IVF is not a treatment but provision of a commodity

It was a conversation with a male friend that first unsettled my up until now very settled views on the use of reproductive technology for older women, personified by the story of Necia Wilden, a new mother at 50. ("Women who go beyond conceivable doubt", Inquirer, January 14-15).

My friend has, like me, grave reservations about the consequences of our unbalanced modern reproductive patterns, which have caused many young women by design or accident to delay motherhood. My friend understands as well as anyone the personal and social costs. But my friend's view of a woman wanting a baby at 50 was alarmingly masculinist. He thought it was analogous to him wanting a Rolls-Royce. "I've always wanted a Roller ... I don't see why I can't have one. Same thing with these women!"

He was quite surprised when I told him it is not the same at all. As a grandmother of about the same age, I say good luck to her. But women certainly understand the difference between a baby and Rolls-Royce.

If we can't understand how different it is, then we can't understand the real ethical problems of late artificial conception. Those ethical problems are not the motivations or desires of women themselves, nor the practical problems they face further down the track.

No, the ethical problems lie with the IVF industry itself, an industry which has commodified the "production" of babies, and which to some degree encourages the false hope and unrealistic expectations of desperate women, allowing by its own guidelines, IVF until 51 years.

Most people do not really understand that IVF is an industry, not a branch of medicine. There are two realities operating with IVF. One is that on a deep emotional psychic level women want to fulfil their natural desire to have babies. That is a universal desire.

But we have allowed that desire to be hijacked by another reality, the manipulative rationale of a highly profitable industry which talks about babies as products. Just as my friend talked about his wish for a Rolls, the IVF industry talks about "take-home babies", as the commodity they produce.

In Canberra IVF companies even advertise on daytime television using soft-focus soap opera-type scenarios with attractive young-looking participants

This industry is unique. It represents itself as a branch of medicine, subject to the same ethical scrutiny as medical practice. But though individual medical practitioners might have their individual ethical constraints, the industry in Australia as a whole is subject to very few, and has quite flexible guidelines.

The NHMRC and ARTAC guidelines apply, and there are some strict legal restraints in Victoria and South Australia, but there is no uniform Australia-wide legislation governing ART practices. What is more, because this industry is in the baby-making business, it has conferred special ethical status on itself so every time there is some new technique the industry wants to move the ethical goal posts to incorporate it.

The ethics of this industry should concern every Australian taxpayer for another reason. The Assisted Reproductive Technology industry is heavily subsidised by taxpayers through Medicare. Our taxpayer-funded medical system was set up to treat sick people, not well people. However, most seeking IVF are not doing so for medical reasons. Most IVF customers are actually sub-fertile, they have just left it a bit late to conceive with ease, so there is no practical or ethical reason why the government should subsidise any IVF treatment for people who do not have a medical condition.

However, the unique product of the IVF industry is coupled, at least in Australia, with a unique sense of entitlement. Consequently, Australia is the only country in the world providing unrestricted public funding for IVF through its national health scheme. There is no limit to the number of cycles that women can have and no legal age limit. (Sweden and Britain provide three on the national health and they have to be before age 39. In New Zealand women get two free cycles in a lifetime and in Canada until recently you didn't get any on the national health.)

There is no justification for this, because contrary to public perception, IVF is not a cure for infertility. It doesn't work if you haven't got the goods, and after 45 a woman's chance of pregnancy with her own eggs is practically nil, as Adam Creswell noted in Inquirer last weekend.

Actually, the truth is even more startling. According to Robert Jansen, medical director of Sydney IVF, writing in the Australian Medical Journal "[After age 34] the chance of a pregnancy that produces a live birth falls steadily to become rare after 42 years of age. The community should be aware that despite IVF, fertility ceases for an increasing proportion of women from their mid-30s. After 33 years, there is an almost unremitting, linear decline in fertility to reach zero at 45 years."

These scientists are, according to their own estimation, performing a social good, hence there was a hue and cry when Tony Abbott as health minister tried to limit the availability of the Medicare rebate for ART. He was only trying to bring it into line with international practice with sensible restrictions. Restrictions that would save many women the heartache and health consequences of hyper stimulation needed for multiple cycles.

But the IVF industry doesn't exist for simple altruism. It is a business with a bottom line worth more than $150 million each year - and that bottom line encourages women to have as many goes as they want. Women don't realise this. That is one reason why so many caveats were introduced in Britain on IVF funded by the national health. Limiting public funding for IVF in Britain has resulted in the use of IVF being more thoroughly scrutinised, and there is now a debate about the use of IVF as a first resort for unexplained infertility.

In Australia we cannot afford to continue to bracket the well with the sick in the health budget. If a couple are too old to conceive, whether it is a lifestyle choice or just bad luck, perhaps other avenues, especially adoption, need to be more encouraged, because at the moment the numbers of heartbroken women with empty arms and pockets far outweigh the lucky Necia Wildens.