COUPLES having difficulty conceiving are set to avail of State-supported fertility treatment under new funding proposals to be announced by Health Minister Leo Varadkar.
It’s to be welcomed, say Ireland’s top infertility experts, but they point out that much has yet to be decided, including the nuts and bolts of the system, its structure, the criteria for selection of eligible couples, the kind of support it will provide and the number of cycles a couple will be entitled to.
Currently, the one-in-five couples who experience infertility in this country can get treatment — but it’s private and can cost up to €4,500 per cycle, which is too expensive for many.
Internationally, figures show that about a third of patients experience a live birth after one IVF cycle, and that this rises to around 70% of patients for those who go through three cycles — in Ireland, many couples will undergo an average of two to three cycles.
Mr Varadkar has said he will make fertility treatment available through the public health system under legislation to be published later this year.
However, before any system can be put in place, the Department of Health will first have to carry out an in-depth review of how state-funded fertility treatments are managed in other countries, such as in Britain’s National Health Service where couples are entitled to at least one but no more than three cycles of IVF.
However, warns obstetrician and gynaecologist Mary McCaffrey, medical director of the Scotia Clinic in Tralee, Co Kerry, the British scheme is not a perfect template.
“It can be very postcode driven, so the facilities offered can depend on where you live, and they can be very different in terms of the number of cycles you are offered.”
She also cautions that people who have been advised to go the IVF route should not hold out for any State-funded system, because it is “unlikely to be imminent and every year of waiting affects pregnancy rates.”
The British system would be worth studying, says Dr David Walsh, medical director of SIMS Clinics in Cork and Dublin.
However, he cautions, all the details around any introduction of state-funded IVF here are still very much up in the air, particularly in the context of the general election.
“The new minister will have to want to prioritise it above everything else so we will have to wait and see what happens,” he says.
Under the NHS structure of IV treatment — which accounts for around three in every 10 cycles of IVF in Britain — up to three cycles of IVF are funded to women under 40 with known cases of infertility and who had been trying for more than three years.
Figures show that the age of the mother is linked to the success of the treatment — the Zita West Clinic in London, for example, boasts a success rate of 60% for the under-35s.
“However,” Dr Walsh adds, “the number of IVF cycles a person gets depends on what region of Britain they’re in — and on the different resources available in different areas.
“It’s about rationing it,” he says, adding, however, that he believes the NHS system would be a good place for Ireland to start.
If a similar system was introduced here, he estimates, the Irish State would be funding about 1,000 cycles of IVF ever year.
“However, as yet there’s no agreement about how to do it.
“We’ll have to get a new Government in place, there will have to be a review and then a decision on the model we will take.”
But if we take the British model as a guide he believes, Ireland would be ready to start very quickly, because a similar network of IVF clinics is available here:
“A patient would be given a voucher to go to whatever clinic they want — and there is no stigma about how it is funded.”
While the Government could build an IVF unit, he says, it would involve huge — and probably quite unnecessary — investment as the State could engage with the existing infrastructure.
As to how many cycles of IVF an Irish couple could expect, and what criteria will be applied, Walsh says that is very much down to budget.
“I cannot guess what the priorities of the new Minister for Health will be, or how much money he or she will have to spend.”
A state-run IVF scheme — which, if all goes well could be in place next year — would need to be very carefully structured to ensure there would be no misuse of the system, cautions McCaffrey.
She believes the Department of Health should also examine other examples of state-run IVF treatment.
“I think the UK system is reasonable,” she says.
“People get at least one cycle of IVF. I welcome the proposal; I think it is a good idea.
“We should look at UK but also at other structures because the UK system has flaws and we need to structure our scheme properly.”
Giving couples the option of seeking IVF treatment abroad is worth considering, she believes.
Many Irish couples now travel abroad for treatment, often spurred on by the high cost of fertility treatment here — some couples are going to the Czech Republic where the costs are roughly half, at between €2,000 and €2,500 for a round of IVF.
“I have couples now who have embryos, sperm or eggs stored abroad and if this system comes in, they need to be facilitated to continue their treatment abroad,” says Dr Ahmed Omar, medical director at Beacon CARE Fertility.
Another advantage of the proposed new legislation on the area is that it will “address the complicated area of assisted human reproduction, surrogacy and IVF,” which is currently unregulated.
“The proposed new legislation would help to address this area as well as provide funding for fertility treatments,” says Dr Omar.
What is In Vitro Fertilisation?
IVF literally means fertilisation “in glass”. This refers to a process where a woman’s eggs are fertilised in a laboratory. The resultant embryos are then transferred back into the woman’s uterus a few days later.
IVF is specifically recommended for women with absent, blocked or damaged fallopian tubes. It is also used in cases of unexplained infertility.
There are four general steps involved in an IVF cycle:
- Stimulation of the ovaries for development and growth of eggs.
- Harvesting or retrieval of the eggs.
- Fertilisation of the eggs and growth of embryos.
- Transfer of the embryos back into the woman’s uterus.
Research shows that at puberty most women ovaries contain about 300,000 eggs. However, by the time the woman reaches menopause (usually somewhere around the age of 50) there are only several thousand eggs remaining. As a woman’s age increases, the remaining eggs in her ovaries also age, making them less capable of fertilisation and successfully implanting.
This is an increasingly common issue as more Western women have babies later in life.