Sinead Ryan: Why couples struggling with infertility need more help from the government
Methods like IVF are not State-funded and regulation in the booming industry is badly needed
It should be the most natural thing in the world. After all, there are almost seven billion of us alive today because the instinct to make babies is imprinted in the human genome, as well as being the drive and purpose of the race.
But for many, of course, it's not that simple. Couples can find it incredibly difficult to get pregnant and may have to call on invasive, and expensive, treatments to assist them. It's an alphabet soup of help: IUI, IVF, ICSI, PGS, PGD, not to mention DIY (the good old turkey baster), so you could end up feeling you need a degree in biology before you start researching, and a second mortgage by the time you've finished.
Currently, assisted human reproduction (AHR) is not State-funded, or even assisted. Ireland is one of only three EU member states where this is so, yet the HSE routinely pays for vasectomies, tummy tucks, boob jobs and Viagra on the medical card.
The cost is not inconsiderable, starting at around €4,500 for a single cycle of IVF, which carries just a 30pc success rate. "It's much more expensive to fund a tonsillectomy," says Joanna Donnolly, who runs pomegranate.ie, a charity that helps couples pay for IVF treatments.
"By the time they get to us, many couples have spent all their savings on IUI, bloods and other tests," she says.
"Everyone knows it is expensive but it's not that huge a burden on the State to provide it if they wanted."
Dr Rhona Mahony, Master of Holles Street concurs, and says that lack of funding means that assisted reproductive techniques are left entirely in the hands of commercial entities without national debate. "Access is also an issue: is it only those who can afford this treatment that should have access?", she asked in an interview with the 'Irish Medical Times'.
"This, for me, is the huge concern - when you see some of the ads and when you see some of the descriptions of what's going on and meet some of the patients who have been through what I think is, at times, unethical treatment."
Mahony and Donnolly may finally have found an ally in Health Minister Simon Harris though, who has set up a commission, to report by year-end, on how IVF regulation and funding might now be made.
It follows on from other reports commissioned by his predecessors, and the biggest study of all, in 2005 - the Commission of Assisted Human Reproduction, which had no fewer than 25 expert members, making identical, wide-ranging recommendations on regulating this fast growing industry. Most of them were shelved.
Regulation is badly needed. It is 10 years since the Supreme Court handed down a judgement (and fine) to the State for failing to bring in legislation surrounding IVF. The 'Roche' case, as it was known, brought clarity to the 'status' of the embryo and said there is no connection between the life of the mother and a pre-implanted embryo under Article 40.3.3, which protects the life of the unborn in the Constitution.
This, naturally, raised more questions than answers and successive Governments sat on their hands under the reports gathering dust, despite around 8,000 new baby citizens being born each year without any regulation.
Most private fertility clinics are carefully and properly run by medical professionals. In the absence of legislation, which was due to be enacted as part of the 2015 Children and Family Relationships Bill, but was fudged while the rest of the Bill went ahead, much confusion still reigns.
Who owns non-implanted (frozen) embryos, for instance? What happens if they are discarded - does that conflict with Article 40.3.3? Is it 'abortion'? What if donor eggs or sperm are used? Who is the 'father' or 'mother'?
While some of this comes under existing legislation, much remains murky and ill-thought-out. For most couples, however, their desperation to have a child means they simply get on with what technology is available with scant regard to the wider issues.
AHR has increased by 257pc in 20 years; frozen embryo transfers are up 385pc. One in six couples will have difficulty conceiving and women are older when having babies, despite fertility halving at age 40, and halving again by 45.
For now, the most common options are:
IUI (intrauterine insemination)
A relatively 'natural' method where healthy (father or donor) sperm is injected into a fertile uterus in a natural or stimulated cycle.
Used for: Single women or lesbian couples with undiagnosed infertility or ovulation problems.
Success rate: 10pc to 12pc per cycle
Ivf (in-vitro fertilisation)
First performed successfully in 1978, eggs are collected after a stimulated cycle, fertilised and implanted in the uterus. Used for: Couples with blocked fallopian tubes, ovulation difficulties, or low or no sperm.
Success rate: 30pc
Icis (Intracytoplasmic sperm injection)
Similar to IVF, but with this method one single sperm is injected into the egg for a more precise approach.
Used for: Men with low motility sperm, or where conventional IVF has failed.
Success rate: 25pc per cycle
Tax relief is available on all medical treatments via the MED1 form at 20pc.
Medicines and other drugs are capped at €144 per month under the Drug Payment Scheme, or are free with a prescription charge to Medical Card Holders.
Case Study: 'We were prepared to try as many times as our finances would allow'
"We never 'decided' to become parents, we just knew it was something we wanted to be from the moment we met", says Dil Wickremasinghe of her wife Anne Marie Toole, now proud parents to baby Phoenix and founders of Insight Matters Counselling.
"We contacted Clane Fertility Clinic (now Institut Marques) in 2013 and with our embryologist's help, selected a suitable donor. We started with IUI, which sadly was unsuccessful. Then we tried IVF in September 2014 while I also practised acupuncture and daily mindfulness. After two weeks we received the joyous news we were pregnant!
"Looking back now, we are so glad we tried IUI first, as it gave us the opportunity to ease ourselves into the process and I sincerely believe it prepared my body and increased my chances of getting pregnant on the next round.
"It cost around €8,500 in total and we were prepared to try as many times as our finances would allow."