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One in six Irish couples will struggle with infertility – what are the options?
The average cost of
raising a child
from birth to the age of 21 was put at almost €170,000 in an eye-watering report in May, a 60 per cent increase since 2015.
The figure, gleaned from a survey of 1,000 presumably financially-scarred parents in Laya Life's Cradle to College Cost Index, covered everything from essentials such as nappies and baby formula through to pocket money, family holidays, Communion and Confirmation gifts, third-level fees and rent supports.
But for one cohort of people, the financial challenges around raising a child begin years in advance of shopping for cots or even maternity wear because of infertility issues.
Fertility treatments are not cheap. One round of
in vitro fertilisation
(IVF) in a private clinic costs as much as €6,500.
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With an average of three rounds considered standard per couple and tests and other medical exams heaped on top, IVF can cost about €20,000, with no guarantee of success.
Sarah Magner (46), a pharmacist, and her husband, Darren O'Brien (43), a teacher, self-funded their four-year IVF journey at a cost somewhere between €40,000 and €50,000. The couple used up savings and worked extra jobs; Magner as an assessor in the Irish Pharmaceutical Union and O'Brien worked as a photographer, while the couple lived as frugally as they could. Even so, the costs and disappointments continued to mount.
'I only met my husband when I was 35, so I was over the hill fertility-wise and when nothing was happening for us, I went to my GP when I was 37, who referred me to a fertility clinic,' says Magner.
'We did one round of IVF and got one free embryo transfer and it didn't work. And we kept trying – again, the first attempt didn't work but the second embryo did and we had our daughter who is now six.
'The third transfer didn't work, the fourth resulted in a miscarriage and then it was in the middle of Covid and we found ourselves out of embryos, and the IVF clinics were closed. So we contacted a clinic in Ukraine to try again and after our second round, we found out we were pregnant with my son, who has just turned three.'
Sarah Magner and Darren O'Brien's two children, Meadhbh and Iarlaith. Photograph: Darren O'Brien
The costs racked up, with the first round of IVF in a private clinic, which produced one embryo, at €6,000. The second round cost €12,000, in which eight embryos were produced and the first transfer was included in the cost, with each subsequent transfer costing €1,500.
The couple also paid another clinic €10,000 and a further €1,000 for transfers along with extra costs for any tests carried out along the way.
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'It sounds stupid, but if they ask you to have a test for €300 or €400 for something, there is a part of you thinking of the thousands you've already spent and how €400 on top of that wasn't actually that bad,' says Magner.
'It all becomes relative to that huge amount of money you've already invested into IVF. All those tests add up, and if you go down the supplements route, which I didn't because of my professional background, you are looking at even more costs.
'Ukraine was slightly cheaper overall; we spent €8,000, plus flights and accommodation.'
Magner and O'Brien's journey through IVF spanned from 2017 until 2021 and the huge financial squeeze on the household reflects that of thousands of others in Ireland.
'It's a big financial outlay no matter how you look at it,' says Caítriona Fitzpatrick, chairwoman of the National Infertility Charity, which provides support to and advocates for people seeking fertility treatment.
One round of in vitro fertilisation (IVF) in a private clinic costs as much as €6,500. Photograph: iStock
She said the charity sees many people at their support meetings who 'get a credit union loan, sell a car, borrow from family members, or take on a second job' to fund fertility treatment. 'This financial burden tends to come at times when people have lots of other financial demands such as marriage or buying a house.'
'If IVF is unsuccessful, it's absolutely devastating for a person because they've put a huge amount of emotional and mental time into this, as well as the huge costs, and they can come out with nothing at the end of it.'
But is there any financial relief on such fertility costs? Well, like most medical expenses, you can claim tax back on the cost of fertility treatments at the standard rate of 20 per cent.
So, if you paid €5,000, you can claim €1,000, once you have not claimed these expenses elsewhere, such as from a private health insurance provider or through compensation.
Any drugs required as part of the fertility treatment can be acquired under the Drugs Payment Scheme, where you will pay a maximum of €80 per month for all approved prescribed medicines.
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If you have to travel abroad for fertility treatment, such as Magner and O'Brien, there is also an allowance to claim 20 per cent back on treatment expenses in a hospital or clinic. And if that treatment isn't available in Ireland, travel expenses can also be claimed.
The
Health Service Executive
(HSE) estimates that about one in six heterosexual couples in Ireland may experience infertility – an issue the World Health Organisation labels as 'a disease of the male or woman reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse'. However, progress to make assisted human reproduction treatments more affordable and transparent remains slow.
Unlike all other EU countries, Ireland still has no specific legislation governing the area of assisted human reproduction treatment, though that is expected to change in the coming months, with a board and staff currently in formation.
'Fertility treatment through the public system is only available since September 2023, along with the announcement of six regional hubs and the first partnerships with private clinics, but this is being rolled out very slowly,' adds Ms Fitzpatrick.
'There are a lot of restrictions around that too and we have been told that when the regulatory authority is in place, they'll be able to expand that into donor conception and other areas to allow more people to avail of the public system.'
Time off work is another contentious issue in the fertility treatment debate. There is currently no legislation requiring employers to allocate paid leave or time off for important appointments or indeed, disappointments, during an IVF journey.
Qualifying couples, and primarily women, must first meet strict requirements to avail of the state-run Model of Care for Fertility service. Photograph: iStock
But, in the absence of statutory duties, more and more employers are taking the lead in offering supports when it comes to compassionate leave. Bank of Ireland, and Lidl are among those offering additional leave days for those seeking IVF treatment.
Others are even more progressive. University College Cork offers employees five additional paid leave days per cycle, up to a maximum of three cycles, while PwC provide eight days of paid leave for fertility consultations and appointments.
Ms Fitzpatrick also says the charity sees more employers 'seeking our advice or looking to create an internal policy' around supporting staff undergoing fertility treatment. Although, she says this 'varies widely' from proactive employers to those dealing with a staff requests on the matter.
'It would be very beneficial to see some guidance given to employers around this and certainly when the new regulatory authority is in a position to draw from the data around the whole area of fertility treatment in Ireland.'
Since the introduction of the State-run Model of Care for Fertility, run in conjunction with the HSE's National Women & Infants Health Programme, which also includes intra-cytoplasmic sperm injection, 2,300 couples have been referred for assisted human reproduction treatment as of last month, with hubs receiving an average of about 550 referrals a month.
But qualifying couples, and primarily women, must first meet strict requirements to avail of the service. Aspiring mothers must be under 41 at the time of GP referral to a regional hub, while men must be under 60, and the aspiring mother must have a body mass index (BMI) of between 18.5 and 30.
'We have asked for the criteria to be medically reviewed... [Here's] one example, we had one person contact us and there was male infertility in the relationship, but because her BMI is over the criteria, the couple are not allowed to apply for the scheme even though she has no fertility issues,' says Ms Fitzpatrick.
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'This seems incredibly unfair that she was penalised for a male infertility issue. If it's male fertility issue in the need for IVF treatment, do we still need to be looking at woman BMI in terms of criteria?'
Ms Fitzpatrick says educating people on fertility journeys and the limitations in the State's offering should be a priority because often assisted human reproduction is only on a person's radar when conception becomes a problem. Also, individuals going down the treatment route alone, using sperm donors, can incur costs of more than €5,000 depending on the number of sperm straws required. And that journey is not catalogued by any State scheme.
'There's a bit of a historical hangover in this country around contraception and having children, but when somebody decides they do want to be a parent and struggle to conceive, the HSE scheme will only fund couples not individuals,' adds Ms Fitzpatrick.
'From a really practical perspective, we will always advise people on this journey to start with their GP, who will refer them into the public health system. That is covered and funded so it's worth being in the public system even if they can't take you the full length of the journey.
'Even reaching out to someone such as ourselves – can help as everybody involved in the charity has been part of the process at some level.'
