatment.
While this kind of extreme tactic is less widespread in the UK, it can only be a matter of time. “It really does depend on your health board," says Phillips. “That's why it's called the NHS postcode lottery – because, depending on where you live, you're going to get different treatment.
“Recently NHS Fife announced they were only going to allow two cycles, which is a cut from three, and you had to be within a certain BMI and you weren't to be a smoker. So there are different registration criteria for different health boards."
The result has been, as in many other areas of healthcare, an increasing number of people travelling abroad for treatment – to places like India, South Africa and Eastern Europe. A European Society of Human Reproduction and Embryology study in 2010 estimated the number of cross-border IVF cycles was as high as 25,000. “It is becoming a much more talked-about subject on fertility forums," says Phillips.
With a Phd in embryology from Edinburgh University, research work with Professor Sir Ian Wilmut, whose team created Dolly the sheep, and several years working in IVF, Phillips has just launched a service that matches people with clinics in the Czech Republic. There, she says, the regulations and quality of care can be just as high as in the UK, but the costs can be dramatically lower. “Egg donation – when you get someone else's eggs and your own sperm – in the UK can cost anywhere up to £10,000. If you go to the Czech Republic, it's between ¤4,000 and ¤7,000.
“The exchange rate also works in your favour. And some of these clinics also offer a situation whereby, if you have two unsuccessful cycles, they offer the third one free. Of course, you then have to have your travelling expenses and accommodation but it is probably still about a third cheaper.
“Another driver for going abroad," Phillips adds, “is the fact that the anonymity laws in the UK changed in 2005, so egg and sperm donors aren't coming forward and there are huge waiting lists." The service costs £295, and patients can expect to travel to the their destination for an initial consultation, then again for treatment. “It can take over your whole life when you want children but can't have them," says Phillips, “so if I can help them, it's a real privilege."