Treatment only for those who can pay

FROM the home to the workplace to the altar the national financial crisis is affecting every facet of life and infertility is no exception.

At the Galway Fertility Unit in Rahoon, medical director Dr Declan Egan says they used to treat medical card holders free of charge but the demand became too great.

“My clinic is full of people from abroad who have no money, who have no job, or are on the dole, or are refugees from wherever, who had no money when they came and still have no money, so there’s a hell of a lot of those around.

“Frustratingly, you work them up, you tell them ‘You need IVF because you’ve bad endometriosis or because your partner has no sperm or because your tubes or blocked and you won’t get pregnant probably without it’. And then that’s the end of it. You’ve spent all the money doing the investigation end of the diagnosis and you can’t carry it forward and translate it into having a baby.”

Dr Egan now offers IVF and ICSI (where sperm is injected directly into the egg) at two-thirds the normal cost where both partners are medical card holders. The same concession is offered at the Cork Fertility Centre.

For public patients who cannot afford private health insurance and who do not qualify for medical cards, there is very little help. For private patients, the only company in Ireland to cover actual assisted reproduction procedures is Quinn Healthcare. Since September 1, 2009, couples have been able to claim up to €1,000 towards the cost of IVF and related treatments. Those who pay for the treatment themselves can also claim a 20% tax rebate.

Medical card holders are not funded by the state for the full cost of IVF. Funding extends to medication only, for up to three IVF cycles, but not the actual IVF process itself.

Marie-Louise Brennan, CAO of the Human Assisted Reproduction Unit (HARI) in the Rotunda Hospital in Dublin, says since the recession hit, people are being more selective about the number of treatments they seek.

“We have also experienced a situation where people who attended us privately in the past are now returning for treatment as medical card holders,” she says.

Medical card holders who attend the HARI are fortunate to be patients of the only fertility unit in the country to treat medical card holders free of charge. The cost is borne by the hospital and patients have to be referred from the Rotunda outpatients department.

Patients attending the Merrion Fertility Clinic in Dublin — referred by the National Maternity Hospital, Holles St — are offered treatment at 20% of the cost where both partners hold medical cards but clinical director Dr Mary Wingfield believes the state has a role to play.

“I know you can’t have funding for everyone but I think what we need is some sort of group or national task force to look at what could be put in place and to draw up the basis on which couples could qualify. And the group should work to a deadline,” she says. Figures from the Health Service Executive (HSE) show the state spent almost €18 million on infertility drugs in 2008 and more than 7,600 patients benefited.

Dr Egan says the lack of help in the system is “very hard for public patients”.

“If you have a poor fertility patient with blocked tubes or something that needs IVF, some women just can’t afford it, and they can’t have a family, full stop. And somebody needs to make that point.”

At Clane Fertility Clinic, consultant obstetrician/gynaecologist Dr Osman Shamoun points out that VHI covers the cost of a hysterectomy but not fertility treatment.

“Fertility is a huge medical condition and can lead to a lot of other problems. People get divorced because of it, they get upset and stressed and get depression.”

Nurse manager at the Clane clinic Martina Kelly says it is their duty to offer patients the best but the patient can’t always afford it — IVF treatment at clinics around the country typically costs between €4,000 and €5,000.

“You have to sit in front of them and say ‘well statistically, IVF is the best treatment, it’s going to cost X amount’, and then to actually have to sit at the far side of the desk and have the patient say ‘I can’t afford that, I wouldn’t be able to afford that’.”

Gladys Leyden, unit manager at the Clane clinic, says: “It’s very sad when you see someone coming who has their mind made up to start on the fertility journey and all of a sudden they say, ‘Look we have to abandon this, we can’t afford this treatment, in other words we can’t afford to have the most precious thing in the world’ and that sentiment is coming through, I would say much more so, even in the last six months.”