Hansard

I am grateful to secure the first debate on infertility in the Parliament and I thank those members who have stayed on for it. Coincidentally, there was an adjournment debate on infertility this week in Westminster Hall, led by the Labour MP Kevin Barron. He is chair of the all-party group on infertility, and its vice chairman is the Conservative MP Andrew Lansley. In that debate, Kevin Barron stated that 80 per cent of infertile couples in England have to pay for their treatment, the cost of which can run to tens of thousands of pounds. I do not have the figures for Scotland, but they are worth seeking.

It has been said that, in Scotland, we are more likely to discuss our debts and our bank balances than infertility. Infertile people naturally do not like to talk about their problem, not even to close family in many cases. Consequently, many will not even come forward for treatment. A recent article by Kate Foster in Scotland on Sunday states:

"This is the debt generation. It's not just about delaying childbirth to have a career, it's about being able to afford a home."

In The Scotsman, Gillian Bowditch says:

"Get the economy right and we'll get breeding".

The issue is complex, but I will concentrate on infertility treatment. Recent research in Aberdeen shows that the average sperm count has fallen by 29 per cent in the past 13 years. I have not read every word of the sexual health strategy that was launched today, but I would like sex education to be more about getting pregnant and not all about preventing girls from becoming pregnant. One couple in four in Scotland will need assistance to conceive at some point in their reproductive lives—that is equivalent to 32 MSPs. In a year, 5,062 couples present to their general practitioners and some 4,657 of those couples will be referred to hospital care. Members might not know this, but I understand that the commonest single cause of infertility is defects in male fertility, not in female fertility. That is followed by problems with ovulation, and disease of the fallopian tubes.

According to Infertility Network Scotland, births in Scotland could be increased by around 2,000 a year if all current attempts at in vitro fertilisation were successful, and more if present limits were removed. Infertility can have a profound effect on individuals, couples and relationships and is associated with high levels of depression and marital break-up. The Infertility Network describes the feelings that are expressed as fear, guilt, anger, shock, shame, isolation and inadequacy. That is not to mention the issues of femininity and machismo, which are too complex even to start to talk about.

Although we do not treat it as such, infertility is a public health problem as defined by the World Health Organisation. It is often described as a lifestyle, rather than a medical issue. It might not be life threatening, but it is life affecting.

Modern infertility treatments exist, and they offer an excellent chance of success. After three cycles of IVF or intracytoplasmic sperm injection—ICSI—treatment, a couple stands a 50 to 65 per cent chance of having a child. Well, almost: the cut-off age for the treatment currently stands at 38, when the success rate for treatment is about 25 per cent. However, it drops to less than 20 per cent after the age of 40.

In Grampian the waiting list is nearly five years—I see Margaret Ewing nodding. In the Lothians, it is two to three years, and it is about 12 months in Glasgow. Many couples end up paying the full cost of treatment themselves. Someone from Edinburgh e-mailed me last week to say that there was a seven-month waiting list for an initial test in Edinburgh. In order to get in before the deadline, she paid for it herself, through BUPA. Poorer couples clearly cannot afford to do that.

At a time when there are concerns about Scotland's falling population, as mentioned by the Registrar General for Scotland in his annual report, it makes sense to provide those who dearly wish to have a child, but who are experiencing difficulty, with every assistance, particularly given that the total number of births registered in Scotland in 2002 was the lowest figure ever recorded—and 2002 was the sixth consecutive year in which the total number of births reached a new low.

The raising of the upper age limit for IVF treatment to 40 has been mentioned. That is welcome, but unless it is accompanied by more prioritised resources, the waiting lists and waiting times will simply lengthen. As everyone knows, the earlier that treatment is available and the younger the age, the greater the success rate. I ask the minister why infertility treatment sits outside the waiting time directives and why it is acceptable for infertile couples to wait for up to five years for treatment, while waiting list targets for other treatments are six months.

In March 2003 a meeting was held, in the presence of the Executive, involving all the key players in infertility in Scotland. The meeting produced consensus and I hope that the minister will accept its recommendations in her winding-up speech.

The current criteria disallow infertility treatment for couples if there is a child from a previous relationship living in the home. That means that many women and men could be barred from treatment despite not having their own biological child. The options for such couples are to fund treatment themselves, or to return the child from the previous relationship to the former partner. What a choice.

Sperm donation legislation passed at Westminster comes into force in Scotland in April this year, from which time sperm donors will give on a willing-to-be-known basis. That means that information about the father will be kept, so that the child, at 18 years old, can trace his or her father. That will undoubtedly reduce sperm donation, which, in Scotland, is already critically low. We bring in a large percentage of sperm from England. In Glasgow, much of the sperm is imported from Denmark, but sperm from outwith this country will stop when the legislation commences in April. The removal of anonymity is a huge issue, and we need to plan now for how to recruit donors with the awareness that they are willing to be known. Scotland is now classed on an international scale as a very-low-fertility country. On that ground alone, we need to do more.

Women are choosing to start a family later. The average age for first-birth mothers is now 30. Unfortunately, two years of unsuccessful attempts to conceive and a five-year wait for treatment—which applies to many women—with a cut-off age of 38, means that women need to get serious about childbirth earlier than age 32, or they might be too late.

I will finish with a quote from Lord Winston, which was cited by the Infertility Network:

"The infertile deserve compassionate social, not demographic consideration of their problem."

I am grateful for the debate, and I look forward to the minister's response.