The booming business of life: Fertility treatment has come of age, but the NHS can't cope and couples are turning to the private sector, Mary Braid reports

FROM THE deep-pile carpet to the impressive fireplaces it has all the trappings of a plush country house. But in the tiny basement room of 112 Harley Street, hundreds of potential human beings wait on ice as freshly extracted eggs are artificially fertilised in incubators in the laboratory next door.

In a tidy little room on the top floor a steady stream of men masturbate for fatherhood helped along by Playboy, soft porn videos and, occasionally, their partners.

For the 1,000 childless couples who pass through the door of the London Gynaecology and Fertility Centre every year there are reminders everywhere of why they are there. In the hall, the country's first test-tube twins beam down from the wall-to-wall baby pictures. In the waiting room, the bronze of a pregnant woman and the bust of a toddler must make the desperate envious.

Between the basement and the attic room, women pay thousands of pounds to have their eggs extracted under anaesthetic and introduced to their husband's or a donor's sperm.

With women approaching pensionable age giving birth to test tube twins, the prospect of eggs from aborted foetuses being used in treatment, and, last week, a couple claiming to have paid pounds 650 to the country's first gender clinic to ensure their new baby was a girl, it is clear the baby business has become a multi-million pound private enterprise.

Between 1985 and 1990 the number of patients receiving test tube or in vitro fertilisation (IVF) - the most common of a dozen treatments - in Britain rose from 3,717 to 9,964. The number is still rising.

According to the latest figures from the Human Fertilisation and Embryology Authority (HFEA), recently set up to monitor and license the country's 107 fertility centres, 6,195 patients had IVF treatment in the second half of 1991. The number of treatment cycles - costing about pounds 2,000 each - was 6,653.

IVF is just one treatment in a dizzy array available at the London Fertility Centre. There women are treated with drugs to improve ovulation. They undergo intrauterine insemination (IUI) or IVF. Under another treatment (Gift), an egg/sperm mixture can be transferred into a healthy fallopian tube or early embryos from IVF can be implanted there under a variation of it (Zift). Egg, sperm or embryo donations or a surrogate pregnancy are available.

The newest treatments are aimed at infertile men. Defective sperm is believed to account for about 30 per cent of problems. The centre is one of only four in the country currently licensed for ICSI, a procedure that can help men with only a few mobile sperm to become fathers. In the laboratory, just one healthy sperm is needed for a bull's eye microinjection into the centre of an egg.

Treatment does not come cheap and success is far from guaranteed. IVI is the cheapest at around pounds 400 a go. IVF costs pounds 2,000 with pounds 700 charged for every subsequent implant. ICSI costs pounds 3,000; Gift and Zift, pounds 2,000 and pounds 2,500 respectively, while couples can pay pounds 4,000 for an egg donation. Accompanying drug treatments cost pounds 500, although GPs often agree to provide them free.

Even at the London centre, which boasts some of the highest success rates in the country, women have just a 30 per cent chance of becoming pregnant with their first IVF treatment and around the same chance with ICSI once a fertilised egg has been successfully implanted.

The bulk of intervention takes place in private clinics. The NHS has long since abandoned most fertility treatment to private clinics.

Dr Brian Lieberman, director of the IVF unit at St Mary's Hospital, Manchester, one of only three NHS units in the country, says the situation is sad. 'We have a waiting list of 21 months. We advise anyone over 36 to go to the private sector.'

Sally, 37, is making her first visit to the London centre. She and her husband, David, 39, a building surveyor, have travelled from Chichester to begin IVF. Egg collection day has proved less painful than Sally expected. David is also relieved. He has just been to the small attic room and provided the sample.

'Men kept disappearing from the waiting room. I was worried I wouldn't be able to do it at 8am. But it's not as clinical as you fear. It is quite a cosy little room.'

The couple have been trying for a family for five years and first sort NHS help more than two years ago. Eight months of tests followed before Sally was prescribed clomiphene to stimulate ovulation. That was unsuccessful and in October the couple were referred to a private consultant. 'He said we could wait three years on the NHS or we could pay and be seen immediately at his clinic around the corner,' said David. 'When you are our age three years is far too long. But I am annoyed to have to pay for the treatment.'

Sally and David's family have clubbed together for the pounds 2,000 treatment. 'We also paid pounds 75 for the first consultation just to talk about how much the whole thing would cost,' said David. 'Tests for HIV, rubella and sperm count have cost us another pounds 500. Then we have had to pay to come up here and stay in a hotel.'

The road to parenthood has been 'stressful' with tears along the way. But now they are excited. 'We'll know by 10am tomorrow if the eggs have fertilised,' said Sally. 'We have to wait another day see if they can be implanted. Then we have to see if I take a period. We are paying pounds 200 to have any extra embryos frozen but I can only see me going through this once more.'

Blooming in her seventh month of pregnancy is Catherine, 38. She and her husband, James, tried for a baby for three years before they sought help. She went private because time was running out only to be told that she would never have a child by her husband who has a low sperm count.

Catherine is one of the first wave of British women to become pregnant by the ICSI method, which only became available last May. It worked first time. 'It was my husband who was really keen to have children. He was devasted when he was told we couldn't'

Her treatment has cost pounds 5,500 and she plans to have another baby by the same method. No one in the family knows how her baby was conceived. 'I have told two friends but my husband has told no one. He is very private. Perhaps its because it was his sperm that was the problem. Stupidly, some think these things are a sign of manhood. It's a shame it's all so taboo. I think it should be out on the open.'

If a hard-pressed NHS gives the infertile a tough deal, it takes its lead from an unsympathetic public.

John Dickson, director of Issue, the national fertility association, deplores 'the general attitude to disease of the reproductive organs.' He believes the public hates the notion of 'spontaneous and mysterious' sex being challenged by invasive techniques and science.

'Anything from between one in six to one in 10 couples are said to have trouble having children but there have been no national studies and no body collects data,' he says. 'The issue is swamped by people who can't find their way around an NHS system which seems designed to frustrate them. I don't know if its meant to force people into the private sector but that's what's happening.' Many people cannot afford private help and because of the taboos they subject suffer in silence.

Dr Lieberman argues the desire to procreate is fundamental to humans. Thwarted, it causes enormous pain. 'It is a basic human drive which should not be denied to some people.' He claims he proved as early as 1982 that IVF could be provided cost-effectively on the NHS and argues the NHS is misguidely sticking to old treatements such as tubal surgery when it should be redirecting funds to IVF.

The London centre, like most private clinics, insists it is not making huge profits and points to the cost of sophisticated equipment and highly skilled staff.

'Most of the clinics don't worry me,' said Mr Dickson. 'But there are some rogues. The HFEA is there to stop people being ripped off but it does not fulfil the role as well as it could. It is consulting on the use of foetal tissue but more important is the fact that some clinics have a 33 per cent success rate with IVF while it is as low as 2.7 per cent at others.'

The HFEA is currently considering requests that it names centres with poor success rates but a spokesman said it believed raw league tables could be misleading.

(Photograph omitted)