'Why are we an afterthought?' — LGBT+ couples left out of State-funded fertility treatment online
Sonia Kelly and Tara Ryan. Sonia, who’s a childminder and baker, and her wife Tara, who’s a civil servant, earn less than €60,000 annually. Picture: Kieran Ryan-Benson
Starting next week, couples who are struggling to have children will be able to access Ireland’s first State-funded fertility treatment.
Following an assessment in one of eight regional fertility hubs, couples will be referred to private clinics where their treatment will be provided free of charge. Funding is available when there is a known clinical cause of infertility with limits based on age (41 for the woman, 60 for the man), BMI and the number of existing children the couple has.
However, couples using donor gametes — either egg or sperm — cannot access funding. This final requirement excludes all same-sex couples.
Sonia Kelly, and her wife Tara, live in Ballina, Co Tipperary. Sonia was anticipating the government’s announcement and expected that LGBT+ couples might have to cover some additional costs compared with heterosexual couples.
“I assumed we’d have to pay for the donor sperm, but I wasn’t expecting to be excluded entirely,” she says. The realisation that she wouldn’t qualify for State-support “really, really hurt”.
“We feel very supported by the local community. We’d love to raise a family here. We’re doing IUI because we can’t afford IVF. But the funding isn’t means-tested, so people on high incomes can access it.”
Sonia, who’s a childminder and baker, and her wife Tara, who’s a civil servant, earn less than €60,000 annually. Statistically, LGBT+ people are more likely to experience economic disadvantage than their heterosexual counterparts. Lesbian couples are also twice penalised by the gender pay gap.
At 36, Sonia knows it’s a “race against the clock. It weighs on you very heavily. All you can do is keep going, keep trying. It would break our hearts not to have a family because we couldn’t afford it”.
Sonia’s story is familiar to Ranae von Meding, CEO of Equality For Children, an advocacy group campaigning for the rights of children born to LGBT+ families. “We’ve been waiting two decades for this,” she says, “but the entire LGBT+ community has been excluded”.
Since details of the funding scheme were announced in July, she has heard from many queer women who can’t afford fertility treatment. Many were excited to hear that public funding would soon be available and devastated to learn that they wouldn’t be eligible. Shannon Murphy-Howard, a singer and legal secretary, based in Cork, is one such woman.
“My wife and I have been saving our pennies for the last few years. I was so excited when I heard that the government was giving funding towards IVF, but my excitement quickly turned to disappointment when I realised that we would be excluded.
Von Meding expects that it will be at least two years before any changes are made to the proposals. “We’re told to wait our turn. It’s very upsetting for people,” she adds.
There are thousands of couples — gay and straight — accessing fertility treatment in Ireland right now. The Child and Families Relationships Act was passed in 2015 and aims to “modernise the law regarding children living in diverse family forms”.
It put in place a donor registry which is crucial in vindicating the right to identity of donor-conceived people. Donor-assisted conception is common practice in Ireland. It is regulated for and practiced in private clinics across the country. For lesbian couples, it is a requirement that they undergo clinical conception in an Irish clinic if they want to be jointly recognised as parents from their child’s birth.
Announcing the new funding scheme, Minister for Health, Stephen Donnelly, talked about “targeting the resources”, about how he wants to help couples who have the greatest chance of success. If that were true, lesbian couples would arguably be a stronger bet.
Heterosexual couples seek fertility treatment when they’ve been unsuccessful becoming pregnant naturally. Whereas for many queer women, fertility treatment is the first time sperm has ever been in their bodies. They have no known fertility issues, but need access to donor sperm.
Couples — either gay or straight — who use donor gametes arguably have a higher chance of success given the testing involved in ensuring the gametes are of a sufficiently high quality.
Nicole O’Kelly, a doula and yoga teacher based in Dublin, described the decision not to fund donor-assisted conception as a “huge disappointment”.
“I’m in a same-sex relationship and went through the process of IUI last year without a positive result. It is so expensive to go through testing and treatment as well as the purchasing of donor sperm so we can both legally be parents to our child.
Minister Donnelly has pointed to the need for the bill on Assisted Human Reproduction to be made law before donor conception can be covered in the funding. He has promised that the bill will be finalised by the end of the year.
Von Meding believes there is “no chance” this deadline will be met. Minister Donnelly has been “very unresponsive to our LGBT+ advocacy groups”, she continues. “He seems to think that it’s the same for everyone, but queer people face a different set of issues. You can’t be an ally if you don’t see my identity and recognise the additional challenges our families face.”
Many also worry about what message this discrimination sends at a time when homophobia is on the rise. According to the CSO, LGBT+ people in Ireland experience very high levels of discrimination. 33% of queer people said they had experienced some form of discrimination in the previous two years.
“Besides the pain of being left out of this funding, it furthers the rhetoric of the bigots and homophobic people who say that we are less than, that we don't matter, that we shouldn't exist,” Shannon says.
“I know this was not the Government's intention but it shows how little awareness they have for what life is like for queer people in Ireland.”
Others point to the exclusion of larger women. The intending birth mother is required to have a BMI of 18.5 kg/m – 30.0 kg/m in order to be eligible to access funding.
Body Mass Index (or BMI) is a statistical formula based on a person’s height and weight. It was created by a Belgian statistician, Adolphe Quetelet, in the 1830s to aid in carrying out population-wide research. Quetelet was not a healthcare professional and his formula was never intended to be used as an individual health metric.
“Using the BMI metric is extremely flawed and is not an indicator of health. Being in a bigger body doesn’t mean that you can’t get pregnant and have a safe, healthy pregnancy,” says Jess Willow, a registered dietician and owner of Willow Nutrition.
Women seeking fertility treatment tend to be older and they know they have a limited period of time to conceive. Knowing that they need to reach a particular weight in a short period of time will put women at risk of developing eating disorders.
“You can’t restrict access based on a number like the BMI without looking at the bigger picture, including the woman’s general health and lifestyle,” Jess continues.
Publicly funded access to fertility treatment is long overdue. Ireland ranks 41st out of 44 nations for access to fertility treatment, according to the European fertility atlas published in December 2021.
The map, which was published by Fertility Europe and the European Parliamentary Forum for Sexual and Reproductive Rights, ranks countries on what fertility treatments are available, as well as their funding and reimbursement. In most EU countries, either partial or full funding is available for fertility treatment.
According to the World Health Organization, one in six adults experience infertility. Many couples rely on loans or financial help from family or friends in order to fund treatment. A round of IVF costs between €4,500 and €6,000, with donor sperm costing up to €1,000 per straw.
The costs associated with fertility treatment quickly become a medical poverty trap for those who embark on it, while others simply can’t afford to pursue treatment.
By necessity, same-sex couples often take a different path to parenthood than heterosexual couples. The Irish funding model fails to recognise those differences, and offers no support to either gay men seeking to become parents through surrogacy or gay women pursuing fertility treatment.
“It is just not fair,” Sonia says, “everyone should have the same chance to access the funding.”
