Any parent will tell you, babies are expensive. For people who have had help in the form of assisted reproduction, this is acutely true.
The State’s long-awaited funding scheme for fertility treatment has finally been introduced, but the list of those who do not qualify for participation under the restrictive criteria is longer than those who do.
The Government has ring-fenced €10 million to pay for couples – and it is only couples – to undergo treatment at private fertility clinics throughout the country following assessment at one of six fertility hubs throughout the country.
At an average cost of €4,000-€5,000 per IVF cycle – and that’s at the lower end of the scale – this means that about 2,000-2,500 couples will get to benefit from the scheme each year.
And if roughly 60,000 babies are born every year and one in six couples will need assistance getting pregnant, that’s a lot of disappointed people. The number of IVF cycles carried out in Ireland each year is 9,000-11,000, so it’s clear the scheme is woefully inadequate when it comes to making truly publicly funded IVF treatment a reality.
Those who do qualify will be offered one full cycle of IVF or ICSI (intracytoplasmic sperm injection) treatment, but the eligibility criteria appears to have been drawn up by the most parsimonious of bean counters in the relevant departments.
Couples have to have been in a relationship for more than one year, must have no children with that current partner, have never undergone a sterilisation procedure or any previous IVF treatment, have a BMI within a certain range, be aged 18-41 if you are a woman, and under 60 if you’re a man.
Ireland has long been an outlier when it comes to funding IVF and other assisted reproduction techniques, with almost all other European countries funding it in some shape or form
The Government has painted this as “targeting resources” but to the surprise of absolutely nobody, these access criteria have been widely slammed as “crude” and overly restrictive.
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That’s because they simply do not reflect modern life nor the evolution of the nuclear family. First-time parents are getting older – fertility clinics say the average age of the women they treat is 38. It doesn’t account for the growing problem of secondary infertility where a couple has a healthy child but then cannot get pregnant again. And it completely obliterates the hopes of a couple who have already undergone fertility treatment that has failed, cleaning out their bank accounts and perhaps even putting themselves into debt in the process.
And the scheme does not even allow for the use of donor eggs or sperm, meaning the growing cohort of prospective parents in same-sex couples or single female patients are completely excluded. The HSE website also states: “You cannot have this free treatment if more than two people plan to be parents to the child.” That’s that, then.
The website proudly reports that research has shown that 74 per cent of the public support publicly funded fertility treatments to help people conceive. For the other 26 per cent, I remember interviewing a fertility expert many years ago, at the beginning of my career in health journalism. “Look, it’s a health issue like any other,” she said. “If you had asthma, wouldn’t you treat it?”
Ireland has long been an outlier when it comes to funding IVF and other assisted reproduction techniques, with almost all other European countries funding it in some shape or form. Most are far more inclusive than Ireland’s efforts. A 2020 study found that accessibility is limited to infertile couples in just 11 of 43 European countries who do offer funding, while a total of 30 countries offer treatments to single women and 18 to female couples. Five countries treat everyone for free, including infertile couples, single women and same-sex couples.
In the UK, where the NHS has funded fertility treatment for many years, the criteria state that women under 40 should be offered three rounds of IVF treatment if they’ve been trying unsuccessfully to start a family for two or more years, or if they’ve had 12 or more unsuccessful rounds of artificial insemination. It’s not perfect – there is something of a postcode lottery as local health authorities may have additional criteria, such as not having any children already or age/weight restrictions, and in recent years the number of people using private fertility clinics has grown due to longer and longer waiting lists.
No one expected the Government to write a blank cheque for fertility treatment. But right now it looks like little more than a pilot scheme, rather than a fully embedded element of our health service. Minister for Health Stephen Donnelly has already admitted the scheme’s criteria will not be revisited before the next general election, but it’s not too soon to think about where it could go from here. The network of private clinics offering fertility treatment has evolved in parallel with our public health service – why can’t we bring this expertise back into our public hospitals? It would take time, granted, but with the proper investment and foresight we could have a public fertility care service to be proud of.
Danielle Barron is a freelance health and medical journalist