Fertility maths: What price on parenthood?
With one in six Irish couples now facing challenges to conceive naturally, the wealth of options to help those struggling to fulfil their dreams of parenthood can be an absolute lifeline. But the staggering range of medical interventions and sheer volume of choices can also be overwhelming, financially challenging and a positive outcome is never guaranteed.
"Clients in my practice often describe the ongoing costs of fertility treatment as a massive 'hidden haemorrhage' of unrelenting cost," says Helena Tubridy, fertility therapist and coach. "They say 'you're afraid to get off the treadmill in case this just might tip the balance. It never ends, and there's always something else to try'."
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Prices can vary significantly between clinics in Ireland, and many clinics abroad offer comparable results, excellent treatment and reasonable prices but they aren't always covered by all health insurers.
Everyone's circumstances will be different. The following is just a brief overview of the main options available and approximate costs involved.
Tests and medications: €1,000+
"Medical fertility treatment usually involves a baseline menu of blood tests checking things like iron, thyroid and fertility hormone levels," explains Helena.
Costs vary from €30-€80 for each of the eight or more tests involved. Monthly blood tests, doctor visits and transvaginal scans will cost about €350 per month and checks for food allergies (which are often advised) cost between €400-€800.
"Adjunct antibiotic therapy may also be prescribed costing around €500 for the couple," adds Helena. Costs incurred to check the patency of the fallopian tubes and interior of the womb (€500) or surgical excision of endometriosis (€2,500) will usually be covered by health insurance. Semen analysis costs about €150 and all couples must have an STI test (€220) at a private STI clinic.
IUI (interauterine insemination): €550-€750
Washed sperm is transferred directly into the uterus at the most fertile time of a woman's menstrual cycle with three attempts usually recommended by clinics. Couples will go for an initial consultation and oral medications may be prescribed to increase egg maturation in the ovaries. There may also be vaginal scans to monitor the growth of the follicles. The partner produces a semen sample on the appointed day and it is transferred after preparation. Then follow-up visits ensue.
IVF: €4,500 per cycle
Eggs are removed from the woman's ovaries and fertilised with the partner's sperm in a laboratory. "But that ballpark figure of €4,500 often omits crucial medications integral to the process of ripening a year's worth of eggs in one month and preparing the uterine lining for implantation," warns Helena. "You're talking an extra €1,300-€1,900 on top of that oft-touted baseline IVF fee."
Blastocyst culturing, where the embryos mature for a few days before implantation, is an additional €600-€700 and freezing spare embryos will be some €600/year.
IVF with donor egg/sperm: €7,000+
The procedure is essentially the same as standard IVF but potentially without the need to stimulate the ovaries or retrieve the mother's eggs. ICSI (where sperm is directly injected into the egg) costs an extra €600-€1,500. The cost of donor sperm ranges from €1,000-€2,000 with Denmark a popular supplier with the option of identifiable donors.
Adoption (overseas) : €9,500+
There are no direct fees charged by the Adoption Authority of Ireland, Tusla or the relevant accredited body to apply for domestic adoption in Ireland. Couples applying may need to pay GP fees or administration fees but these are private expenses.
If applying for inter-country adoption then adoption mediation agency Helping Hands require fees of €9,500 with additional miscellaneous fees incurred for services such as 'homeland trip co-ordination'.
Couples looking to adopt make an assessment application through Tusla, they will then be allocated a social worker and undergo pre-adoption training. Waiting lists for adoption are usually at least a year long depending on region. See aai.gov.ie and helpinghands.ie for more details.
Ireland is now one of the largest user nations of cross-border surrogacy in Europe, due in part to the lack of domestic options in place. "There is no legal route for transfer of parentage for Irish surrogates carrying for Irish citizens currently, which means the majority of Irish people requiring surrogacy need to engage offshore," says Sam Everingham, global director of Growing Families.
The most common destinations are the US and Ukraine with Greece, Georgia and Canada being utilised to a lesser extent.
An overseas agency will recruit and screen a surrogate, then support her through pregnancy and birth. Irish citizens will usually also need to engage with an overseas IVF clinic or potentially cryoshippers (who ship embryos from Ireland to the surrogacy country) and engage legal representation.
"It's vital to meet with your surrogacy solicitor prior to travelling as there are a number of procedures that need to be set in motion before the child is born," explains Dublin-based solicitor Tracy Horan, who specialises in surrogacy.
The baby will need an emergency travel document and other court documents. A solicitor may need to liaise with the Department of Foreign Affairs and oversee paperwork such as a Declaration of Parentage and an order of guardianship. Depending on the country, translators may also be required.
"There is currently a draft bill in review to allow domestic surrogacy in Ireland but it is currently not fit for purpose, so it is being redrafted to better meet the needs of changing family types," says Sam.