Infertility is not a choice but treatment should be
Posted on March 20, 2013
Infertility is a medical condition. If you have not conceived after 12 months of trying, you can go to your GP, get a referral to a specialist, have some tests done and get a diagnosis such as low sperm count, blocked tubes or polycystic ovaries. At this stage, your specialist can recommend fertility treatment for your medical condition but only if you stump up your own cold, hard-earned cash. Our public health service can bring you as far as a diagnosis of infertility but it will not treat it. If you don’t have the money, your diagnosis is simply the end of the line.
Many are surprised to hear that there is no fertility treatment available on the public health system and none of it is covered by private health insurers either. Ireland, along with Russia, offers the worst access to fertility treatment in Europe.
If that wasn’t bad enough, there is no regulation in Ireland for the provision of assisted reproductive services. The Irish Medical Council has issued guidelines but there is no legal framework within which fertility clinics can operate. A Commission on Assisted Human Reproduction produced a report in 2005, which made 40 recommendations but successive governments have preferred to ignore the situation than legislate for it.
It’s not that officials think that providing access to treatment is a bad idea. A spokesperson at the Department of Health and Children told me in 2008 that they were planning on making one cycle of IVF available to medical card holders and that this would be implemented in due course along with the recommendations of the Commission. In 2010, Mary Harney, the then Minister for Health, said that she was “considering policy options in this regard”.
As fertility treatment can be claimed as a medical expense for tax purposes and, as fertility drugs are available on the GMS and DPS schemes, the State clearly views infertility as a medical condition. However, when it comes to providing treatment on the HSE, patients are a soft target because infertility is often a private matter and it has had a long history of shame and stigma in this country. You won’t see tens of thousands of people marching in the street against this but, with more than one in six couples experiencing infertility, there are tens of thousands of people being discriminated against.
There are those who oppose public funding of fertility treatment on the grounds that they would rather their tax money be spent elsewhere. Well, putting aside the argument that infertility patients are taxpayers too, health services don’t work like that. You don’t get to vote on whether Mary down the road gets her ingrown toenail fixed or Uncle Brian gets his vasectomy. A health service in a civilised society provides medical treatment to those that need it, regardless of political popularity. And anyway, a Dutch study has found that, when the State pays the cost of IVF and only allows a single embryo to be transferred each time (thus ruling out the risk and cost to the State of a multiple pregnancy), there is a huge net saving to taxpayers. Pregnancy rates are higher when two embryos are transferred so it is understandable that private patients will take the chance of twins if it is their only shot at pregnancy.
Infertility is a very difficult and painful struggle. A 2004 study found that 40% of infertile women suffered from depression, while 87% had anxiety. Luckily, the HSE will pick up the tab for these side-effects of infertility but this doesn’t make the problem go away.
In the three years it took to have my daughter, I endured two cycles of IVF, three IUIs (intrauterine inseminations), several rounds of fertility drugs and six miscarriages. That was the easy part – the treatments gave me the luxury of hope and I knew that I would carry on until I was successful. But what if I hadn’t even been allowed to try? How could I have begun to deal with the pain, the grief, the loneliness of infertility?
That’s why I set up the infertility charity, Pomegranate, with my friend, Joanna Donnelly. We had both been through infertility, had come out the other side and wanted to give something back to those who might never even have the chance to try for a baby. Pomegranate raises money to pay for IVF for those who could not otherwise afford it. Our selection policy is simple – any couple who approaches us, has two medical cards and has been recommended for IVF but has not tried it is put forward for a lottery, and whenever we raise enough money for an IVF cycle, we have a lottery.
But the fact remains that Pomegranate shouldn’t have to exist. Infertility is not a choice but treatment should be.
By Fiona McPhillips. First published in The Journal on 24 December 2012.