IT'S no news to anybody that hundreds of Irish women cross the Irish Sea for abortions each month. But there is another secret stream of traffic to Britain which is rarely discussed far from wanting to terminate a pregnancy, this is of people who hope to start one.
Nobody has collated the figures so it's impossible to know exactly how many Irish people make this journey for fertility treatment but the National Infertility Support and Information Group (NIAIG) estimates it at more than a hundred a year. A phone around to a number of infertility clinics in Wales and England and one in Northern Ireland ascertained that most of them had at least "some" and many had "several" Irish clients in the past year. British clinics are well aware of, in fact appreciative of, Irish business, picking women up from airport or port, transporting them to the clinic and even arranging bed and breakfast accommodation nearby.
But while this is welcome, travelling for treatment is a stressful experience, as one Dublin woman who went to Britain last year explains. "Having infertility treatment is not something you broadcast, so when you're off to England for a few days you have to lie and make up excuses. Then there's all the extra expense and when you get there you don't know where you're going; you're in a strange, unfamiliar environment. Once I started treatment everything was all right in the clinic itself, very carefully managed. But it's horrible when you come back here and you're on you're own again.
"I remember I had to give myself these injections and I wasn't sure if I was doing them right. I rang the clinic to ask them but they weren't really able to reassure me so they said I should go to my GP, which I did, but he didn't have a clue about IVF. I felt I knew more myself than he did. I felt so alone.
"But I did what I had to do and we went back to England again for the next stage as arranged - more lies, more excuses. They extracted the eggs and fertilised them and three embryos were placed in my womb. Then we were sent home to wait and hope and pray but it was no good. By day 10 I had my period and it had all been in vain. It was an immensely stressful experience and travelling made it more so.
So why travel? For most people the reason comes down to restrictive and anomalous guidelines on IVF and other reproductive technologies which are laid down by the Irish Medical Council. For example, infertility treatment is available only to married couples in Ireland. Egg donation is not permitted here and neither is sperm donation for surgically assisted reproduction, though the latter is allowed in low tech, artificial insemination.
Another reason for travelling is because there is no facility for the freezing and storing of embryos here. To appreciate the implications of embryo storage it is necessary to understand the process of In Vitro Fertilisation (IVF), the most widely used, high tech fertility treatment, which produces what were once called "test tube babies". IVF begins with the woman taking high doses of hormonal drugs to stimulate the ovaries to produce several eggs, an average of 12. The eggs are then removed from her body, and fertilised by sperm in a test tube. If fertilisation occurs, the successful embryos obtained - an average of eight - are placed in a laboratory incubator for a few days until they are ready for transfer to the woman's uterus.
The IVF process makes more embryos than are needed. The norm is for three embryos to be placed in the womb in the hope of at least one implanting and ill other countries the "spare" embryos are frozen.
In the Republic there has been no public debate about IVF or any other form of assisted reproduction. There is no authority overseeing these developments. There is no legislation. Reproductive technologies quietly slipped into use 10 years or so ago and have been available since then in the Rotunda Hospital in Dublin and more recently at University Hospital, Galway. In the absence of regulations, the Medical Council has issued guidelines which it says should be adhered to" and which are followed by all doctors operating here.
"The guidelines as they stand are illogical and show a complete disregard for infertile women and couples," according to Betty Edgeworth who travelled to England for IVF treatment six years ago. "IVF and other infertility treatments are traumatic enough without the hassle of travelling on top of everything else." Her motive for going to Britain was because her embryos could be stored. "As it turned out we were successful on the first attempt and subsequently had another child naturally. But I wanted the reassurance of knowing we could go again at minimal risk to my health."
Not storing embryos means that the woman who wants a second attempt must subject herself to the entire procedure all over again. This has huge health implications. IVF is an invasive procedure, involving blood tests, scans, massive doses of hormones and surgery. "Minor" side effects include vision problems, nausea, dizziness, and weight gain but ovarian hyperstimulation syndrome can lead to heart failure, stroke and even death. Storing embryos allows a second chance at implantation without having to go through the egg stimulation and extraction phase again, thereby greatly, reducing the risks.
And there is a cost factor. To transfer stored embryos to the womb costs approximately £500 compared to an average £1,500 for a full IVF cycle.
There is also the question of what happens to the "spare" embryos. The Irish Medical Council guidelines say "all fertilised embryos produced by IVF should be replaced, optimally three in any treatment cycle". However, the average number of embryos produced is eight. All eight are not being placed in the womb - or we would have an epidemic of Mandy Allwood like pregnancies - so what's happening to the others?
According to Dr Peter Brinsden, medical director of Bourn Hall, a leading British clinic which intends to set up an IVF unit in Ireland early next, year, they are replaced in the woman's body as the guidelines; demand three in the womb, the rest in the cervix, "which, as they stand no chance of survival there, is the equivalent of disposing of, them". Declan Egan of University College Galway agrees that is the practice in this country at present.
Peter McKenna, Master of the Rotunda, says of the situation: "All embryos are replaced in accordance with the guidelines, some in an area where they are less likely to survive".
So the Medical Council guidelines result in hard won, healthy embryos being effectively discarded; many women being subjected to unnecessary drugs and surgery; many others adding travel stresses to the numerous factors which can jeopardise treatment - like Cathy Murphy from Dublin who could not get a taxi from Belfast railway station to her fertility clinic in time for a crucial injection; yet others going though an ordeal feeling isolated and alone - like one Dublin woman in her mid 30s who found herself with cramps and pains, crying into a phone for help from clinic staff who were hundreds of miles away across the Irish Sea.
The guidelines are currently being reviewed by a sub committee of the Institute of Obstetricians and Gynaecologists. Dermot MacDonald, chairman of the committee, is unable to predict what the new recommendations will be or even when they might be completed and says there is "no desperate rush" to come to a conclusion.
Betty Edgeworth disagrees. "We're sitting on a timebomb," she says, adding that she believes if we continue to stick our head in the sand, a tragedy could happen if a woman suffered serious side effects from having to take such massive doses of drugs twice or more.
In their 10 years in Ireland, reproductive technologies have directly affected the lives of only a tiny minority. But they have changed the way we all think about fertility. They offer an escape from the tyranny of biology - but also put the ability to create and destroy life in human hands. The ethical decisions which this raises have to a large extent been sidestepped here.
Rather than grapple with the issues and recognise their impact on people's health and lives this seems to be yet another area where, in certain cases, once again the problem is exported.