Emma deSouza: Fertility options for women still don't provide real choices

Public policy must catch up with real-life barriers and give women genuine choices about reproductive futures

US Democratic Congresswoman Alexandria Ocasio-Cortez has been criticised for freezing her eggs. Picture: Tom Williams/Pool Photo via AP

US Democratic Congresswoman Alexandria Ocasio-Cortez has been criticised for freezing her eggs, as though a woman's decision to explore her reproductive options is somehow a political statement. 

The public reaction has been revealing — women are told to build careers, financial independence and families, while simultaneously being judged for trying to reconcile these competing demands.

Her decision to maintain reproductive choices contrasts with the altogether different ideal being pushed by social media influencers and conservatives under the so-called “trad-wife” movement: early marriage, motherhood and domesticity.

But this is not simply an American culture-war story. Ireland has begun to recognise fertility treatment as a public health issue, but what happens when we as a society look more closely at the choices that remain outside the State's definition of fertility care? 

And why, when it comes to reproduction, are women still expected to navigate the gap between biology and modern life largely on our own?

In September 2023, Ireland introduced publicly funded fertility treatment options, including IVF, with an initial allocation of €30m to establish its assisted human reproduction services. 

Nearly 6,000 referrals were accepted across the six regional hubs in 2025, with almost 2,000 people referred onward for IVF or other assisted reproduction treatments. Of those referred onward for treatment, 45% were aged between 36 and 40.

For IVF, the HSE reports clinical pregnancy rates of 42% for women aged 34 and under, 33% for those aged 35 to 39, and 15% for those aged 40 and over. 

The figures tell us something uncomfortable: by the time many women reach the point at which the State offers advanced fertility treatment, age has become one of the most significant factors determining their prospects of success. Is a system genuinely offering reproductive choice if it only intervenes once a woman has a fertility problem?

The service provided is undeniably a lifeline for couples who, prior to the 2023 Health (Assisted Human Reproduction) Act, would have faced a significant financial barrier to accessing fertility services, but access is not universal and nor does it offer women meaningful choices. 

The current publicly funded scheme excludes single people, same sex-couples and those who require donor eggs or sperm. There are also rigid limitations on age and weight. Society has changed dramatically over the last generation, yet the State continues to apply an outdated concept of what constitutes a family or relationship.

The HSE’s national clinical guideline explicitly identifies fertility preservation as an area in which publicly funded services should be expanded, but fertility preservation is not currently included in the publicly funded pathway.

Other European countries have made different choices: France allows women to preserve their eggs without a medical indication and provides assisted reproduction to single women and female couples, with treatment available to women carrying a pregnancy up to the age of 45. 

Spain has explicitly opened publicly funded assisted reproduction to women without partners and lesbian women, including through donor sperm, while providing publicly funded IVF within an age limit of under 40. 

The Netherlands permits publicly funded IVF to a later age than Ireland. Ireland, by contrast, requires women to enter the publicly funded pathway before their 41st birthday and excludes treatment requiring donor gametes from the current scheme.

France, Spain and the Netherlands are not models of unlimited reproductive freedom. They still have age limits, medical criteria, funding constraints and practical barriers. France's egg-freezing system, for example, has significant waiting times and only covers retrieval rather than ongoing storage. 

What they have done however is make thoughtful decisions regarding whose reproductive choices should be entitled to public support. That distinction matters.

I am 38. I don't know if I want children. I am fortunate to be able to sit with that uncertainty, but I am also conscious I cannot do so indefinitely. At some point, time will make that choice for me. More women are choosing not to have children; more are having them later; more are forming families on their own or with same-sex partners. 

At the same time, housing is increasingly unaffordable, childcare remains expensive and the economic security that previous generations might have taken for granted is harder to achieve. These factors inevitably shape the decisions people make about whether, when, and how to have children.

The point is not that these circumstances should determine whether someone becomes a parent. It is that people are making deeply personal reproductive decisions within them. Public services should recognise that reality. 

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Ireland has taken an important first step. The next is to ensure public policy catches up with modern family life and gives women genuine choices about their reproductive futures.