Doctor at hospital with UK’s largest sperm bank says discriminatory funding system behind relocation
Many would-be parents are moving house in order to access free IVF on the NHS, sometimes saving themselves £10,000, according to the lead fertility doctor at the UK’s largest sperm bank.
Dr Raj Mathur, a consultant gynaecologist at Saint Mary’s hospital in Manchester, said he “constantly” saw patients moving house and/or GPs in order to get more free IVF cycles.
Mathur, whose clinic accepts NHS patients from 23 clinical commissioning groups (CCGs) across the north-west of England, said the geographical differences in funding were discriminatory.
“It’s a bloody nightmare, localism in the NHS. I’m all for centralisation. It’s a scandal because it should really be decided by the National Institute of Clinical Excellence [Nice] … They came up with national guidelines but everywhere in the country has its own version of those criteria,” he said.
Nice recommends that women aged under 40 should be offered three cycles if they have been trying to conceive for two years. Cost-cutting CCGs are defying advice set out by the government and NHS advisers.
“Some CCGs will specify that both should be childless; others will specify that there should be no children in that relationship … In my clinic Mrs Manchester will get one cycle and Mrs Rochdale will get three,” Mathur said.
Some borders between Greater Manchester boroughs are so tight that patients can be one house away from qualifying for extra NHS fertility treatment. Some streets in Bolton, which offers one free IVF cycle, turn into Bury (three free cycles) across the road.
Mathur said people constantly move house to register with a GP in another CCG: “You set up a game and people will play the game.”
Greg Horne, a consultant embryologist at Saint Mary’s, agreed: “It’s like if you try to find a house in the catchment area of a particular school.”
The average market price for a single cycle of IVF in a private clinic is £3,348, research by Opinium found. With just one in three cycles resulting in pregnancy, many patients spend in excess of £10,000 on three attempts or more.
“It’s discriminatory. It’s a classic example of a postcode lottery, it goes against evidence-based guidelines,” said Mathur, who is also secretary of the British Fertility Society.
Provision is being reduced as a cost-cutting measure in some areas and has been cut altogether in others. Mathur’s patients in most parts of Cheshire used to have three IVF cycles funded but as of last April are offered one.
Saint Mary’s, which was the first hospital in the UK to offer an NHS IVF service, is home to the UK’s biggest sperm bank. Working in partnership with a private American company, Fairfax Cyrobank, sperm from 100 American donors is held in a depot in Manchester.
The sperm is frozen in liquid nitrogen and flown over in “dry shippers”, which look like metal milk churns. It is then inserted directly into a woman’s uterus via a small catheter through the cervix – a process known as Intrauterine Insemination, IUI, which has a one-in-10 success rate – or is used for IVF where a woman’s egg is fertilised in a laboratory and is then returned to her womb as an embryo.
Like most fertility clinics, Saint Mary’s has faced a severe shortage in donor sperm since a 2005 change in the law giving children the right to know the identity of their donor once they reach 18. Donors cannot be paid more than basic expenses and can contribute to a maximum of 10 families.
In recent years, the hospital had just three regular donors on its books, all of whom were white. This was a problem as 20-25% of the hospital’s fertility patients are British Asians.
In Sunni Islam, sperm donation is forbidden “... so they wouldn’t have told people it’s a donor child, so it’s very tricky. There’s a red-haired gene that pops up in the caucasian population of the UK, for example,” said Mathur.
In 30 years working at the clinic, Horne said he could recall just one Asian donor. Ten of Fairfax’s current US donors are of Asian heritage and all have accepted that their donor children may contact them in adulthood.
Faye Penny is the donor coordinator at Saint Mary’s, and sits down with each patient to look through Fairfax’s online catalogue. They can search by detailed criteria including physical characteristics, personality, baby photos and can even hear his voice. “Most straight couples don’t want to see the photos,” said Penny. “Often all they want to know is the hair and eye colour and the ethnicity.”
Donor 4848 is 175cm tall and 90kg and is of Indian origin. His favourite animal is a hamster, he is Muslim, likes going to the theatre and reading.
Donor 5319 is described as: “Shy at first, he is insightful with a warm heart and caring spirit. He loves spending time around children and seeing the potential of the world’s future first-hand ... Our staff consider him attractive, with a handsome face and a tall, athletic build.”
Penny believes that being able to offer patients a choice of donor without making them wait is important. “Previously, you didn’t know the donor was going to be available the next time someone came in, because they can only make 10 families.”
According to the Human Fertilisation and Embryology Authority (Hefa), more than 300,000 children in the UK have been born from licensed fertility treatment since 1991. Of those, at least 15,000 were born at Saint Mary’s in Manchester.
Art: Stefan Kalmar AN AGE OF CRISIS: WHAT A GREAT OPPORTUNITY…
2018 is all about reclaiming reality, opposing governmental and corporate paradoxes, and dissecting lies, before they become a new truth, the new normal – a new reality.
A moment of crisis is also the moment in which new movements come into focus and new ideas are formed. I’m excited by Forensic Architecture, an interdisciplinary group based at Goldsmiths College in London, which includes artists, journalists, architects, film-makers, lawyers, data analysts and activists.
Forensic Architecture is the name of the research group as well as an investigative practice that crosses fields. It is grounded in the use of architecture as an “optical device”, employing forms of spatial analysis, mapping and reconstruction, overlaid with witness testimony and visual documentation. The group has undertaken a series of investigations into human rights violations and acts of state and corporate violence that have informed military, parliamentary and UN inquiries.
At the same time, Metahaven, a Dutch design studio, deals with information democracy and corporate identity. Its most recent work, The Sprawl, considered the “ways in which fantasy can be designed so as to seem or feel like a truth … how propaganda multiplies within that upload/download architecture; an architecture in which both fact and fiction can exist side by side and even overlap”.
These groups are, in many ways, the contemporary version of the Independent Group, a collection of radical young artists, writers and critics who in the 1950s called the Institute of Contemporary Arts (ICA) their home. And if the groups look similar, then this is because the struggles are too.
Stefan Kalmár, a former Turner prize judge, is the director of the Institute of Contemporary Arts
Politics: Ed Miliband
EMBRACE THE IDEALISM OF THE YOUNG
A major reason to be cheerful in politics in 2018, and for years to come, is young people. Amid the gloom that has hung over politics and society since Brexit and Trump, young people have represented the most noticeable countervailing force. We saw it this year at the general election, and we have seen it in the waves of young people engaged in the anti-Trump movement, the #MeToo campaign and much else.
The significance lies not just in another set of people demanding progressive things, but a set of people with a new set of demands, unencumbered by the past and driven by the circumstances of today. People born after the fall of the Berlin Wall, for many of whom LGBT+ rights, a new wave of feminism, the fight against climate change and an openness to radicalism are part of their generational DNA. When they look at the mess previous generations have made, they are driven to this desire for something better. Our deeply unequal world, including inequality between generations, is turbocharging this movement, which is not scared to demand big change.
Their idealism will often be dismissed as naivety or worse, as every wave is always dismissed, including the 1960s wave of feminism and anti-war sentiment. But older generations should resist the “we know better” impulse, the tendency to being a “centrist dad” as the term goes. Of course, this idealism is not always right, but its spirit is essential, and the demand it embodies for a new, fairer, more equal society should be embraced.
Pessimism and cynicism achieve nothing. By contrast, the energy and vitality of this new generation can help defeat Trump and lead us to build a post-Brexit Britain that doesn’t float off into a low-wage, offshore tax haven.
Just as the causes of earlier generations of young people, once dismissed as outlandish and radical, eventually became mainstream, so too it can happen again. They are the best hope for the transformation of the country we are to the country we can become.
What we are is determined by our genes and by the sequence of the four chemicals – nucleotides – that make up the strands of our DNA. Fifteen years ago scientists sequenced and mapped the DNA in the human genome: they determined the order of the three billion nucleotides that make up our genetic material and they established (roughly) what the different parts of the genome do.
That has been extraordinarily powerful in helping us understand how life works and what it is to be human. But to say we have sequenced “the” human genome is misleading. Our genomes are all different, and if we are to understand susceptibilities to disease, or how people will respond to certain treatments, we need to correlate the health of individual people with their individual DNA sequences.
2018 should see this begin to happen. Thanks to advances in DNA sequencing technologies, and contributions from private sources, government and charities, it is now feasible to read the precise DNA sequence in every volunteer recruited to UK Biobank. Set up 10 years ago, UK Biobank represents a cohort of half a million people between 40 and 69, all of whom contribute information about diet, activity, body measurements and other personal information, as well as samples of blood, urine and saliva. Participants have agreed to have their health monitored, and approved researchers from academia and industry have access to all the anonymised data.
Already UK Biobank has transformed our understanding of health and disease, improving diagnosis and care for those with cancer and rare diseases. But if every participant has their genome sequenced, the prospects for understanding and treating disease, including obesity and mental health disorders, will be extraordinary. We do not know what we will find, but we can be confident it will transform our understanding of what it is to be healthy and what it is to be sick.
Dr Jim Smith is a developmental biologist and the director of science at Wellcome, the science and health foundation
Infrastructure: Sadie Morgan
TIME TO BUILD PRIDE IN OUR ROADS AND RAILWAYS
Our built environment is so integral to our lives that most of us rarely think about it – we take it for granted. We can say the same about the design of our infrastructure and how it affects people and place. It rarely gets the attention it deserves.
As architects and designers our focus has been on buildings at the expense of everything else. We can all think of our favourite building, but can you name a great streetscape, road junction or railway viaduct? That’s because often what defines the infrastructure of our countryside and cities is the miles of security fences, concrete noise barriers and railway stanchions.
Reimagining our built environment is one of the greatest opportunities we have to put a healthier, more compassionate and greener philosophy into place.
From stations to bridges, roads to railways, electricity pylons to flood defences,our infrastructure should engender national pride and a sense of local ownership. Look to the past, and there are plenty of great examples from Brunel’s bridges to Bazalgette’s sewers and pumping stations to power stations reimagined for the 21st century, as in Battersea and Bankside, now Tate Modern.
The UK consistently nurtures some of the best engineering, technical and architectural minds in the world, but we are building it elsewhere.
The good news is that big projects such as HS2 – the largest infrastructure project in the UK for a decade – has committed to high-quality design from the outset.
Britain has proved it is capable of designing and building world-class infrastructure. Add that to a commitment to invest hundreds of billions over the next decade, and this is an exciting prospect. I see 2018 as the year Britain rediscovers its infrastructure mojo.
AS PRICES RISE, RESTAURANTS AND FARMS WILL STRUGGLE
Of all the falsehoods peddled by the pro-Brexit lobby, the most egregious was the notion that it was a decision for our future; the impact of the decision to leave the European Union on our food chain was instant, with the devaluation of sterling leading to an acceleration in food price inflation. By November this year it was running at 4.2%, a third higher than the headline rate.
In 2018 it is only going to get worse: the price of food will continue to rise ahead of general inflation, and as a weakened pound makes exporting ever more attractive, the major retailers will find themselves locked in competition with international markets for produce. Expect to see the big four supermarkets – Sainsbury’s, Tesco, Asda and Morrisons – softening up their customers for higher prices. Meanwhile, the discounters, especially Aldi and Lidl, which keep prices low by restricting choice but buying in enormous volume, will flourish.
The optimistic view is that this should all be good for food producers in 2018. In reality, Britain’s farmers have rarely benefited from competition among retailers, which have always prioritised shareholders over suppliers. What’s more, farmers have their own price issues. Few food items are the result of a solely domestic supply chain. They depend on inputs – seedlings for fruit growing, for example, or animal feeds – from abroad and the prices of those have also risen. More pressing are the accelerating labour issues. British agriculture depends on migrant labour, and there is increasing evidence of a reluctance to come to work here, both because the wages are worth less when sent home, and a growing perception that Britain is a less welcoming place for workers from abroad.
This is all going to be felt most keenly in the restaurant sector, which is preparing itself for a brutal 2018. Those ingredient price rises, combined with increased business rates, a shortage of vital staff from abroad and a general softening in consumer confidence, are expected to result in many restaurants going bust. For Britain’s food industry the next 12 months are not expected to be kind.
Jay Rayner is Observer restaurant critic
GRAVITATIONAL WAVES WILL CHANGE ASTRONOMY
We all know Einstein was a pretty smart chap, but few things show how ahead of his time he was as the recent detection of gravitational waves, which came out of his theory of general relativity, and is now transforming the way we look into space.
In this theory, Einstein merged three-dimensional space and time into a four-dimensional continuum called spacetime. Within it, mass causes distortions in spacetime and this manifests itself as gravity (you may have seen this shown as a distortion of a rubber sheet). A gravitational wave is formed when two or more super massive objects collide, resulting in ripples in spacetime that, like ripples on a pond, expand outwards into space.
The challenge was that these ripples are minuscule. The measurement needed is the equivalent of detecting a movement of 1mm over the distance between us and Alpha Centauri (our neighbouring star about 25 trillion miles away). It sounds impossible, but the gravitational wave has a very distinct signature that can now be detected.
The joy of this is that it gives us a whole new way of doing astronomy. For thousands of years observations with the eye, telescopes, photographic plates and digital detectors all relied on detecting electromagnetic waves – one of the few things that can travel through the vacuum of space.
Ligo (Laser Interferometer Gravitational-Wave Observatory) can now make these challenging detections and is now fully operational after a big refurbishment. And with five confirmed gravitational wave detections in the past 18 months, we are gaining momentum – many more exotic collisions should be detected in 2018. A whole new field of astronomy is being established, and it all stems from Einstein’s genius.
Maggie Aderin-Pocock is a space scientist and honorary research associate in University College London’s department of physics and astronomy
Equality: Sophie Walker WOMEN MUST BE AT THE HEART OF A FAIRER FUTURE
Politicians could make 2018 the year that women matter, not by talking about equality but by creating it. Not by telling women to try harder – (“All you need to lift centuries of oppression is to ask better for that pay rise and stop making lifestyle decisions about babies”) – but by understanding the structural inequalities holding women back. By remaking our economy, our society and our institutions.
That would mean understanding that harassment is caused by a power imbalance and is not the result of occasional deviant behaviour; that austerity and welfare cuts damage women because they are designed to; that unaffordable childcare hurts national productivity; that we all get less from gender-blind spending choices.
We could all share care if paternity leave was funded and extended. We would all value it if we saw the benefits of investment in it: care yields twice the economic benefit of investing in construction. The next generation could thrive on relationships based on consent and respect if we taught equality in classrooms. And ending competitive tendering of women’s services could give the specialists who understand how to end violence against women and girls sustainable grant funding to do that work.
We could create a fairer future. If Brexit is the process of remaking our relationship with the world, women must be at the negotiating table. If Brexit is the result of our qualms about immigration, we must build a new system that gives women equal chances to build new lives, with access to public funds. If Brexit is opportunities for all, then women’s jobs and rights must be protected and extended as part of trade talks.
2018 marks the centenary of a small group of white, wealthy women winning the right to vote. It should also mark the year when all women, in all their glorious diversity, could finally vote for their equality.
Sophie Walker is a former journalist and the leader of the Women’s Equality party
Books: Jonny Geller WE’LL WANT ‘REAL’ PEOPLE AND NUANCED STORIES
We have seen a shift in the nonfiction market to “authentic” voices such as memoirs of doctors (Adam Kay’s bestseller, This is Going to Hurt), nurses (Language of Kindness by Christie Watson, to be published in May), shepherds (James Rebanks’s No1 bestseller The Shepherd’s Life) and surgeons (Henry Marsh, Paul Kalanithi). I suspect this trend of “real” people writing about “real” experiences will continue.
But it is fiction that gives voice to our greatest fears and the political upheavals of 2017 have proved a great distraction to the necessary occupation of reading fiction. I can see sweeping love stories that take us away from the Twitter rages of world leaders (Ruth Jones of Gavin and Stacey fame and Jojo Moyes have new books out early in 2018), complex thrillers that take us closer to how the world works (McMafia on BBC1 from 1 January is taken from Misha Glenny’s book on the links between international crime and business), and fantastical stories to transport us (Harvill’s big debut, The Mermaid & Mrs Hancock by Imogen Hermes Gowar).
Added to this, the Weinstein earthquake and its inability to swallow Trump will result in a new narrative conversation. In the 80s and 90s, movies such as Fatal Attraction, Basic Instinct and Disclosure emerged from Hollywood’s sense of a perceived threat posed by a new working female population, and I suspect Hollywood will find a way to give voice to the #MeToo movement. I also believe one response to “populism” will be detailed and specific stories of human struggle, filled with nuance, complexity and ambiguity. Most of all, the huge diversity of voices in Britain that have been waiting to be heard will find a place in the mainstream, and as we move away from continental Europe politically and economically, we will find expression in the bigger questions and multifarious voices in this country.
Jonny Geller is a writer, book agent and joint chief executive of Curtis Brown