The hope that keeps us going

For 25 years, IVF has brought happiness to thousands. But those who undergo treatment, like Bill Parry and his wife, receive little emotional or financial support - especially when things go wrong

Life's funny, isn't it? I spent nearly half my life trying to avoid becoming a parent every chance I had. Now, for the past three years my wife and I have been desperately trying to have a child. We have a handful of names picked - we just need the baby.

Life's funny, isn't it? I spent nearly half my life trying to avoid becoming a parent every chance I had. Now, for the past three years my wife and I have been desperately trying to have a child. We have a handful of names picked - we just need the baby.

For the past 18 months we've undergone invasive and humiliating fertility tests that have, fortunately, revealed no apparent problems. We've had our sex life reduced to a dry, clinical ritual, and we've been through three courses of assisted fertility treatment at Guy's Hospital - two of intra-uterine insemination (IUI) and, just recently, a botched effort at in-vitro fertilisation (IVF). The effects on us, individually and on our relationship, have been traumatic and costly. Still, we'll keep trying.

IVF celebrated its 25th anniversary last Friday as Louise Brown, the world's first "test tube baby", turned 25. It would be churlish not to applaud the profound happiness that IVF has brought to countless couples by way of their own bundles of joy. After all, since 1978, more than 68,000 babies have been born in the UK through IVF treatment, and more than a million worldwide have been conceived through such assisted-fertility techniques.

As Ms Brown has grown and developed, so has IVF. Professor Ian Craft, a controversial and pioneering fertility expert, and the director of the London Fertility Centre, notes several important advances in fertility treatment. These include improvements in culture media, new techniques, use of donated eggs, freezing embryos, controlling ovulation so that you "harvest" an ideal number of eggs, and better management of a treatment cycle by monitoring with ultrasound scans and hormone assays so that you "tailor-make treatment to suit individuals [to] get the most favourable response," he says.

One couple whose lives have benefited from these advances in IVF are Russell and Beth Henley, who live in Salisbury. After Russell had an accident at the age of seven, he was told categorically that he would be unable to father any children. He came to accept this, despite it contributing to the breakdown of his first marriage, but Beth, whom he met in 1988, was determined that they exhaust all treatment options before giving up. Thanks to her resolve and support, their first son, Toby, was born in 1996, a long seven years after they first sought medical help. Again through fertility treatment, Beth and Russell had another son, Marcus, two years later. Two attempts, two successes. Both were then flabbergasted to discover in 2001 that they were expecting a child conceived naturally; Sasha, a cute girl who "holds her own with her brothers", says Russell, with the clamour of children's voices in the background, is now 22 months old.

One in six couples experience fertility complications. Considering that, and given medical advancements in determining and treating those complications, it is unsurprising that growing numbers of us are signing up to this, albeit humiliating and uncomfortable, treatment.

Since 1991/1992, the number of children born from IVF treatment has almost trebled and success rates have nearly doubled. Some 24,000 women underwent more than 25,000 cycles of IVF between 2000 and 2001 in the UK. An average of 22 per cent of them had live births (25 per cent for women under the age of 38) according to the 2000-2001 statistics from the Human Fertilisation and Embryology Authority (HFEA), a statutory body that regulates and licences many fertility treatments in the UK. When you're desperate to conceive, especially if the race is on against the clock, a few percentage points can take on monumental significance in the heart of a wannabe parent.

This hope is what makes IVF treatment so alluring, so tantalising. My wife and I sat through the initial induction at Guy's with perhaps 40 other couples, heard the statistics, grimaced at what it would involve, yet were beguiled by the hope it offered - we were healthy, there were no obvious complications, so we might be one of the lucky couples. I don't think we consciously or unwittingly deceived ourselves - we just invested more optimism in our case. It was like betting on a horse we liked the name and look of, rather than looking solely at the odds involved. And who wouldn't?

But hope can also make IVF a profoundly devastating experience. Nearly four out of five couples will endure weeks of wretched hormone injections, messy suppositories and self-imposed social isolation, undergo potentially painful and invasive egg-collection procedures, and then wait a few weeks to find it was all in vain. Most will also have splashed out about £2,500 for this. We were, in this our first attempt at IVF, one of those couples sorely winded by our hope.

"I don't think everyone has the right to have a baby," says Professor Craft, adding: "They have a right to try." Frustratingly and infuriatingly for many desperate couples, such as ourselves, the "right to try" is too often precluded by financial constraints, as 80 per cent of fertility treatment in the UK is not covered by the NHS. You may have a better chance of getting pregnant naturally than of getting fertility treatment on the NHS, or of understanding how it's determined: the postcode lottery, the woman's age and one's past record of fertility all play a part to varying degrees, as do individual local health authorities.

Russell and Beth endured five years of inept and niggardly NHS fertility treatment, which put more effort into advising a succession of cheap, unlikely treatment possibilities than into determining and providing the right treatment. They then turned to Guy's Hospital for private care. Although they were put on an 18-month waiting list, once consultations began their case was swiftly assessed and they were advised that the best course of treatment was intra-cytoplasmic sperm injection (ICSI). They calculated their finances, decided they could afford four cycles of treatment, and, just a few months later, Beth was pregnant with Toby.

"Infertility is not treated as a medical condition, with all the potential side effects (psychological and medical) that can come with not treating it soon enough," says Russell. Prompt NHS treatment for other conditions, such as breast reductions and largely "self-inflicted" conditions (cancer, heart disease, liver damage) riles him: "Infertility is totally beyond the control of its sufferers. It is common, classless and devastating, both physically and emotionally... yet little is done to help," he says.

The NHS's approach to funding infertility treatment is under review, says a spokesman at the Department of Health. The National Institute for Clinical Excellence is conducting a full review of the matter. The DoH will adopt its guidelines, which should "ensure that, in the future, couples get fairer and faster access to clinically cost-effective and appropriate infertility treatments," the DoH reports.

Some fertility experts complain that HFEA guidelines are insufficiently flexible and do not reflect data from overseas, or approaches successfully tried elsewhere, which could benefit UK couples. Professor Craft mentions the strict rules concerning the number of embryos that can be transferred back into the womb - the standard is two, the code of practice maximum is three - and believes that each case requires a particular approach. "I don't know of any discipline of medicine where a doctor, on occasion, is prevented from doing the best for his patient because of rigid guidelines which are inappropriate to that particular couple. Flexibility is very important, and treating people as individuals, and we're less able to do that with fairly rigid regulations. That's sad, really, because that's not the basis of medicine."

His centre is using the potential of Gift, or gamete intra-fallopian transfer, which is not regulated by the HFEA. Consequently, a higher numbers of eggs can be collected, mixed with the partner's sperm, then returned to the fallopian tube for fertilisation. "There's a possibility that Gift treatment may actually be more efficacious than IVF in the laboratory," says Professor Craft, "in that you're putting eggs back into a fallopian tube environment, which you know is optimal because it's natural." His centre has shown it to be twice as successful as IVF for women aged 40 and over, and it has helped younger women who have had repeated IVF failures. Risks of a high multiple pregnancy seem negligible, he says, though this approach alarms other fertility experts. "Those who are critical haven't done it," Professor Craft retorts.

Strides in fertility treatment are sure to continue. Hopefully it will be more widely available to more couples through the NHS in the coming year or two, lifting Britain from the bottom of European fertility league tables. My wife and I will continue the best we can in the meantime to conceive with professional assistance, drawing on each other's love and support.

Who knows? Perhaps in another 25 years, we'll have a next generation test-tube baby - perhaps a Gift-ed child - of our own.

HOW TO MAKE A BABY

* IVF The woman undergoes a period of hormone stimulation, then a number of eggs are collected from her and mixed with her partner's (or donor's) sperm. Fertilisation takes place in a culture dish. Up to three of the embryos created are transferred to the womb. IVF can also be used with donated eggs, sperm or embryos, where appropriate.

* ICSI may be appropriate when the male partner has very few sperm. It follows the same course of action as IVF, except that a single sperm is injected directly into each egg. Again, a maximum of three fertilised eggs can be transferred back into the womb.

* IUI The woman's ovaries are stimulated to produce several eggs. A preparation of the man's sperm is deposited directly into the uterus through the vagina, and ovulation is induced.