By all accounts life in lockdown is going to lead to a baby boom. They’re badly needed as our reproduction rate has been falling, and if nothing else future taxpayers are vital if we’re to pay off our eye-watering national debt.
ut for many couples it’s fraught with pain and heartache. It’s estimated that one in five have difficulty with fertility, requiring some form of medical assistance. But costs are huge and the law hasn’t yet caught up with the technology. So, this week I’m looking at what’s involved.
The average age of pregnancy is 32.8 and rising, according to the CSO; In 1987 it was 29.4. The numbers of women over 40 having children is also on the increase (4,293 in 2017) as is the incidence of multiple births, a common side effect of assisted human reproduction (AHR).
Our ‘twinning rate’ is 18.7 sets per 1000 live births. In 1991 it was just 11.7.
Read More
Since the first successful IVF baby – Louise Brown in 1978 – it is a commonly performed procedure. However the success rate is still only 51.3pc for patients under 39 and half that for those over 40, according to leading clinic SIMS. Despite advances in medicine, the biggest factor remains the mother’s age.
One of the biggest deterrents is the cost. AHR is not publicly funded so going private is the only option. There are some insurance and tax breaks (see below), but before starting, it’s important to check the financials.
IUI
Intrauterine insemination – healthy sperm is collected and inserted directly into the woman’s uterus at ovulation. With donor sperm there may be extra fees. Cost is up to €1,000.
IVF
A woman’s eggs are removed, fertilized by sperm in a laboratory, and embryos transferred back to the uterus. Cost is around €5,000 per cycle.
IVF plus ICSI
Sperm is injected directly into an egg to assist contraception before re-implantation to the womb. Cost is around €4,500.
Egg Freezing
Eggs are extracted and cryogenically frozen for future use. Cost is around €3,000.
“Once you do decide to undergo fertility treatment, cost can be a significant prohibitive factor especially in a country such as Ireland that does not offer public funding towards IVF, and especially if you are undertaking successive rounds of treatment,” says author and broadcaster Dearbhail McDonald, presenter of RTÉ’s Fertility Shock who has had her eggs frozen. Additional costs for consultations, scans, hormone treatments, annual storage etc. hike the bills further, so you need to tot these up.
“My debit card nearly had a heart attack each time I received a new hormone injection. But I was incredibly lucky to have the financial resources to freeze my eggs, with family and friends kindly supporting me financially as well as emotionally on my journey,” says Dearbhail, who opted for a private clinic in London because of concerns over the law here.
“I chose the UK as it has a comprehensive legal and regulatory regime in respect of Assisted Human Reproduction. I still laugh at seeking legal protection not available in Ireland, only for the UK to decide to leave the EU in 2016. My frozen eggs have now left the EU – so Brexit has become eggsit for me!”
Surrogacy
Like much of reproductive medicine, there is no law around surrogacy. On one hand there’s nothing stopping anybody being a surrogate. The problem, says Family Law Solicitor Marion Campbell of KODLyons, is registering the baby as yours.
“In Ireland the woman who gives birth is the mother. Therefore, a father has to prove a genetic connection to the baby to permit application for a Deed of Parentage Order.”
In 2013 Campbell won a case in the High Court for the genetic mother of twin girls born to her sister, a surrogate, to be recognised as their legal mother, after the Registrar refused a request for the married couple to be listed as parents on the girls’ birth certificate.
The decision was later overturned in the Supreme Court due to the paucity of law.
“They were sympathetic, but nothing has changed,” she told me. However, at least now, the Children and Family Relationship Act 2015, brought in to assist same sex couples, permits genetic parents of a baby born by surrogate to become guardian of their own child, after two years.
“The real problem,” says Campbell, “is when you go abroad; that’s where it gets messy.”
Many countries, like India, have banned foreign surrogacy. The Ukraine and the USA are popular, but not only is it extremely expensive, getting baby home to Ireland is a legal minefield.
“The father must prove, via DNA , that he is genetically linked and be an Irish citizen. You need to give undertakings to the HSE and Department of Foreign Affairs that you’ll declare guardianship in the Circuit Court and pay for legal representation in order to get a one-off emergency travel document to come home.”
Ironically, by opting for the United States, baby gets American citizenship, a passport and can travel home freely.
Shortcuts – Fertility Finances
Tax Relief
Any medical expenses incurred for fertility treatment is tax deductible by 20pc each year. This includes tests, treatments and medicines.
In addition, fertility medication can be bought under the Drugs Payment Scheme, which limits monthly expenditure to €114 per month per family.
Insurance
Some private health insurance policies pay a contribution toward fertility treatment says Dermot Goode of Total Health Cover. However, it’s “marginal at best”, he says.
VHI offer the PMI 3613 semi-private plan which costs €1,405 per adult. The allowance for eligible treatments is €1,000 (max twice in lifetime).
Irish Life Health have the 4D Health 2 semi-private plan (€1,394) with an allowance for eligible treatments of €750 (max twice).
Members can select the Fertility Extra personalised package if this benefit item is important to them.
Laya offer the Care Select private room corporate plan (€1,591) which has an allowance for egg freezing of €1,500 per lifetime and up to €1,000 max for approved treatments in approved centres (payable twice per lifetime).
In all cases, waiting periods apply to new members and also those who may have recently upgraded their health insurance cover.
You must attend approved clinics to qualify for the benefit so always check first.