By Annette Chrysostomou
She was the oldest British woman to give birth to triplets. But while Sharon Cutts, 55, made headlines in Britain last month there was only a passing reference to the fact that the grandmother received her fertility treatment in Cyprus.
It was never made clear whether the clinic was in the north or the south – a point of little interest to most British readers.
Yet there are intriguing differences between what each side of the island has to offer those seeking fertility treatment. Northern Cyprus, for instance, is the only place in Europe where you can choose the sex of your baby using this method – a highly controversial choice that is likely to go if Cyprus is re-united and the north is obliged to follow EU law.
Cutts’ age, and the fact that she already has four grown up children and four grand children, meant that the nurse from Boston, Lincolnshire could not receive treatment in Britain and came to Cyprus instead.
Whilst it is not known for sure where she was treated, doctors in the south say it was most unlikely she came to a clinic here.
A law passed last year specifies that only women under the age of 50 can receive fertility treatment. Passed on May 15 2015, roughly 10 months before Cutts gave birth on March 21, it has since been suspended for technical reasons and is currently being reviewed, but it was in place when Cutts received her treatment.
The existence of a law does not necessarily equal adherence to it, and because there is no central authority which records every single case, sources in the medical profession told the Sunday Mail it was still possible some fertility clinics in the south would treat older women.
But the president of the Cyprus society of human reproduction, Krinos Troukoudes, said he did not think this was the case with Cutts.
“As president of the association, I asked all clinics in the south, and they reported that they didn’t treat her,” he said.
In northern Cyprus, there are no regulations on the age of the patient.
“While our ‘recommended’ age limit is 45,” states one clinic on its internet advertisement, proudly declaring its ‘relaxed regulations’. “There is no legal age limit at our clinic as long as our patients are found fit for pregnancy. We can also assist women over 50 as long as they have no health problems that can put their own health at risk in case of a pregnancy.”
This makes northern Cyprus one of the few places in Europe other than Ukraine and Spain where IVF treatment can be legally administered to women over 50 years old.
But the story is not that simple.
In the UK, for example, NHS doctors have been accused of aiding illegal practices. Cutts’ procedure involved both places, as apart from the treatment in Cyprus, for which she paid, she also had to spend nearly three months in a hospital in UK, paid for by the same NHS which would have denied her the initial treatment because of her age.
Even more controversially, northern Cyprus is also the only place in Europe where sex selection is legal, and providing couples with NHS care after they have gone to the north for treatment and chosen the sex of their unborn baby has been labelled as carrying “enormous moral issues” by the British press.
Quite apart from issues to do with sex and age, coming to Cyprus both in the north and in the Republic for fertility treatment has its advantages.
In their advertisements, private clinics like to point out that Cyprus is a great place to combine treatment with a holiday. Apart from the weather, Cyprus is a relaxing place, they say, and it is important to be relaxed if the fertility treatment is to work. Doctors also argue that treatment only takes a few days if the woman has been prepared for the treatment where she lives before travelling to Cyprus.
But there are other, more compelling reasons for women to pay for the procedure in a private clinic in Cyprus. In the Republic the procedure is easier than in UK, where people are often subjected to a long and complicated process to get approved.
In England and Wales there are long waiting lists, at least for those treated under the NHS. This is due to a lack of donors which is not a problem in Cyprus.
“There are a lot of female donors in Cyprus, because we have a big number of college students who are young and healthy and from various backgrounds,” Troukoudes said.
In addition, in the UK the law gives children the right to receive information about the identity of the donor once they turn 16. Though the name and last known address is not revealed, the number of donor volunteers has fallen since the passing of the law in 2005.
Troukoudes believes there is also less demand among Cypriots for treatment unlike the UK where around 60,000 fertility treatments are performed in licensed clinics each year.
Though price is obviously a factor, Cyprus is not necessarily cheaper than the UK.
Each case needs different treatment and there is not just one fee but a combination of different ones so comparisons are not easy.
“The price in the Republic of Cyprus is similar to the UK,” Troukoudes said, “between £2,500 and £5,000, according to what exactly is being done.” This is only for one treatment though, and often multiple treatments are necessary.
This may still be cheaper than the UK, where the Human Fertilisation & Embryology Authority (HFEA) lists the price at around £5,000 to £7,000.
Clinics often also advertise higher success rates than the 28 per cent recorded in the UK.
But according to Andreas Stavroulis, head of the endometriosis centre at the American Medical Centre, these claims should be viewed with caution.
“In the UK, there is a central controlling body,” he said. “All clinics must register and keep strict records so there can be comparable records.”
In its database – known as the Register – the HFEA holds detailed information about all fertility treatments, including outcomes, performed in the UK dating back to 1991.
In countries like Cyprus, where there is no such central body, it can be tricky to measure, said Stavroulis.
“What is it? You can base it on age groups, or on how many women get pregnant, or on how many actually give birth. There are also different causes, so success depends on the initial condition. So it’s a good marketing tool; I could tell you I have a 90 per cent success rate, but it doesn’t say much.”
Another way to achieve ‘success’ is to implant multiple embryos into women, as happened with Sharon Cutts. In the UK, it is recommended to insert only one or two embryos to lower the chance of multiple pregnancies, which tends to add complications, especially for older women.
In the UK, four in 10 in vitro fertilisation treatment cycles in 2011 were funded by the NHS and the rest was paid for privately. But that figure hides the wide regional discrepancies between availability of and eligibility for treatment in the UK which can also work in the favour of clinics in Cyprus for those who can afford it.
“In the UK funding depends on the boroughs,” Stavroulis explained. “In one place funding might be available once for a woman and in another she can have treatment three times.”
According to guidelines issued by the NHS for in England and Wales IVF is recommended only for women under 43 years of age. However, the final decision about who can have NHS-funded IVF in England is made by local clinical commissioning groups (CCGs), and their criteria may differ from those recommendations. Some of them only treat women under 35, for example, or have other criteria women need to meet such as not having children already and being a healthy weight.
One thing is for sure. The success rate depends on the age.
According to the HFEA in UK, the IVF success rate was only 1.5 per cent for women over 45 in 2012, but 32.2 per cent for women under 35. Most older woman don’t even attempt a treatment. In 2012, only 1.9 per cent of the women were 45 and older, whereas 41.6 per cent were aged between 18 and 34.
Sharon Cutts, meanwhile, knows only too well that she is in a tiny minority.
“I don’t care that my babies are younger than my grandchildren – it means they’ve got lots of playmates,” she told the Sun newspaper shortly after giving birth to her triplets.
“I also have great family genes. My mum is 75 and healthy and my great-grandma lived until she was 100,” she said, adding that she was confident she would live to see her new babies’ children.