Daughters are poisonous!' rages Donald, a technology entrepreneur in his sixties who I meet at the Alternative Families Show in London, held each year to showcase the options for lesbians, gay men and single people who want to have a baby. 'I only want boys,' Donald insists, 'and I'm going to have four of them. We'll have a lot of fun. That's why I'm looking to America.'
We are loitering near the stand of the Center for Surrogate Parenting Inc, a US company with offices in Los Angeles and Annapolis, Maryland, which is promoting itself heavily in the UK. The commercial brokering of a 'womb for hire' is illegal in Britain, as are advertising for a surrogate and paying her. So, British men (whether gay or simply misogynistic) are turning to agencies like the CSP to buy what they want. So too are heterosexual couples who are infertile, miscarry repeatedly or risk complicated or even life-threatening pregnancies.
Such solutions come at a price. 'The costs could be anything from £15,000 to £30,000 or more, just for the legal fees,' says Andrea Woelke, a solicitor with Alternative Family Law, which deals with the complex issues surrounding surrogacy, paternity and immigration. 'People are paying $150,000 (£95,000) to the surrogate, the agency and the egg donor, so those fees have to be seen in context. But it's hugely expensive by any stretch of the imagination.'
The fertility game is truly global. In India, this lucrative surrogacy industry is expected to be worth $2.3bn (£1.9bn) a year by 2012, as westerners take advantage of services costing a fifth of what they do in the US - but the drawback, for Donald at least, is that sex selection for social purposes is outlawed there, as it is in Britain. In the US, clinics can legally use pre-implantation genetic diagnosis (PGD) to identify the sex of an embryo and implant it only if it matches a client's requirements - what the CSP website refers to as 'family balancing'.
It's a rare example of political incorrectness in an achingly right-on show. In the first lecture, called Inseminar, I am the only man in a sea of lesbians finding out about egg sharing and IVF as a means of having a baby together. In the second, I am the only straight man interested in gay surrogacy - where a woman (in Ukraine, say) carries an embryo created from the sperm of one gay partner and a donated egg. That egg might come from the sister of the other gay partner, meaning both men are genetically linked to their 'gayby'.
Wandering around the exhibition hall, with its stands representing sperm banks, IVF clinics, adoption agencies and support groups, it is clear gaybies are big business. And Hollywood has prospered too. Last year's hit comedy The Kids Are Alright starred Julianne Moore and Annette Bening as a lesbian couple who have both given birth using the same sperm donor. And now Elton John, aged 62, and his partner, David Furnish, have their ultimate consumer durable to complete their happiness.
'The London Women's Clinic sees a lot of lesbian clients,' says Andrea Woelke (a man, incidentally). 'One reason why (clinics) are so keen on them is that lesbians tend to be young and have good eggs, while heterosexual couples who go there will have tried IVF before, will be a bit older and may not be as suitable for egg sharing. It makes perfect sense. Those lesbians get a reduced price or free treatment, and the clinic has eggs for other patients.'
Outside the Inseminar room, the LWC is handing out information packs to lesbians as it competes with other clinics for their eggs - but after talking to some women at the show, I can't help feeling they are after my sperm as well. Since 2005, when a change in the law meant registered donors lost their right to anonymity, there has been a shortage of sperm and eggs in Britain. Nor can donors be paid for their gametes, beyond 'reasonable' (receipted) expenses.
Hence the explosion in websites (Prideangel.com, Feelingbroody.com, Co-parentmatch.com) that introduce would-be parents to unregistered donors. As long as they do not 'procure, test, process or distribute' sperm and eggs, they are legal - even if they allow 'natural insemination' (unprotected sex) and home insemination in place of the usual clinical procedures. In October, two Berkshire men were given suspended jail sentences for procuring sperm, using their home-based company Fertility 1st. In their 12 months of operation, Ricky Gage and Nigel Woodworth were able to amass profits of £250,000.
However, these pink and grey areas are only the tip of the IVF iceberg. The mainstream fertility industry in Britain is worth an estimated £500m and is growing at an unstoppable rate. Its annual jamboree is the Fertility Show at Olympia, which in its first year (2009) attracted 3,000 visitors. Last year, 5,000 registered in advance and the total was more than twice the 2009 number.
In the halls, 100 exhibitors touted their technologies and products while, on stage, 60 expert speakers shared their ideas. One of them was Mohamed Taranissi, the controversial fertility specialist whose wealth is estimated by the Sunday Times Rich List to be £41m - down £11m since 2008, but enough for him to retain his position as the richest doctor in Britain. 'I'd disagree with that figure,' he tells me, chuckling, 'because I probably have more - but I'm not too focused on it. I'm not saying it's irrelevant, but you don't set up a service to generate lots of money. You set out to make it the best.'
If you look at the latest IVF league tables, it seems he has succeeded. The Assisted Reproduction and Gynaecology Centre (ARGC) in Upper Wimpole Street, London, which Taranissi owns, achieves a success rate of 64.3% for women under 35 and 41% for those in their early forties. The nearest contender is UCH, with 51% and 27% respectively - but its prices are £375 higher per cycle: £2,875 for IVF and £3,875 for ICSI (injecting sperm directly into the egg). And that excludes the costs of drugs. Perceived value for money brings the patients flocking, translating into profits in the region of £8m a year for the business.
'In surgery or general medicine, there isn't a definitive outcome that you can measure and which speaks for itself,' Taranissi says. 'For us, there is a very clear measure of success: people are either pregnant or they're not; they either have babies or they don't. That's what makes our specialism different.'
Taranissi is also offering something that, previously, money couldn't buy. The urge to have children is very powerful in most people. The nice house and the car and the holidays only get you so far in life. A child is beyond price. Thus the sums that individuals are willing to spend in order to defeat infertility are often very high indeed.
What also makes it different is that most IVF treatment is in the private sector - which is likely to be a growing trend as NHS primary care trusts withdraw free IVF provision to save money. North Yorkshire and York, Bury, South West Essex, East Kent and Surrey have all scaled down or suspended their services, leaving patients in those areas with no option but to go private. Even where free IVF is available, the number of cycles allowed is limited and women can fail to qualify because of their age or other factors, such as already having a child.
Couples are now caught between a rock and a hard place: either they pay for their treatment in Britain, where a single cycle costs £5,000 on average and three or four may be needed to get pregnant; or they seek cheaper IVF abroad, where regulation is less strict and there may be risks. In the US, for instance, multiple births are more common due to a less cautious attitude towards implanting several embryos in order to improve the chances of success.
In Europe, Spain is a popular choice because of its high medical standards and the easy availability of donated eggs and sperm, for which Spaniards can be paid. Around 3,000 British women go there every year to have a donor egg fertilised and implanted - in what has become known as 'fertility tourism'. In Denmark, the DanFert clinic in Copenhagen treats 50 to 100 British women each year, while the number of Brits going to the city's Vita Nova clinic has risen by nearly 50% since it opened in 2005.
The main reason is the easy availability of sperm, a fecundity exploited by the Danish sperm bank Cryos. Marketed with the slogan 'Congratulations, it's a Viking', it exports sperm to 60 countries and is a multi-million-pound business. In 2007, it opened a franchise in the US and, in 2008, one in India.
In this global market, Britain is missing out because of decisions made by soon-to-be-disbanded regulator the Human Fertilisation and Embryology Authority (HFEA) regarding donor anonymity, payment and commercial surrogacy. Undaunted, Britain's 138 fertility research clinics are embarking on a charm offensive - not just to stem the rush of patients to rival clinics abroad, but to see off competitors here by offering five-star service, new technologies and radical procedures.
One strategy involves teaming up with overseas clinics where gametes are available; the Bridge Centre in London regularly sends its patients to Crete, Spain, Ukraine and the US. In Harley Street, the London Fertility Centre (founded by IVF pioneer Professor Ian Craft) says success rates and quality of care have increased since opening a state-of-the-art 'procedure suite' in nearby Portland Place. Investment has come from the Spire Healthcare Group, the second-largest private hospital provider in the country (after BMI Healthcare), which in March acquired the LFC and launched IVF Scotland - a comprehensive fertility service at the new Spire Shawfair Park Hospital in Edinburgh. Owned by the European buyout firm Cinven, Spire aims to be the biggest provider of private fertility treatment in the UK.
In November, the LFC broke new ground again by throwing a financial lifeline to couples let down by the NHS. 'We began offering, through a finance company, loans over a period of time, to help people who cannot instantly afford treatment,' its clinical director, Dr Asaad, explains. In the past, he says, low-cost IVF was offered to patients, using fewer expensive drugs to stimulate egg production, but take-up was poor due to its lower success rate - about 10% for women under 35, compared with 40% on average for the high-cost version. 'When they're coming for IVF, people really want the best chance, the full chance,' says Dr Asaad, 'so they go for the normal cycle.'
However, it is fertility drugs - not just clinical procedures - that make IVF expensive: up to £1,990 a cycle, depending on which high-street pharmacy provides the medicines prescribed by an IVF doctor. Responding to the scaling down of NHS services, the Asda supermarket chain pledged in March to sell fertility drugs at cost price - £1,170, a saving of up to £820.
Even with such help, a surge of patients from the NHS into the private sector seems unlikely. Their numbers were quite small anyway (accounting for perhaps 1,000 cycles of IVF per year, Taranissi estimates, out of a total of 46,829) and most won't be able to afford it. The total number of cycles is growing too slowly (by 5.8% a year, according to the latest HFEA figures) to deliver the kind of growth demanded by the industry's big players. Taranissi's practice is thought to have quadrupled its profits in six years, while Care Fertility, the UK's largest independent IVF group, doubled its profits to £1.1m in four years.
'One reason we have grown is that we've taken market share,' says Professor Simon Fishel, managing director of Care Fertility. 'Patient numbers are growing slowly, but there is continual movement (migration to a new clinic after several cycles fail). We're the largest due to our ability to offer cutting-edge technologies and relatively successful treatments for the very difficult cases.'
A good example is where women repeatedly miscarry owing to a chromosomal disorder. 'Care Fertility's new technology enables us to examine those chromosomal disorders in embryos before we put them back,' says Fishel. 'We are able to improve the efficiency of IVF and the efficiency of holding on to a pregnancy - so we have more and more patients returning for further attempts. We get a huge influx of patients nationally and internationally.'
Other novel treatments include freezing a woman's eggs while she is young, allowing her to put motherhood on hold without compromising her fertility, and helping women over the age of 50 get pregnant - a dramatic upward trend, with 107 giving birth in 2009, an increase of 55% on the previous year.
'Yes, we are an industry,' Fishel concedes, when I ask whether this brave new world of assisted fertility is strictly a branch of medicine. 'And, yes, we are industrious because there is an absolute clinical imperative to develop new technologies and reach out to couples who need some form of treatment that may not be available to them today.'
- £550m: Estimated value of the UK fertility industry
- 50,687: Total number of IVF cycles performed in the UK (2008)
- 75%: The proportion of all IVF cycles performed in the private sector
- Live birth rate per IVF cycle: UK 29.6%; EU 27.6%; US 38.2%
- 3.5m: The number of people in the UK with fertility problems
- 76%: The proportion of Britons with fertility problems who would consider going abroad for treatment*
- 11m: The number of infertile couples in Europe
- 50%: The proportion of those couples expected to seek medical treatment
*Based on 339 respondents to a survey initiated by Infertility Network UK
Sources: European Society of Human Reproduction and Embryology (ESHRE), Human Fertilisation & Embryology Authority (HFEA)