APPENDIX 71
Memorandum from Professor Arne Sunde
In my opinion you cannot use regulation to achieve
excellence. Regulations can of course determine what type of treatment
is available, prevent the worst cases of malpractice, and define
a minimum standard of treatment. To discover the reason for the
relative success in countries like Belgium and the Nordic countries,
you will have to look at the way infertility treatment is funded
and organised. In these countries the national health service
is on a par with the private sector in the quality of the treatment
and the service offered.
Another factor is that in countries where the
patients have to pay a lot out of their own pocket for the treatment
you find that those who seek treatment do so relatively late,
since many couples cannot afford modern infertility treatment.
If the woman is above 36-37, the success rates starts to drop.
They usually opt to have many embryos replaced at the same time
because they can afford only a limited number of treatment cycles.
This leads to a lower national success rate, and to a relatively
high multiple pregnancy rate (at a huge cost to society).
My guess is that in the UK, there is a good
case for making economic incentives rather than raising regulatory
hurdles if you want to improve treatment in the UK. Belgium has
adopted this approach, where the government decided to fund more
IVF, providing that the couples at risk of having multiple pregnancies
agreed to have only one embryo implanted at a time.
November 2004
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