Who decides how babies are made?: Today, amid the flood of stories about designer babies, comes a document from the body that monitors the new birth business in all its moral intricacies - and really wants to hear what people think. Celia Hall reports

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Hundreds of frozen embryos stored in British fertility centres will come to the end of their five-year 'use-by' date in a couple of years' time.

What is to become of them? Will these potential human beings be flushed down the laboratory drain?

Many of these embryos will be left over from a successful test-tube baby treatment. They will have little brothers and sisters. They have been stored because many couples want the chance of another test-tube baby who will be a biological sibling of their first child. These embryos therefore have history; they are not even truly anonymous.

The five-year 'use-by' rule is established by law: the Human Fertilisation and Embryology Act 1990, administered by the chairman, members and staff of a statutory body, the Human Fertilisation and Embryology Authority (HFEA). The authority's 18 members are predominantly non-medical men and women. They include the Bishop of Edinburgh, the Most Reverend Richard Holloway, the actress Penelope Keith, and Ian Cooke, professor of obstetrics and gynaecology at Sheffield University.

Today this body will publish a consultative document on yet another ethical and moral fertility problem, this one plucked from the very frontiers of science: the problems surrounding the use of 'donor' human ovarian tissue from foetuses, corpses and living women.

While there has been public clamour in recent weeks for Parliament to 'do something' about fertility treatment practices and embryo research, the authority has been calmly getting on with it for three years.

The HFEA, perhaps navely, has not seen itself as high-profile, but three recent controversies have pitched it into public view: the birth of twins to a post-menopausal, 59-year-old woman; requests by ethnic minority couples to have white babies; and the gruesome but real possibility of using ovarian tissue from aborted female foetuses as a source of eggs for infertile women. Perhaps the British people need big headlines and talk of 'designer babies' and 'human body shops' to get to grips with life-and-death subjects that do not directly touch their own lives. But the notions are hardly new. After all, in vitro fertilisation (IVF) has been with us since 1978, when Louise Brown, the first test-tube baby, was born.

The future of the embryos is only the latest of these questions to absorb the HFEA's attention. It has been thinking about the hot topic of ovarian tissue for nearly a year.

The HFEA was set up to deal with such issues. It regulates and issues licences for fertility clinics; it licenses embryo research which leads to fertility treatment; and it holds a confidential register of donors of human eggs and semen. It makes recommendations to Parliament, which has accepted all of them so far.

It is an extremely rare thing: a quango with democratic principles. It is powerful. Those who contravene the law it patrols and its codes risk prison. It is tied up with rules that forbid disclosures because of the sensitivity of its work. It deals with some of the most controversial issues of our time. Yet the HFEA could not be less controversial or less adversarial, or more willing to seek and accept the views of lay people. And then to act on them.

Take today's ovarian tissue report. Last July it announced its intention to open up a public debate on the subject, by publishing a report setting out the problems and inviting comment. Only when this process is completed will it make its recommendations to Parliament.

If you ask the chairman, Professor Sir Colin Campbell, where he thinks the public anxiety lies, he will tell you he does not know until people respond to the report, and he means it. So do not expect this document to be full of the views and opinions of this group of the great and good to whom Parliament has handed a particularly tricky nest of baby vipers. The report will set out the pros and cons.

Sir Colin is vice-chancellor of the University of Nottingham; his background is law. He is passionate about the need for assisted fertility issues to be in the public domain and 'not decided in private by some elite group of experts, some London quango'.

He is even determined that the HFEA, made up largely of men and women who are not involved in fertility research or treatment, will not itself become inured to what is called the 'yuk factor', to which the subject of foetus research is particularly prone. Although this Scottish lawyer admits that he can now raise with equanimity at the dinner table subjects that make others push away their plates, he does not want the members to cease to feel the initial distastes or disquiet shared by many when confronted by some new embryological advance. The authority should see, therefore, a fairly rapid turnover in its membership.

The good opinion that Sir Colin has of the common sense of members of the public is central to the authority's decision-making. 'I deliberately speak to people about this all the time, and I deliberately speak to everybody, not just the sort of people I work with professionally - I mean people in shops, in the street, at football matches. I was speaking to a taxi driver in London recently and his sophisticated grasp of the issues was tremendous. He got all the points first time round.'

If the HFEA has not been exactly a household word, it has not been idle. But the work of its first two years has been predominantly organisational.

Its first task was to formulate a code of practice for clinics and researchers from a brand new Act of Parliament. Its second was the licensing of fertility clinics and research projects. It has established a system of rigorous inspections, through both announced or unannounced visits to clinics.

The authority has refused five licences, including two for research projects. It currently licenses 32 research projects and 107 treatment centres. Of these, 65 are for in vitro fertilisation (IVF), 37 are for donor insemination only, and eight are for storage only. Fertility clinics are now the most tightly monitored medical treatment centres in the country.

At the outset the HFEA had to solve two problems that quickly emerged. One was that the Act had been drawn up with such strict provisions for the confidentiality of patients that it would have been criminal to inform a woman's GP that she was receiving fertility drugs. The HFEA had the law amended.

The second problem had the authority considering the future of stored sperm and embryos for the first time. A key provision of the Act was that a new national register, held by the authority, would list the names of donors (which were never to be revealed). It followed that it would have been illegal to use material already held in the absence of the name on the new register. The authority sensibly decided to allow a changeover period.

In 1993 it has been able to spend more time looking at social and ethical questions. 'We cannot stop the advance of science but we can decide how we want to limit its effects,' Sir Colin said.

One of its first recommendations was that cloning embryos was not an acceptable way to produce more of this scarce commodity. Embryos cloned by splitting produce identical twins. In addition, if these are stored, true twins can be born years apart, producing twins of different ages.

Its first appeal to the public, early last year, was over the question of sex selection - whether couples having IVF should be allowed to select the sex of their baby. The HFEA sat down and deliberated; produced its first consultative document; sent out 2,000 copies to organisations and individuals on request; took advice from interested groups; and then decided that sex selection for social reasons should not be allowed.

Sir Colin says that this surprised some pundits, who had predicted that sex selection would be permitted and accused the authority's members of having made up their minds already. Nearly 80 per cent of the 200 or so members of the public who responded to the consultative document were against the idea.

'With the use of ovarian tissue we want a bigger response. The issues are very difficult and a formal document cannot give all the explanations. So we want to hold meetings where people can ask their questions. We are going to be very active in ensuring people can talk about this.'

At the heart of its work will always be the argument over what is natural or unnatural, normal or abnormal. In the future, its debates will be led by science as the implications of the newly possible throw up yet stranger ways of creating human babies.

For now, the HFEA seems to be getting it about right.

(Photograph omitted)

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