your great life

Got kids? Good financial planning brings peace of mind

In a recent article for Mindful Mum, I suggested that older mothers could benefit from seeing an independent financial adviser (IFA) to help plan for the upbringing, education and legacy for their children. Actually, all of us should do some financial planning, regardless of the age at which we start our families. It isn't just about feeding and clothing a child. We are fortunate in this country that school uniforms are sold in supermarkets for next to nothing, health and dental care are covered by the NHS and public transportation is free for children. Still, the most recent cost estimates of raising a child born in the UK to the age of 21 is £200,000. The average UK family has 2 children. Scary, isn't it?

The financial pinch is getting just a bit sharper all the time, with rising costs and cuts to public budgets. When they're young, children's costs seem to be mainly about after-school clubs, sports kit and birthday parties. Fast forward a few years and it's a different story. You may find that your teenagers can't find the Saturday jobs that once helped support their social lives. School-leavers may think twice about higher education now that tuition has risen to £9,000 a year at some universities. Many children are now happy to stay at home with Mum and Dad into their 20s, rather than fork out their earnings for shared rental accommodation. Whether you are worried about how you will meet your financial commitments in the future or you just want to make sure that you can uphold a certain standard of living, complete with winter and summer holidays, it pays to do some financial planning now. The benefits don't just apply to older parents; they are applicable to everyone, regardless of age or how much money you have. Good financial planning can help you:

1. Protect your family with the right type and amount of health, property and life insurance;
2. Plan your spending and saving;
3. Plan your retirement;
4. Secure your house with the right level of borrowing and best mortgage rates;
5. Build your assets through smart investment;
6. Find the right combination of assets based upon your attitude to risk and your financial position;
7. Obtain an objective assessment so you can make informed decisions;
8. Save money through tax incentive schemes;
9. Keep you on track by monitoring your investments in a changing market; and
10. Have the peace of mind.

It's also important to think ahead about how you would cope if you or your partner lost your job, your business took a downturn, or at worst, one of you became seriously ill or died unexpectedly early. Would one of you be able to cover your mortgage, council tax and utility bills so you could stay in the family home? Actually, it's never too early to address the issue of a Will, regardless of how uncomfortable it makes you to think of your mortality. Make sure that your partner and children are provided for appropriately, especially if you are not married.

What you should look for in a financial advisor:

• (S)he should be fully independent, so that her recommendation of financial products is objective and based upon your needs;
• A free, no-obligation telephone consultation
• Confidentiality
• Good rapport and ease of communication
• Registration with the Financial Services Authority

 

 

 

 

 

Stepmums can be denied NHS fertility treatment

This morning on The Wright Stuff, presenter Matthew Wright posed the question whether stepmums should be denied IVF treatment because they have (someone else's) children in their life. This isn't the first time I have heard of this. There have been occasions in the past when Primary Care Trusts (PCT) have denied fertility treatment to women whose husbands already had a child, albeit with another woman, or who have had children themselves in previous relationships. It's an example of bureaucratic policy making that doesn't take into account the human experience of the people it is meant to serve.

Susi Henson, a 33-year old woman has been denied IVF because her partner has a 20-year old son from a previous relationship who she has never even met.  This seems like blind adherance to a rule that does not take into account her medical condition, Polycystic Ovary Syndrome, that prevents her from conceiving. The Nottinghamshire County PCT has ignored the true facts surrounding this woman's childless status, in favour of a view that this is not a "childless couple."  However, in no way could Susi Henson ever be considered to have had the opportunity to parent her partner's child, considering that he is only 13 years younger than she is and lives in Wales. 

Some of the points made by Wright and his guests, including Anne Diamond, concerned the limited NHS budget, whether everyone has a right to have children, whether everyone who needs IVF should be able to access it free and how many cycles of IVF should be alotted per patient. There will always be controversy, as long as individual PCTs can use their own criteria for eligibility. For instance, Wright mentioned that about one-third of PCTs will allow patients who are smokers to access IVF, even though smoking is known to inhibit conception, raise the chances of miscarriage and impact upon the health of the foetus during pregnancy and after birth. It is, perhaps, the uneven and confusing allocation of fertility treatment that galls people the most. 

A caller to the programme, Katie, was also denied IVF which she needed due to blocked fallopian tubes because her partner had adult children.  She eventually managed to save the money for private treatment and is now the mother of a 5-month old baby, but considers the financial hardship it caused to be unfair.  Susi Henson phoned in to the show to say that she has received a lot of public support, as well as a phone call from one of the policy-makers who has promised to review her case and the PCT's policies on IVF treatment. However, the policies are only reviewed in April each year. Matthew Wright emphasized the inadequacy of this offer, pointing out that the delay of nearly a year could negatively impact upon Henson's chance of conceiving, as age is an essential aspect of a woman's fertility.

Even if a woman is the stepmother to her partner's young children, and partially responsible for their upbringing, should she be denied the ability to have her own children? By definition, those children have, or had, a mother already. Step-parenting can be difficult and is not always loving or even cooperative, depending upon the degree of amicability between the estranged parents of the children involved, custodial arrangements and other emotional factors. While step-parenting may fulfil some women's needs, others will never see it as an adequate replacement for the experience of giving birth to, raising and loving her own children. Further, it is entirely natural for a couple to want to create a family of their own.

If a woman meets all other criteria for fertility treatment on the NHS, and it is deemed medically necessary in order for her to conceive, it seems cruel and unjust to deny her that chance. Most women have no inkling of their infertility until they have begun trying to conceive, therefore, they will not had the chance to take it into account when agreeing to marry someone who already has children from a previous relationship.  Ironically, they may have had an easier time accessing NHS treatment is they were single, as many PCT's will allow IVF to single women.  This is symbolic of the incoherence and uneven-handedness of the present policies existing across the UK. If we are to ensure a fair allocation of NHS funds for fertility treatment, wouldn't it be better to look at the people concerned and make more individual decisions? Matthew Wright thinks an IVF ombudsman could work. I like the idea of individual, people-centred decision making, but I imagine I can already hear cries of alarm about the cost involved in that: how many IVF procedures could have been paid for with the salary of the ombudsmen?   

You know about the National Lottery and Euromillions, but have you heard of the IVF Lottery?

We are used to hearing about how the National Lottery or Euromillions has changed someone’s life, but have you ever contemplated a lottery that can actually result in new life? The UK charity, To Hatch, has just been granted a license by the Gambling Commission, allowing it to sell lottery tickets online. The prize, to be awarded monthly, is £25,000 worth of bespoke fertility treatment at one of the UK’s top clinics.  Camille Strachan, the founder of To Hatch, has told the media that the lottery is more like a raffle, open to single, gay and older people as well as couples who have not been able to conceive.  She explained “This is not a wacky stunt; it is about helping desperate people who cannot afford to go [for fertility treatment] privately.”

Criticism has been harsh - The plans for the IVF lottery were released to the media this week, prompting a flurry of comments by spokesmen from public interest groups and regulators, including the Human Fertilisation & Embryology Authority (HFEA), the British Fertility Society (BFS) and Comment on Reproductive Ethics.  All three voiced concern and negativity, the HFEA’s position that “using IVF as the prize in a lottery is wrong and entirely inappropriate.” While headlines branded it the “win a baby” monthly lottery, what is really being offered is access to treatment and a few conveniences such as accommodation in a luxury hotel, chauffeur-driven transportation from the hotel to the fertility clinic and a mobile phone for constant contact with doctors. 

A dream come true? - On the face of it, that all sounds like a dream come true for anyone who has failed to access fertility treatment through the National Health Service (NHS) due to age, the birth of previous children, their Primary Care Trust (PCT) insufficient budget or those who can’t afford private treatment.  There would be a dozen lottery winners a year and the profits, approximately 20% of ticket sales, would go to Strachan’s charity, To Hatch, which offers fertility information and advice to members.  Even for those who have already been footing the bill for IVF themselves, I anticipate that many would appreciate being pampered a bit while undergoing stressful treatment.  

The patient's perspective - Having felt the desperation associated with infertility myself, I will admit that if I was still trying to conceive I would be tempted to buy a ticket for the IVF lottery. After all, with a lottery win, the time I spent consulting different doctors, going for lab tests, crying over the failure of the NHS to offer me help, trying to find the money for treatment and choosing a clinic, could have been spent feeling lucky, supported and hopeful. Furthermore, this is in no way a chance to “win a baby” as the news headlines are screaming. At its best, this scheme offers someone who wants a baby, not only the chance to pay for treatment, but also the ease of access to quality treatment in the UK that Strachan will provide. Let’s not forget, that plenty of UK residents who have been frozen out by the NHS restrictions on fertility treatment look into fertility tourism schemes that require them to go to the US, other European countries and India for treatment. The risks presented by treatment abroad include the lack of continuity of care and the differing regulations regarding fertility treatment.

The most substantive concern over what the IVF Lottery will actually provide centres on the possibility that winners could access donor sperm, donor eggs or even the services of a surrogate to carry their baby. Josephine Quintavalle from Comment on Reproductive Ethics demanded to know “surely it is not legal to pay £20 to have access to another woman’s womb?” Isn’t she missing the point? The surrogate wouldn’t be paid £20. The proceeds of the lottery win would be used to compensate her appropriately, within the restrictions imposed by law.  Does it matter from whose pocket the compensation actually comes?  Furthermore, there is no suggestion that winners are guaranteed to conceive, give birth to or otherwise receive a healthy baby; participating doctors will still be governed by medical ethics and regulations.

Other schemes already exist to defray the costs of treatment, such as the practice of offering fertile, gay women free or discounted IVF in exchange for their surplus eggs, which are then “sold” to infertile patients at the clinic. This is euphamistically called "egg sharing." US fertility clinics run promotions offering free IVF, from which they build a mailing list, gain media attention and can claim to be philanthropic. One of these, the Fertility Treatment Center in Scottsdale, Arizona, is currently running a promotion on their website: “Enter to win a FREE IVF Cycle worth an estimated $15,000. Open to the first 100 guests ONLY...RSVP today!” This type of promotion has already made an appearance in the UK; earlier this year, the Genetics & IVF Institute in Virginia and the London Bridge Centre offered a free cycle of Donor IVF to one attendee of their joint seminar in London.  

If nothing else, the controversy over Strachan’s plans is positive; forcing more attention to be paid to the plight of those who can’t access appropriate fertility treatment in the UK.  We need to keep the spotlight on the medical, lifestyle and environmental causes of infertility, the inability of the NHS to meet the demand for fertility treatment and the advances in medical science that could allow more people to create families of choice.  I doubt that there would be this level of controversy if there was a cosmetic surgery lottery, a bariatric surgery lottery or a hip-replacement lottery.  When balancing the arguably sensational and gimmicky nature of a lottery against the hope and joy it could give someone who wants a baby, I would have difficulty pointing the finger of disapproval at anyone who decided to give it a try.

Medical tourists to the UK drain our taxpayer-funded health service

Once again, the allocation of taxpayer funds for IVF and maternity care is in the news.  This story concerns a Nigerian woman who was prescribed Clomid, a fertility drug that stimulates the production of eggs, in her native country. She then came to the UK knowing she was pregnant and subsequently gave birth here to quintuplets.  Her care, and that of her five newborn babies, has cost the taxpayer 200,000 pounds already.  Bimbo Ayelabola, 33, would like to stay in the UK, rather than return to Nigeria, claiming the babies, born on April 28th, are too fragile to travel.

Ayebola's presence in the UK at the time of her children's birth meant that she was provided with free maternity and post-natal care. Her delivery by caesarian section at Homerton hospital in Hackney, London, required the involvement of Consultants, midwives, operating staff, social workers and health visitors. The premature babies were then cared for in a special-care unit.  She is unable to pay back the NHS for the treatment they received, as she is already struggling to pay for the most basic items of food and nappies. As she is not entitled to claim benefits or work in the UK, her ongoing presence here would continue to drain public funds. Eventually, her housing needs will need to be addressed as well, as she is currently living in a 2-bedroom flat with her sister and the quintuplets, while her husband remains in Nigeria.

Balancing an individual's needs against the public interest - Upon hearing of Ayelabola's previous miscarriages and anxiety regarding this pregnancy, it may be understandable that she did what she could to protect herself and the babies. She has a better support network of friends and family here. Moving to the UK specifically to make use of the NHS is an attractive proposition.   However, NHS funds are stretched to the limits already, causing many who are legitimately under its care worrying that they will be denied treatment. While it bills foreign nationals who do not have a right to free medical care in the UK, the NHS has little hope of receiving that money from people who purposely travel here with undisclosed medical issues to take advantage of the system. According to The Sunday Times, the government has instituted rules recently that deny overseas visitors entry if they owe more than 1,000 GBP from a previous visit, but that still leaves alot of room for someone to come in to the country just once, like Ayelabola, and drain its resources.  

Who is responsible? It would have been impossible for immigration officials to know that Ayelabola was 3 months pregnant in December, let alone with 5 babies, when they issued her a 6-month visitor visa.  They can only go on information provided, and she kept that vital bit of information to herself. When a woman presents herself at a hospital, about to give birth, maternity care is provided first and questions asked later, to ensure the safety of mother and children. Both systems were abused. In this case, while Ayelabola has relatives and friends in the UK, they don't seem to be stepping up to take care of their own. Approximately £7 million in bad debts and claims were abandoned in respect of overseas patients in 2009 - 2010, according to the Secretary of State for Health. 

The impact on public opinion - Some will use this as an excuse to criticize the delivery of funded fertility treatment and maternity care. We frequently hear an outcry about who should and shouldn't be entitled to care, including one this week regarding a single mother who received IVF on the NHS. There are those who believe that having children is a right to which they are entitled and others who believe it is a blessing that is, unfortunately, not universal.  While Ayelabola did not have NHS-funded IVF, the fact that her quintuplets were born as a result of fertility treatment, will link her case in people's minds with the financial burden on the taxpayer due to fertility treatment. I don't see it that way. Unfortunately, all systems are subject to abuse. I would rather have funded treatment available to all who are entitled to it and deal with the minority of questionable cases as they come up.

What now? - I haven't seen any official comment on how or when the quints would be fit for travel, but I don't see why the Home Office couldn't require a return to Nigeria based upon medical clearance, rather than an extension of 6 months to Ayelabola's visitor visa or allowing her permanent residency. The problem is that allowing Ayebola to stay here indefinitely; 1) increases the cost to the taxpayer, 2) lowers public tolerance for NHS-funded fertility treatment, including premature and multiple births and 3) opens the door for others to try the same tactic. Unfortunately, without knowing of any extenuating circumstances that would threaten the health or safety of Ayebola and her children, I have to come down on the side of public interest this time.

This is what some of you said about my talk on the Telesummit!

I really enjoyed being a part of the Fertility Focus Telesummit and I'm touched by your response. Here are just a few of the messages I have received:

• "Lisa,Thank you so much for what you do. I'd love to get the worksheet.Warmly," L. 
• "[T]hank you so much for our talk and for your valuable information.  I actually listened to it twice, once by myself live and then again with my husband." MS
• "I really appreciated your talk. I would love to get your worksheet for creating a support network.Thanks so much for offering this." NS
• "I listened to your very interesting call today, thank you so much! Could you please send me your work sheet I think it is exactly what I need." PC
• "Thank you so much for sharing your insight at the Fertility Focus Telesummit - it was truly appreciated." CP
• "I found that you really "spoke" to me and it was very timely in my fertility journey." AR
• "I had a chance to listen to you on Telesummit. You are awesome! My goal is to find a friend (or maybe two) who I can talk to when I am ... down and vulnerable." SP
• "It was wonderful listening to you. Thank you." LF
• "Just listening to you doing such a great job on the Fertility Focus teleseminar - very proud of my former study buddy! [iI]'s a great idea to actually list my support network under the different categories." AS

 

If you, or someone else you know, could benefit from the other topics covered by the fertility experts listed below, get the word out to them quickly! To grab a free place on the remaining calls <--- click here.

• Using An Integrated Approach To Getting And Staying Pregnant - Dr Marilyn Glenville
• Using Acupuncture and Herbal Medicine to Increase Your IVF Results - Andrew Loosely
• How the 11 Pillars of Fertility Reveal the Secrets to Optimum Health and Fertility - Gabriela Rosa
• Aging Eggs: What You Can Do to Improve Your Chances of Conception - Zita West 
• Your Fertile Mindset: How To Prepare Yourself For Conception With EFT - Sarah Holland
• How Hypnotherapy Encourages Successful Conception -  Kristin Hayward
• Solving Your Fertility Puzzle - Sue Dumais
• Using Astrology To Optimize Your Chances Of Success In The Treatment Of Infertility - Nicola Smuts
• Finally Take Control by Charting Your Two Primary Fertility Signs - Toni Weschler
• Fertility At 40 Plus with the Law of Attraction - Deirdre Morris
• Eating to Optimize Fertility - Cindy Bailey

AND 3 Fabulous Bloggers:

• Katie from www.fromiftowhen.com;
• Elphaba (aka Runny Yolk) from www.eggsandsperm.com; and
• Heather from www. surviveandthrive.co.za

If you didn't manage to get on the first few calls, including my talk on Creating an Effective Support Network, Dr Genville, Andrew Loosely or Gabriela Rosa, you can still listen to the recordings!

By upgrading to a Golden Ticket for you can still get all 17 audio files full of information and advice about how to get what you need to maximize your chances of having the baby you want, emailed to you as an MP3 download after the Telesummit is over. That includes all 15 talks listed above, plus Sarah Holland's introductory and concluding sessions, to listen and refer back to at your leisure. This is an incredible value, for a total of $67, available while the Telesummit is still running this week. For more information and to upgrade your place on the Fertility Focus Telesummit <---- click here.

Where will you go from here and how will you get there?

Do you feel exhausted by your attempts to conceive this past year? I wouldn't blame you. If you are on the side of the world where December is the darkest month in the calendar, or even worse, you live in a place where the sun forgot to shine this week at all (yes, you Londoners!), you may feel just a bit hopeless. If you spent a substantial amount of time during the Thanksgiving to Boxing Day month in close proximity to women who are pregnant, or who have recently become mothers, you may feel more than a bit discouraged by your personal lack of success in that area. Or frustrated, fed up, resentful or downright furious. The big question is where are you going to go from here?

January is a great month to re-assess your position. It may be the cliche of out with the old, in with the new, but hey, if it works then why not follow it?  I'll be writing more about this during the next few weeks, including a new coaching programme that will help you solidify your intentions, streamline your actions and recognize shifts as soon as they show up in your life.

What I do want to get across to you today, is that what worked for you last year may not be what is working for you now, or what will work for you in the next 12 months. Why? Because we are always evolving; not static. You are a year older, your body may either be more or less fit, fertility treatment and/or miscarriage may have taken its toll, you may be recovering from positive surgery to clean up endometriosis or from an unexpected diagnosis, your stress level may have changed, your financial situation may have changed, and more. When creating your plan for 2011, it's essential that you do a physical and emotional audit, so that you and your partner, and even your doctor, have your eyes wide open to how you feel right now.

Instead of looking at your infertility as one long haul, it can only help to stop and assess where you are now and whether any changes need to be made. The answer may be that you are satisfied with the way things are, and you can continue on with confidence. However, if your exploration of the way you are going about life brings up questions about what can be done differently, or better, for a more effective outcome, we can work out some of those issues together. 

It would be great if you could begin jotting down notes now, as thoughts occur to you. Then, you will be ready to work with me as I introduce each step of the process in the coming weeks.  Ease yourself in gently, so you don't feel like it's hard work or get overwhelmed. My favourite first purchase every year is a new journal. I love starting fresh with the clean pages, whether I am using an old-fashioned black-and-white speckled Composition Book or a pretty and cheerful, designer journal. Just make sure it is big enough that you can use it for several months, or buy more than one, so you can continue on.

Watch for more news on the launch of this new programme.

 

 

 

NHS fertility treatment suspended in West Sussex until the new fiscal year

Some people would say that if you get something for free, you really shouldn't complain too much if it's faulty, late, slow, or not all that. If you moan when Twitter goes over capacity, or all your followers disappear, you may very well get messages telling you to chill out, be grateful and get a life. However, when it's medical care that you're seeking, does that apply?

Okay, so the NHS medical care isn't "free." It's subsidized. Everyone pays in to the system, but we are meant to benefit from medical care based upon need. Coming firmly down on the side that says fertility treatment constitutes a need, not just a desire, I think it's well within our rights to moan, whine and bitch when it's withheld, or even postponed, because of budget constraints. Why? Not just because I like a cause. It's because the NHS is a government scheme, thus a political machine that becomes complacent if ignored and responds to public pressure. It needs to be held accountable for its decision-making.  If we want a particular level of service, we have to be vocal about it.

Patients in West Sussex have just learned that all fertility treatment has been put off now until the NHS's next fiscal year, beginning in April, 2011. Not just fertility treatment, but also treatment for obesity, varicose veins, vasectomies and even knee operations.

Acting medical director Andrew Foulkes said*: “Our ageing population means that more people rely on the NHS when they are affected by cancer, stroke, dementia, diabetes, and many other serious conditions. “We have invested heavily in improving these services in recent years. “To make sure that we can all access services when we need them, it is necessary to prioritise how the budget is spent although we know that for some patients this will mean waiting slightly longer for treatment."

What is the real impact of this decision? Take into account that:

• It often takes a couple over a year to consult their GP about a failure to conceive;
• Couples are often sent away for several more months with well-meaning suggestions of how often to have intercourse, how to de-stress and make other lifestyle changes;
• Once the GP agrees to make a referral for fertility treatment, there can be lengthy waiting times; and
• Each couple has a window of opportunity for NHS treatment, based upon the woman's age.

The impact could be that a woman who is coming up to her 40th birthday could be denied treatment before the cut-off date and miss out on NHS-funded fertility treatment entirely. Foulkes said “It is also important to remember that there is no blanket ban for any treatment – if someone has a compelling medical need, they will be treated.” Will a woman's imminent 40th birthday be considered a compelling medical need?

My other question relates to the amount of fertility treatment available as a percentage of the NHS budget. If 4 months worth of postponed procedures are being shifted to the new fiscal year, that suggests that there is 1/3 less fertility treatment being performed than was originally budgeted. That doesn't mean that the missing 1/3 is being added to next year's procedures; rather, they will be coming out of the new budget. Unless the budget is increased substantially, which is very unlikely to happen in this economy, another 1/3 of patients will find their fertility treatment postponed or disallowed. The postcode lottery has just had its odds increased.

*As reported by Siobhan Ryan in The Argus.

A chance to listen, learn and speak at PET's Debate - Paying Egg Donors: A Child At Any Price?

There are times when I feel very fortunate to live within easy commuting distance of central London and last night was one of those.  Instead of the usual household chores and evening TV shows, I popped into London to attend a debate organized by the Progress Educational Trust (PET) at the Royal Society of Medicine: "Paying Egg Donors: A Child At Any Price." It was well worth the effort, to be privy to the information and opinion of several eminent speakers on the panel, as well as those audience members from the fields of medicine, counselling, government, related charities and scientific research.

One thing about which there is no debate is the extreme shortage of egg donors in the UK. The Human Fertilisation and Embryology Authority (HFEA), which currently regulates the providers of fertility treatment such as IVF using donor eggs, will be considering various models of compensation in January, 2011, as a possible means of boosting supplies of donor eggs. as well as reversing the increasingly popular choice among British residents to travel abroad for fertility treatment.  At the last HFEA Open meeting on the 8th of September, 2010, which I attended, its chair, Prof. Lisa Jardine, made no bones about the fact that she is concerned that fertility treatment providers in foreign countries may not be subject to the same stringent oversight as in the UK, therefore creating a risk to patients. Others' objections to "fertility tourism" may be equally concerned about the loss of revenue to UK fertility clinics, exploitation of egg recipients' desperation for a baby, and the trading of human, genetic tissue (gametes) as a moral issue.

Currently, in the UK, egg donors are only compensated for their expenses, which include loss of earnings for days of work missed; a daily maximum of £61.28 or a total of £250.  The questions regarding payment were these:

1. Should compensation merely compensate for lost earnings, or for additional factors such as risk to the donor, drug treatment, sexual abstinence and/or pain and discomfort? If the latter, then how much compensation is reasonable, to leave the donor no worse off than she was before the egg donation, but no better off financially?
2. Is egg sharing morally favourable because the donor is giving her eggs to another woman, or is it merely a financial transaction (trading of human eggs for financial gain) by another name (donors receive a discount on their IVF)?
3. Should egg sharing be limited to altruistic donation in which the donor has no expectation of any financial payment, or other compensation?
4. If there is no legal barrier to a woman giving her eggs to someone else, why shouldn't she be able to sell them?

One panel member, Brenda Almond of the Philosophical Society of England, likened the trading of genetic material, cells, to the slave trade.  She cited libertarianism, as a philosophy holding that the vulnerable should be protected, to support her assertion that human eggs, which could one day become embryos and eventually, a living child, need protection. I assume what she meant is that the children who are born of those eggs are not able to assert free will over how the transaction takes place.  She also posed the question of whether, by performing donor egg IVF, clinicians are violating the "do no harm" rule, as there is inevitably emotinal impact upon the donor, the recipient, the donor's children and the recipient's child.

While I don't doubt that Ms Almond holds sincere views on the subject, these controversial views, were, in my opinion, stated for effect last night. While I don't subscribe to her views, I was very open to hearing everyone, but found her to be the least persuasive of all the speakers. My belief is that the slave trade argument doesn't apply, as :

1. the egg is not "human flesh;"
2. if produced by the donor, but unused to create a pregnancy, it would otherwise go to waste; and
3. there is no human child, if the egg is not fertilized with the intended father's sperm and carried in the intended mother's womb.

Opinions diverged widely during the debate, much of it focusing on what the donor could reasonably expect to receive for giving her eggs to intended parents. In egg sharing a woman, who is already planning to have an egg retrieval for her own IVF, can expect to receive £2 - 3,000 worth of fertility treatment as a benefit.Several people present last night voiced opinions that egg sharing is really egg trading because of the value of the benefit received, making it a financial transaction by another name.

But, what of the healthy, fertile woman who doesn't need IVF? She may want to give her eggs to a specific woman; a sister, friend or stranger, completely from a place of generosity. There are avenues for making this gift, such as Altrui - an egg donation scheme that matches donors and recipients. One such woman, Laura Witjens, Chair of the National Gamete Donation Trust, and a mother, sat on last night's panel, personally advocating a payment to egg donors of approximately £700.  She believes that amount would be enough to cover the donor's costs, and constitute a gesture of appreciation for the value attached to the donation, without being potentially exploitative....not enough money to change the donor's life, pay off their debt, etc... Interestingly, while Witjens' twins were naturally conceived, she stated that if she had been infertile, she absolutely would have paid for eggs to become a mother.

Some of the people present at the PET debate, both on the panel and in the audience, batted back and forth the idea that knowing their biological mother received payment for the egg that created them would be psychologically damaging. Some people may have difficulty coping with the knowledge that they sprung from a donated egg, regardless of the issue of payment. How is this scenario any different from adoption, where adoptive parents must prepare themselves for educating their child about their origins in a sensitive and understandable way? Raanan Gillon, Chair of the Institute of Medical Ethics, countered that argument in the best way possible; saying "the alternative to having a donor-conceived child be upset about the egg being bought, would be that they don't exist at all." Quite right. How many people would wish they had never existed and their parents never having had children, rather than any payment being made to the donor?

In regard to the argument of almost-inevitable harm, I have to ask: "so what?" The donor should be provided with counselling prior to carrying out the egg retrieval and donation, to ensure that she understands the physical risks and emotional ramifications involved.  Her existing or future children can be raised with the message that Mom did something generous to allow another woman to have a child who would not otherwise have been able to do so. The recipient is surely informed about all of the angles of the process and should be counselled up until she conceives, if not afterward as well. The donor-conceived child is the one who needs the most attention and sensitivity.  Yes, there is a risk, especially in cases of anonymous egg donation, when there will be a loss of genetic connections with biological maternal relatives. This could cause feelings of not belonging, incomplete sense of identity.  However, anonymous donation was not the topic of the evening.

In the case where the donor-conceived child will have the right to seek their biological mother at the age of 18, his parents have the responsibility of preparing their child adequately for what he may discover. Prof. Brian Lieberman, Medical Director of Manchester Fertility Services, called for all of the exchanges taking place in egg donation to be open and transparent. I believe it was he who said that his overriding concern for the donor-conceived child is that they are able to feel proud of who they are and how they are created. That, to me, is the goal in raising any child, conceived naturally, through assisted reproduction techniques or adopted. That message is one of love and belonging.

Much was made of the US free-market model for egg donation, the range being quoted as anywhere from £8 to £19,000.  While Prof. Gillon did not see payment for eggs, in itself, morally objectionable, the consensus of most panel members and speakers from the audience was that if payment was made it should be a regulated, fixed fee, rather than a market-driven fee like in the US.  Among that group, a lump-sum fee of an amount between the current £250 and Laura Witjen's suggested £700 seemed to be favoured; the amount resting on the difference between inducement and coercion.  For those willing to embrace a fee at all, this amount was sufficient as an inducement to give something of value, the egg, to someone else which requires the donor to experience some physical risk and inconvenience. Anything more, in their opinion, could make a change in the donor's lifestyle, therefore running the risk of coercing that person to do something which they might otherwise believe immoral or otherwise wrong. Dr Sue Avery, Director of the Fertility Centre at the Birmingham Women's Hospital and a panel member, felt that the "lump sum argument is fallible, because any amount will be an incentive to someone to do something they would not otherwise wish to do."

You may be interested to hear my contribution to the debate. I had had no intention, whatsoever, of speaking; however at the end of the evening, I felt it necessary to point out that it was all well and good debating ethics in a vacuum, but it should not be forgotten that real people are involved here.  The British government, associated with the Church of England, promotes family values. The evidence is undeniable that most people want to create families and they are not willing to let a diagnosis of infertility come between them and a baby. The country is proud of the breakthroughs in medical science that have occurred here, and more money has been made available for fertility treatment through the National Health Service (NHS). However, there are still many couples who find themselves shut out, some by the severe shortage of donor eggs available.

I shared with the PET audience that my husband and I never got to the point where I was told I couldn't go any further because of a shortage of donor eggs. We felt let down by the medical system here that moved at a snail's pace in responding to my infertility and then told us I was too old to qualify for IVF under NHS regulations. At 42 years old, with few quality eggs left, using donor eggs would have had to be my next step if we had gone further. (I am one who, like the cliche, miraculously conceived naturally 3 months after my failed IVF cycle.) I have clients who are in the same position now that I was in ten years ago. Faced with the probability that their own sub-standard eggs mean they will never conceive, I believe that most women would be willing to pay something in appreciation for this priceless gift from another woman.

As Laura Witjens pointed out, "patients vote with their feet." If they cannot get access to the assisted reproduction techniques they need to create their families in the UK, they will seek them out elsewhere, even if payment must be made. If the government wants those needing fertility treatment to stay in this country, it has to make concessions to the needs and desires of those concerned. It can't rely upon "in the best of all possible worlds..." but, instead, must make the world we live in as easy to negotiate as possible, in a positive way, aimed at a positive result.

If you have been an egg donor, used donor eggs or just have an opinion about whether payment should be made to an egg donor, and if so, how much, I would like to hear from you.

I C LW, do you?

Okay, so it's not the funniest joke around, but I tried. I think people find me too serious and earnest in my attempt to convey useful information and support to infertile people (and anyone else with fertility issues). I do have a funny side; you just might not recognize it immediately. I implore you to stick with me; as we get to know each other, you'll see that I am actually quite fun, albeit in a somewhat sarcastic way. It's too bad you can't see me trying to copy the song and dance moves of various celebs...it gets my kids spraying milk out their noses. Or hiding under the kitchen table in embarrassment.

Please leave a comment and tell me what you think of the blog, or a particular post. I really, honestly want the feedback. I'm writing for you, so you definitely should feel okay about having a say. If I don't like it, I'll just swallow hard and move on.

Now, on to more important matters (the serious bit). This past weekend, I took a stand at a health event which was put on by a respected charity in London. Last year, this event got me buzzing. I learned so much, met so many really knowledgeable and interesting people and came away with bucketloads of ideas about issues to address, articles to write and workshops to produce. While the event had more capacity than it filled with visitors, it seemed busy and full of energy. This year, the same charity, the same brief, the same quality of medical-expert speakers. The turn-out was dismal. There were people there with expertise and time to share it, but few to share it with. A huge disappointment for everyone involved, including the charity's employees. I know that it takes a lot to organize an event like this, but I know that it can be done better than this, because it was. Last year.

My question is this (whether you live near London, in the UK or anywhere in the world):  What would a women's health event (call it what you like...exhibition, conference, etc...) have to offer to get you there, in attendance, visiting seminars and stands, participating in workshops, etc? I think I could put a fantastic, large-scale event together that would be a destination for women in all stages of their fertility, from teenage to middle-age, but I need to confirm if I am on the same wave-length as the rest of you.

Please feel free to touch on any of the topics suggested below, and give me your wish list.

• location
• transportation links (car, train, bus, Tube, airplane)
• venue
• size of event
• well-known speakers
• large, corporate sponsors
• lectures
• workshops in which you can participate
• products on offer (sales)
• incentives (freebies, prizes, discount vouchers, etc.)
• consultations with doctors, counsellors, coaches, financial planners
• variety of health issues addressed
• men's health topics
• networking opportunities with like-minded visitors
• catering
• schedule of events
• 1-day, 2-day 
• weekday v. weekend or both, e.g. Friday and Saturday
• entry cost
• mini-events at optional, add-on cost
• private enterprise producing the event v. a charity

Please take a few minutes to pass on your ideas. Tell me about an event you attended that was great or that you hated and why. Who knows? You may find your opinions form the basis for a new, better, well-attended and exciting event, produced by me. My thought: if I can do it myself and make it successful, I will be able to support my favourite women's health charities out of the profits.

The Newsweek article that unleashed fury in the infertile community; my comments

An article published in Newsweek Magazine, Should IVF Be Affordable For All?, has caused an enormous reaction in the Infertile community, flooding Newsweek.com's own Comment section, as well as social media networks, with furious exchanges of opinion.

Discussion includes the price tag of $15,000 for IVF and the fact that not all American states mandate insurance coverage of fertility treatment.  Reading the many comments on Newsweek's website, I have no desire to engage in a verbal slinging match with people who are uneducated, yet very opinionated about infertility.  I do, however, want to set out my perspective on this topic, having been through an unsuccessful IVF cycle myself, without the financial means to repeat it. Anyone who wants to comment here is welcome to do so.

1.  According to a study by the European Society of Human Reproduction and Embryology, published in The Human Reproduction Update last month, direct costs of fertility treatment vary substantially between countries, but the U.S. stands out as notably more expensive than other countries.

This is direct evidence that the cost of IVF need not be as high as it is in the U.S. I know of plenty of women who are conceiving through IVF in other countries, including the UK where I live, where many women receive up to 3 IVF cycles on the National Health Service and private costs are about £8,000 (currently under $12,000).  The United States fertility "industry" considers itself to be where the sun rises and sets, and take financial advantage of their patients accordingly. Foreign clinics are proving this wrong, and American couples should seek better schemes, through the new clinic founded by Elan Simckes in St. Louis called Fertility Partnership or others like it, charging $7,500 for IVF, roughly half the cost for the same procedure at many clinics, or clinics abroad.

2.  A complicating factor, according to Dr. Sherman Silber, a reproductive specialist at St. Luke’s Hospital in St. Louis, is that up to 80 percent of infertility cases are caused simply by increasing maternal age. “It’s hard to call infertility a disease. It’s normal aging,” he says."

Dr. Silber's comment will play directly into the hands of those who argue that a) women are choosing to have children later, therefore their infertility is not a disease or medical condition that needs fixing but a lifestyle choice, and b) that the resulting need for IVF is self-imposed and shouldn't be covered by medical insurance.

In response to the first argument, there are many sociological/economic trends that have caused the average age of first attempts to conceive and first pregnancies to go up.

• Since the 1950's increasing percentages of women have gone on to higher education and/or employment because opportunities for both have increased.
• As a result, more women are leaving their parents' home as young adults and living independently for a time before meeting and marrying a man.
• Economic conditions now require that both parents need an income in order to pay for the rising costs of raising a family. Consequently, people are choosing to earn enough money ahead of time, before beginning to have their children.

These changes in conditions have necessitated a delay in timing of childbirth. Many infertile women have had no choice but to start later; therefore it can't really be seen as a lifestyle choice using free will.

It is also unfair to claim that infertility is self-imposed, therefore not deserving of insurance coverage. A commenter to the Newsweek article, NS says
"Having children via IVF is a cosmetic surgery. IVF is effective less than 15% of the time and this after multiple attempts. This should all come out of thier pockets and not mine." First of all, the word cosmetic refers to someone's or something's physical appearance, which is clearly not applicable to having medical treatment to overcome a reproductive obstacle, which refers to a function. Second, there are huge numbers of young women finding themselves infertile because of known health issues like PCOS, thyroid function, blood clotting, autoimmune dysfunction, irregular menstruation, etc... that are not self-imposed. Additionally, it is estimated that 40% - 50% of infertility in couples trying to conceive can be attributed to the man.

3.  "David Fleming, director of the Center for Health Ethics at the University of Missouri, says the main concern with making fertilization affordable for more people is the risk of “commoditization” of babies. “The more you have access, the more people will do it.”

I have never heard of anyone in the UK say "I can get IVF free on the NHS, so I may as well do it." IVF is not a picnic in the park. It requires forced abstention from sex, heavy doses of medication (which can be seriously mood-altering, from my experience) administered by self-injection, dozens of physical examinations which require exposure of one's genitals to various medical staff and uncomfortable internal probing, a scary procedure to harvest eggs from a woman's ovaries and another to implant fertilized eggs back in to a woman's womb, a mind and heart-crushing 2 week wait, the possibility of multiple pregnancy/birth and the more-frequent-than-not disappointment that follows, when you have not conceived.

Making IVF more widely available isn't like an advertised release of an IPhone, a 2 for 1 manicure/pedicure, the UK government rebate on purchases of new cars, or getting a tattoo. Children take up a lifetime of love, attention, energy and expense. Parenting isn't something entered into lightly. Not only that, but we are sentient beings, i.e. we have the power to think and make decisions. Just because a woman could conceive 10 children doesn't mean she would. Most people are happy with 2 or 3 children. It's not often a case of "I can, therefore I will." Basically, I think David Fleming's statement is pure nonsense.

4.  "Health insurers in the U.S. typically don’t think “wanting a child” is a medical necessity."

This argument assumes that we all either want or don't want to have children and that having children is not a right, likening it to breast augmentation, hair implants or surgically corrected vision: privileges if you can afford to pay for them. I disagree.

Our bodies were designed to reproduce in order to continue the survival of our species. Physically, the male and female of the human species is meant to function as two halves of a whole, each posessing organs which necessary to the conception, gestation and birth of offspring. The physical inability to do so is as much an integral flaw of our functionality as anything else that threatens our survival.

I believe that, in conjunction with our physical design, we are programmed mentally so as to support our need to procreate and, ultimately, to survive. Therefore, the ability to produce children is essential to our feelings of security, purpose and fulfillment. (Please don't misinterpret what I am saying as saying that everyone has to actually have children in order to feel secure, purposeful and fulfilled. I believe that most people do want to have children, but that some people don't, as with any rule and the exception to it.)

Conversely, it must be true that the inability to produce children creates a stress that threatens physical, mental and emotional wellbeing.  It makes what other people see as a desire to have children, into a bona fide feeling of need. It can cause feelings of low self-worth, lack of femininity or masculinity, a feeling of being "broken" and in need of being fixed, hopelessness for the future, not fitting into their society and being classed as useless, freakish or pitiful.

Surely, if medical science exists that can assist infertile people to conceive, it would be of benefit to all society that this knowledge and skill be made available to anyone who wants or needs them. While I have no medical training, it seems to me that more frequent usage of IVF should increase the level of that knowledge and skill, raising the percentages of success over time. More success should inspire more medical research and progress, that can then bring costs down and increase availability. 

Why aren't we (well, I am) all getting behind that?  Is it a case of haves and have-nots; the haves not wanting to foot the bill for the have-nots to succeed? If you feel that way, I have a theory I would like you to consider. Over a lifetime, what you do for others and what they do for you, indirectly, evens out. If not in numbers, then in our contribution to society or in karma. If you tried to work it out in dollars and cents or pounds and pence, it would take so much time and effort, you could be losing some of your valuable time on this earth and miss an opportunity to either give or receive. So, don't bother. Just trust in it and go forward.